Enhancement of fermentation process in Pu-erh tea by tea-leaf extract

Pu-erh tea is known as a fermented tea and longer storage enhances its flavor and taste. Recently, Aspergillus, Blastobotrys, and Streptomyces are found to play important roles in nutritional enhancement of Pu-erh tea by fermentation. Since water and temperature affect the microbial growth, we therefore explored the factors that might enhance the Pu-erh tea fermentation. The results showed that the addition of fresh tea-leaf extract (TLE) enhanced the withered tea fermentation (at 37 degrees C, 80 to 85% RH) as compared with the water only. Contents of statin, GABA, gallic acid, DPPH scavenging and polyphenol oxidase (PPO) activities were increased, whereas polyphenols and caffeine were decreased over 6 mo. TLE dose-dependently enhanced some of the qualities (that is, statin, PPO) of Pu-erh tea significantly as compared with the water only. The effect was related to the increase population of A. niger and A. carbonarius at 6 mo (from 7.6 +/- 1.2 x 10(1) and 3.2 +/- 1.3 x 10(1) to 3.1 +/- 1.2 x 10(6) and 2.4 +/- 1.1 x 10(5) colony forming units [CFU]/g, respectively). After drying process (90 degrees C, 30 min), the total microbial count from these samples returned to background level (3 +/- 0.5 x 10(2) CFU/g). None of ochratoxin and fumonisin, toxins from Aspergillus, was detected in the final products. The flavor and taste were also enhanced by treatment with TLE. The inoculation with S. cinereus Y11 with 2% TLE further enhanced these functional contents (about 2-fold increase of statin level) in the experimental Pu-erh tea. Therefore, this result may add a new process for Pu-erh tea manufacture.

End-stage renal disease after orthotopic heart transplantation: a single-institute experience

Orthotopic heart transplantation is the treatment of choice for end-stage heart failure, and calcineurin inhibitor agents allow for better allograft survival. However, pretransplantation low cardiac output status and posttransplantation immunosuppressants contribute toward deterioration of renal function. From 1987 to 2008, 350 patients underwent orthotopic heart transplantation in our hospital. Most of them received anti-thymocyte globulin (ATG) as the induction immunosuppressant. The introduction of mycophenolate mofetil (MMF) reduced the maintenance level of cyclosporine. The 26 patients who developed end-stage renal disease required dialysis. We reviewed the patient characteristics, including pretransplantation status, immunosuppressant regimens and drug levels, time and type of dialysis, and mortality rate. The mean age of these 26 patients was 53 years. Three patients underwent peritoneal dialysis. The overall 1-year survival rate was 96%, and the 5-year survival rate was 80%. The duration from heart transplantation to chronic dialysis correlated with the presence of a pretransplantation diagnosis of diabetes (P<.05) and an elevated pretransplantation blood creatinine level (P=.01), but there was no significant effect of the initial level of cyclosporine. In addition, the pretransplantation blood creatinine level was also related to the necessity of immediate postoperative hemodialysis (P=.01). There was no significant risk factor in relation to mortality. Regardless of modification of immunosuppressant regimens and initial drug levels, pretransplantation kidney function played an important inverse role in the duration from transplantation to dialysis: the higher the pretransplantation blood creatinine, the shorter the duration. While awaiting a heart transplant, more effort should be spent on protecting renal function to avoid early chronic dialysis.

Water-assisted CO(2) laser ablated glass and modified thermal bonding for capillary-driven bio-fluidic application

The glass-based microfluidic chip has widely been applied to the lab-on-a-chip for clotting tests. Here, we have demonstrated a capillary driven flow chip using the water-assisted CO(2) laser ablation for crackless fluidic channels and holes as well as the modified low-temperature glass bonding with assistance of adhesive polymer film at 300 degrees Celsius. Effect of water depth on the laser ablation of glass quality was investigated. The surface hydrophilic property of glass and polymer film was measured by static contact angle method for hydrophilicity examination in comparison with the conventional polydimethylsiloxane (PDMS) material. Both low-viscosity deionized water and high-viscosity whole blood were used for testing the capillary-driving flow behavior. The preliminary coagulation testing in the Y-channel chip was also performed using whole blood and CaCl(2) solution. The water-assisted CO(2) laser processing can cool down glass during ablation for less temperature gradient to eliminate the crack. The modified glass bonding can simplify the conventional complex fabrication procedure of glass chips, such as high-temperature bonding, long consuming time and high cost. Moreover, the developed fluidic glass chip has the merit of hydrophilic behavior conquering the problem of traditional hydrophobic recovery of polymer fluidic chips and shows the ability to drive high-viscosity bio-fluids.

Heart transplantation under cyclosporine or tacrolimus combined with mycophenolate mofetil or everolimus

OBJECTIVE

In this study, we examined whether cyclosporine was effective when combined with everolimus in clinical heart transplantation (HT).

PATIENTS AND METHODS

From August 2004 to July 2007, 108 adult patients underwent primary HT. The main exclusion criteria were: donors > 60 years; cold ischemia times > 6 hours; recipients of multiorgan transplantation or a previous transplantation; and panel-reactive antibodies > or = 25%. The cyclosporine plus everolimus regimen (group CE, n = 32) was suggested first; upon refusal or if the recipient or donor was positive for hepatitis B surface antigen or PCR + hepatitis C infection, then patient was randomly assigned to success cyclosporine plus mycophenolate mofetil (MMF; group CM, n = 24) or tacrolimus plus MMF (group TM, n = 25). All patients underwent similar operative procedures and postoperative care with protocol endomyocardial biopsies.

RESULTS

No 30-day mortality was noted in any group. The efficacy failure rates were 3%, 25%, and 16% in groups CE, CM, and TM, respectively (P = .04 between groups CE and CM). The 1-year survivals were 96.7% +/- 18.1%, 89.7% +/- 29.8%, and 81.0% +/- 35.5% for groups CE, CM, and TM, respectively (P = .04 between groups CE and TM). The 3-year survival rates were 91.9% +/- 28.3%, 79.8% +/- 46.0%, and 81.0% +/- 35.5% in groups CE, CM, and TM, respectively.

CONCLUSIONS

The 3 immunosuppressive regimens offered good efficacy after HT. The cyclosporine plus everolimus regimen showed a significantly better result with less efficacy failure (compared with cyclosporine plus MMF: 3% vs 25%) and better 1-year survival compared with tacrolimus plus MMF: 96.7% vs 81.0%.

Optical properties of Ce-doped ZnO nanowires directionally grown by hydrothermal method

Well directionally grown Ce-doped ZnO nanowires were successfully synthesized by a simple hydrothermal method. The Ce dopant plays a key role in evolving the morphology, affecting the crystalline size, and forming the uniform nanostructure of the ZnO nanowires. The amount of Ce dopant in the ZnO nanowires also affects the regions of blue-shift in the UV and green emission peaks and the intensities of emission peaks based on the cathodoluminescence spectra of the nanowires. Moreover, the effect of Ce doping amount on the microstructure of the nanowires is also presented.

Computerized tomography technique for reconstruction of obstructed phase data in shearography

Shearography is an interferometric method that overcomes several limitations of holography by eliminating the reference beam. It greatly simplifies the optical setup and has much higher tolerance to environmental disturbances. Consequently, the technique has received considerable industrial acceptance, particularly for nondestructive testing. Shearography, however, is generally not applicable to the measurement of an obstructed area, as the area to be measured must be accessible to both illumination and imaging. We present an algorithm based on the principle of tomography that permits the reconstruction of the unavailable phase distribution in an obstructed area from the measured boundary phase distribution. In the process, a set of imaginary rays is projected from many different directions across the area. For each ray, integration of the phase directional derivative along the ray is equal to the phase difference between the boundary points intercepted by the ray. Therefore, a set of linear equations can be established by considering the multiple rays. Each equation expresses the unknown phase derivatives in the obstructed area in terms of the measured boundary phase. Solution of the set of simultaneous equations yields the unknown phase distribution in the blind area. While its applications to shearography are demonstrated, the technique is potentially applicable to all full-field optical measurement techniques such as holography, speckle interferometry, classical interferometry, thermography, moiré, photoelasticity, and speckle correlation techniques.

Phaeochromocytoma crisis--a rare indication for extracorporeal membrane oxygenation

We report on a case of phaeochromocytoma whose initial presentation mimicked an acute myocardial infarction. Veno-arterial extracorporeal membrane oxygenation was used for the management of refractory cardiogenic shock and massive lung oedema. Suspicion and diagnosis of a phaeochromocytoma were made due to its unique clinical presentation during extracorporeal membrane oxygenation. Stabilisation of the crisis and recovery of cardiopulmonary function were achieved using the support of extracorporeal membrane oxygenation. This case highlights the difficulty in the differential diagnosis of cardiogenic shock secondary to phaeochromocytoma and the important role of extracorporeal membrane oxygenation can have in the successful resuscitation and management of these patients.

Decreased levels of apolipoprotein A-I in plasma of schizophrenic patients

This study aims to identify the effects of antipsychotics on plasma proteins, and on the proteins associated with schizophrenia. We applied proteomics technology to screen protein aberrations in Sprague-Dawley rats treated with antipsychotics and schizophrenic patients undergoing medication. ApoA-I was found significantly increased in the chlorpromazine-treated rats and decreased in the patients with treatment-resistant schizophrenia, which suggest that decreased levels of apoA-I might be associated with the pathology of schizophrenia and that chlorpromazine increases apoA-I levels as part of its therapeutic action.

Single-center experience of pediatric heart transplantation in taiwan

Heart transplantation (HTx) is a treatment for end-stage heart failure or a complex or inoperable congenital defect. The long-term survival and the adequate donor to recipient body weight (D/R BW) ratio remain to be determined. From March 1995 to May 2004, 14 children (6 months-16 years of age) underwent HTx due to underlying diseases of idiopathic dilated cardiomyopathy (n = 10; 71.4%), congenital heart disease (n = 3; 21.4%), and Kawasaki disease (n = 1; 7.1%). Donor-recipient body weight ratio ranged from 0.89 to 3.9. Big heart syndrome was present in one patient when D/R BW ratio was more than 3. Actuarial survival was 92.9% at 5 years after transplantation. Only the one patient who had Kawasaki disease died due to early primary graft failure. HTx is a feasible method with good long-term survival rates for end-stage heart failure or for complex or inoperable congenital defects. After careful pretransplant evaluation, a high D/R BW ratio (more than 3) is acceptable.

Heart retransplantation for heart allograft failure in Chinese heart transplant recipients: NTUH experience

We investigated the short- and long-term results after heart retransplantation in terms of different causes of heart allograft failure. We sought to establish the data of heart retransplantation in Chinese compared with Western counterparts due to differences in heart allograft vasculopathy. From March 1995 to May 2005, eight heart transplantation recipients with allograft failure underwent retransplantation. Heart allograft failure was due to coronary vasculopathy (CAV) in six patients (75%) and acute rejection in two patients (25%). The mean interval to retransplantation was 32 to 84 months (mean 54.3 months). There were five patients who survived after heart retransplantation for CAV and no patient survived after an earlier diagnosis of acute rejection. Heart retransplantation is a feasible method with acceptable long-term survival rate for heart allograft failure. After careful pretransplant evaluation, retransplantation is acceptable. The survival after retransplantation for CAV is notably great than that after acute rejection. Heart retransplantation is the only way for patients who have cardiac allograft failure to achieve long-term survival.

[Epidemic situation analysis of Japanese encephalitis in 2005.]

BACKGROUND

To investigate the epidemic situation of Japanese encephalitis (JE) in three provinces, Guizhou, Sichuan, and Hubei in 2005.

METHODS

Information about epidemic situation of JE, mosquitoes specimens were collected and titers of JE virus in hosts in the above three surveillance sites were determined.

RESULTS

The reported cases of JE in Guizhou, Sichuan, and Hubei province accounted for 40.7% of total cases in 2005 in China. The numbers of cases in Guizhou and Sichuan ranked at the first two in China, morbidity exceeded 1/100,000, which was higher than average level in China. Zero to 10 years old children accounted for 90% in reported cases. Most of the cases were children lived at home. Almost all JE cases were presented from June to September, but most cases were reported between July and August. Investigaton of the density of vector showed that the dominant mosquitoes were Culex, especially the Culex tritaeniorhynchus.

CONCLUSION

The epidemic status of JE was similar among the three provinces and the whole country. The number of JEV cases in Guizhou and Sichuan were the highest in China.

Extracorporeal Membrane Oxygenation Hybrid With Various Ventricular Assist Devices as Double Bridge to Heart Transplantation

Ventricular assist devices (VAD) have benefitted patients with end-stage heart failure as a bridge to heart transplantation (HTx). We present our experience with HTx after an extracorporeal membrane oxygenation (ECMO) hybrid with various ventricular assist devices (VAD). From May 1996 to December 2003, mechanical circulatory support with a Biopump VAD was performed in eight patients, HeartMate left VAD in eight patients, and Thoratec VAD in eight patients. Before VAD implantation, 19 patients maintained their circulation with ECMO. Half of the 24 patients were implanted with VAD to await a suitable donor for HTx. We observed that half of the patients supported by ECMO hybrid with various VAD awaited a suitable donor for HTx. In our experience, we recommend the application of ECMO for short-term support within 1 week and the Biopump VAD, Thoractec VAD, or HeartMate VAD for medium-term or long-term support as a bridge to HTx.

Successful Treatment of Hepatitis B Virus Infection With Lamivudine After Heart Transplantation

Patients with hepatitis B virus (HBV) infection have a higher morbidity and mortality after heart transplantation (HT). HBV infection is endemic in Taiwan. We studied the effect of lamivudine treatment of HBV infection after HT. From July 1987 to July 2005, 252 patients underwent HT. All recipients and donors underwent routine screening of hepatitis B surface antigen (HBsAg), hepatitis B e antigen, antibody to hepatitis B surface antigen, antibody to hepatitis B core antigen, antibody to hepatitis B e antigen, and an alanine aminotransferase (ALT) level before HT. When ALT was two times greater than the upper limit of normal or serum bilirubin was higher than 3 mg/dL in HBsAg-positive patients, HBV-DNA were checked by a branched DNA assay or polymerase chain reaction. When HVB-DNA was greater than 100,000 copies/mL, lamivudine (100 mg per day) was prescribed indefinitely. There were 14 patients under lamivudine treatment after HT, among whom, none suffered severe adverse reactions from lamivudine. Four patients died: one due to end-stage cirrhosis while awaiting liver transplantation at 14 months after HT. Two died of sudden death at 54 months and 138 months after HT. Another died of diffuse B cell lymphoma at 62 months after HT. All the survivors have normal ALT and undetectable HBV-DNA after lamivudine treatment. But the YMDD mutant was detected in two patients. With successful treatment of HBV infection in HT, it is not necessary to exclude HBV infection patients from HT.

Sparing Immunosuppression in Heart Transplant Recipients With Severe Sepsis

This study described an analysis of severe sepsis among heart transplantation recipients who were treated by sparing all immunosuppressants. Sepsis leading to multiple organ failure (MOF) in heart transplantation has a high mortality. This retrospective study of 190 patients who underwent heart transplantation from 1993 to 2004 included 12 who had severe sepsis with MOF who were treated by sparing all immunosuppressants. Half of them survived after sparing all immunosuppressants with intensive endomyocardial biopsy. Only one case needed pulse therapy for an acute rejection episode. The most common bacterial infectious episodes were caused by methicillin-resistant Staphylococcus aureus (n = 3). All sepsis episodes occurred in the first month after heart transplantation except in one case, which occurred 6 years after heart transplantation. There was a 50% survival rate of heart transplantation recipients who experienced MOF due to severe sepsis and were treated by sparing all immunosuppressants under a program of intensive endomyocardial biopsy.

Simultaneous Heart and Kidney Transplantation for Combined Cardiac and Renal Failure

Simultaneous heart and kidney transplantation (SHKT) is feasible for combined cardiac and renal failure. Herein we reviewed our 10-year experience in SHKT. Six patients underwent SHKT from June 1995 to December 2004. Their ages ranged from 13 to 63 years old with a mean of 45.5 +/- 15.8 years. They were all men except one girl, who was the youngest (aged 13) who suffered from dilated cardiomyopathy with congestive heart failure and chronic renal failure due to systemic lupus erythematosus. Because of aggravating heart failure, she changed from hemodialysis to peritoneal dialysis. Because of intractable heart failure, she underwent SHKT from a 24-year-old female donor. All received hemodialysis before SHKT. The indications for heart transplantation included dilated cardiomyopathy (n = 3), ischemic cardiomyopathy (n = 1), cardiac allograft vasculopathy (n = 1), and cardiac allograft failure (n = 1). The immunosuppressive protocol and rejection surveillance were these employed for heart transplantation. No operative mortality was noted in this study. The 1-year and 5-year survival rates were the same, 83%. The 10-year survival rate was 55%. No cardiac or renal allograft rejection was noted. No renal allograft loss was noted. There were two late mortalities: the one, who underwent redo heart transplantation for coronary artery vasculopathy died of cardiac allograft failure 1 year after SHKT. The other patient died of massive ischemic necrosis of the intestine at 6 years after SHKT. Our experience showed that SHKT had good short- and long-term results without increasing immunosuppressive doses. End-stage failure of either the heart or the kidney did not preclude heart plus kidney transplantation.

Epidural abscess in an obstetric patient with patient-controlled epidural analgesia – a case report

We present the case of a 37-year-old pregnant woman who underwent a cesarean section due to previous cesarean delivery. Spinal anesthesia was performed at the L2-3 intervertebral space with an epidural catheter inserted at L1-2 for postoperative patient-controlled epidural analgesia. When the epidural catheter was removed on day three, an area of redness round the entry point was noted and the patient complained of low back pain, but was discharged from hospital. Later the same day, she felt backache so severe that she was unable to stand up or bend her body. She called for help and was sent to our emergency room. Physicians noted a small amount of discharge from the insertion site, and the body temperature was elevated to 38 degrees C. An anesthesiologist and an infectious disease specialist were consulted, and an epidural abscess was suspected. Urgent magnetic resonance imaging revealed an epidural abscess at L1-2. After five days of unsuccessful treatment with oxacillin, a 28-day course of vancomycin, followed by two months of oral fusidic acid, resulted in complete remission of the epidural abscess. The patient has remained free of neurologic deficit.

Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients

OBJECTIVE

To evaluate potential risk factors and the incidence of bleeding following adenoidectomy or tonsillectomy, with or without adenoidectomy requiring surgical treatment under general anesthesia.

STUDY DESIGN AND SETTING

Retrospective chart review of 15,218 patients who underwent surgery between January 1, 1988, and September 30, 2001, at our institution (St. Anna Hospital, Duisburg).

RESULTS

A total of 229 patients experienced postoperative bleeding (1.5%). Patients of male gender and 70 years of age or older were significantly at risk for post-tonsillectomy hemorrhage. The incidence of bleeding increased with age. Of the bleeding episodes, 76% occurred on the day of surgery; immediate abscess-tonsillectomy was not associated with an increased risk of bleeding.

CONCLUSIONS

Hemorrhage following tonsillectomy and adenoidectomy is rare and predominantly occurs early after surgery. Male patients, 70 years of age or older, infectious mononucleosis, and a history of recurrent tonsillitis were identified as risk factors for post-tonsillectomy hemorrhage. Delayed hemorrhage has the potential to be life-threatening.

The Significance of Hepatic Vein Outflow Volume in Hepatic Outflow Insufficiency of Living Right Liver Graft Evaluated by Doppler Ultrasound

The color Doppler ultrasound has been used to evaluate hepatic vein (HV) outflow insufficiency based on flow velocity and waveforms. In our experience, some cases with flat waveforms are clinically asymptomatic. The parameters of HV flow velocity and waveforms are not always correlated with clinical problems. So, we proposed that total HV flow volume (HVFV) may be a more reliable index. From August 2001 to July 2003, 31 cases among 48 adult-to-adult living related transplants of a right liver graft had one HV anastomosis. HV velocity, waveforms, and HVFV were compared both before and after transplantation. We set the minimal HVFV ratio at 80% based on the original HVFV before graft retrieval. There was no significant difference in HVFV before liver graft retrieval between the 2 groups, but there was a significant change after transplantation. There were no cases of HV insufficiency among group A patients (>80%), whose HVFV ranged from 397 to 1181 mL/min with ratios from 75% to 180% (mean 115%). In group B, there were 4 complicated cases with prolonged severe ascites (<80%) with HVFV ratios from 56% to 76% (mean 66%). Fisher exact test showed a great significance (P < .001). Thus the preliminary criteria of 80% minimal HVFV ratio allows detection of HV insufficiency for further interventional management.

Influence of UNOS status on chance of heart transplantation and posttransplant survival

This study was designed to compare the chance of heart transplantation (HTx) and survival among patients in different UNOS statuses in Taiwan.

METHODS AND RESULTS

From 1996 to 2002, among 203 patients on the heart transplant waiting list, 127 patients had undergone HTx up to December 2002 with 71 dead while waiting, and 5 still alive without transplantation. This study included those 198 patients who had either undergone HTx or who died. At the time of registry, 40 patients were at status IA, 57 at IB, and 101 at II. Nineteen (47.5%) of 40 status IA patients underwent HTx with a mean waiting time of 92 +/- 116 days and median waiting time of 35 days. The 1-month survival was 84%, and 1-year survival was 58%. Seven (64.9%) of 57 status IB patients underwent HTx with a mean waiting time of 85 +/- 100 days and a median waiting time of 40 days. Both 1-month and 1-year survivals were 92%. Seventy-one (70.3%) patients among 101 status II patients underwent HTx. Their mean waiting time was 134 +/- 135 days and median waiting time was 86 days. Their 1-month survival was 95%, and 1-year survival was 85%.

CONCLUSION

Although UNOS status IA patients had a shorter waiting time, their chance to undergo HTx was lower than those in either status IB or status II. The UNOS status IA heart-waiting patients showed lower posttransplant 1-month and 1-year survival rates.

Hepatic venous stenosis in partial liver graft transplantation detected by color Doppler ultrasound before and after radiological interventional management

Hepatic outflow insufficiency remains one of the major complications causing postoperative graft failure especially among partial liver graft transplantations (PLT) including living donor liver transplantation (LDLT), reduced size liver transplantation (RLT), and split liver transplantation (SLT). These procedures are different from the whole liver graft transplantations (OLT), which include multiple vascular anastomoses. Color Doppler ultrasound (CDUS) was used to evaluate the hepatic venous outflow from grafts before and after radiological interventional management and to document treatment effects. From June 1994 to March 2003, our 136 cases of PLTs included 131 LDLTs, two RLTs, and three SLTs. Seven cases (six children and one adult) showed postoperative hepatic vein outflow obstruction and persistent massive ascites, as detected by color Doppler ultrasound (CDUS) and confirmed by interventional angiography. The CDUS showed a monophasic flat waveform with a relatively low hepatic vein average peak velocity (Va) in all cases (mean 11 cm/s). Successful interventional procedures included balloon dilatation in three cases and metallic stent replacement in four cases. CDUS was used with guidance during the procedure to confirm restoration of normal hepatic vein flow with a multiphasic waveform and an objective increase of average flow velocity (high to average 66 cm/s). Ascites disappeared dramatically after the procedure. In conclusion CDUS is the prime modality to diagnose and document a treatment response.

The significance of transarterial embolization for advanced hepatocellular carcinoma in liver transplantation

INTRODUCTION

Transarterial embolization (TAE) is the treatment of choice for advanced HCC to control or even induce tumor shrinkage. The aim of this study was to evaluate the effect of pretransplantation TAE for treatment of advanced HCC.

MATERIAL AND METHODS

From 1996 to 2002, we studied 12 cirrhotic patients with HCC, including six who met and six who exceeded the Milan criteria. All patients had sufficient hepatic function to undergo TAE. Liver transplantations were performed subsequently and they were followed prospectively for a median of 22 months (range = 12 to 53 months).

RESULTS

The explanted livers from the 12 patients who had undergone TAE were noted to have extensive tumor necrosis. The pathological specimens at LT showed downstaging of the HCC, which allowed those six patients to meet the Milan criteria. The overall 1- and 2-year survival rates were 92% and 73%, respectively. The overall 1- and 2-year disease-free survival rates were 92% and 73%, respectively. One death unrelated to liver disease at 2 years after LT was noted in the downgraded group. One patient of the initially eligible group developed lung metastasis at 6 months and died at 12 months after LT.

CONCLUSION

TAE is effective to downstage advanced HCC and reduce the dropout rate on the LT waiting list. Pre-LT TAE may be considered as a better therapeutic strategy for patients with advanced HCC.

Detection of Burkholderia pseudomallei in rice fields with PCR-based technique

Burkholderia pseudomallei Ara- in rice fields was detected using PCR-based techniques with 16S RNA and flagella gene primer sets. The sensitivity of these PCRs was at least 1 CFU/mL of B. pseudomallei Ara- preincubated into Ashdown's medium for 6 h. B. pseudomallei Ara- DNA from watery soil were more detectable than from dry soil. The distribution of this DNA was mainly found at a depth of 300-600 mm under crop-covered fields, but not detected in the location of soil close to the land surface. The results suggest that PCR based on 16S RNA and flagella gene primer sets can be applied to investigate the presence of B. pseudomallei Ara- in contaminated soil of rice fields.

Curcumin inhibited the arylamines N-acetyltransferase activity, gene expression and DNA adduct formation in human lung cancer cells (A549)

It is well known that N-acetyltransferase (NAT) plays an important role in the arylamine metabolism. We analysed the response of A549 human lung cancer cells for N-acetylation of 2-aminofluorene (AF) to curcumin. After curcumin treatment, the NAT activity was examined by HPLC, AF-DNA adduct formation was examined by HPLC, and NAT gene expression by polymerase chain reaction were detected. The NAT activity in the human A549 cells and cytosols was suppressed by curcumin in a dose-dependent manner. The results also demonstrated that gene expression (NAT1 mRNA) in human lung A549 tumor cells was inhibited and decreased by curcumin. After the incubation of human lung A549 tumor cells with AF with or without curcumin co-treatment, the cells were recovered and DNA was prepared and hydrolyzed to nucleotides. The adducted nucleotides were extracted into butanol and analyzation of AF-DNA adducts was done by HPLC. The results also demonstrated that curcumin decreases AF-DNA adduct formation in the human lung A549 tumor cells.

On formation of CaO-Al(2)O(3)-SiO2 glass-ceramics by vitrification of incinerator fly ash

CaO-Al(2)O(3)-SiO(2) system glass ceramics of incinerator fly ash have been prepared by vitrification and then heat-treated in different conditions. The thermal molten process (TMP) was applied to heat treat vitrified samples at high temperatures whereas in the powder sintering process water-quenched vitrified samples were ground into powder and then sintered at high temperatures. Gehlenite was found present as the major phase in all treated samples. Treated samples in general exhibited good leachability characteristics as well as chemical durability, except in the HCl solution. Microstructure and physical properties varied with the treatment condition. Fine and relatively high dense structures with desirable properties were obtained for samples treated by the TMP. For both processes, higher temperature treatments caused crystal growth and thus poor properties were attained. Good physical and mechanical properties achieved at 900-950 degrees C in this study imply the treated samples have attractive potential for engineering applications.

Effects of soil pH, temperature and water content on the growth of Burkholderia pseudomallei

Optimum conditions were determined for the growth of Burkholderia pseudomallei in natural soils or waters. It grows better in paddy soil, crop-covered and fallow field than in fresh and salty water. Although the optimal temperature and pH for the growth were 37 or 42 degrees C, and 6.5 or 7.5 in an environmental-mimicking soil medium, this bacterium can still grow at 4 degrees C, which was suggested to be related with the occurrence of melioidosis in some cold areas. In soil media with water content < 15. B. pseudomallei did not grow until 60 d of incubation, suggesting that water contents of soils in which it dwelled would be one important factor in determining the growth rate.

Digital redesign of anti-wind-up controller for cascaded analog system

The cascaded conventional anti-wind-up (CAW) design method for integral controller is discussed. Then, the prediction-based digital redesign methodology is utilized to find the new pulse amplitude modulated (PAM) digital controller for effective digital control of the analog plant with input saturation constraint. The desired digital controller is determined from existing or pre-designed CAW analog controller. The proposed method provides a novel methodology for indirect digital design of a continuous-time unity output-feedback system with a cascaded analog controller as in the case of PID controllers for industrial control processes with the presence of actuator saturations. It enables us to implement an existing or pre-designed cascaded CAW analog controller via a digital controller effectively.

Ginsenoside Rb1 enhances peripheral nerve regeneration across wide gaps in silicone rubber chambers

Silicone rubber chambers filled with collagen containing ginsenoside Rb1 (GRb1) were used to repair lesioned rat sciatic nerves with 15-mm gaps between stumps. Six weeks after implantation, histology of the nerve regenerated in the chambers filled with GRb1 and collagen contained larger axons than those in the chambers with collagen only. This study showed that the GRb1 could exert a positive influence on nerve regeneration when using silicone rubber tubes.

The cost effectiveness of dual phase 201Tl thyroid scan in detecting thyroid cancer for evaluating thyroid nodules with equivocal fine-needle aspiration results: the preliminary Taiwanese experience

The purposes of this study were to assess the helpfulness of dual phase 201Tl thyroid scan for differentiating malignant from benign thyroid lesions in cases of thyroid nodules with equivocal fine-needle aspiration (FNA) biopsy results. In addition, for thyroid nodules with equivocal FNA biopsy results, we try to make a decision analysis model compared the FNA biopsy alone strategy (strategy A) with decision strategy for the assistance of dual phase 201Tl thyroid scan (strategy B) before diagnostic thyroidectomy as thyroid cancer evaluation strategies for hypothetical cohorts of estimated 17,280-29,160 Taiwanese patients/per year with equivocal FNA biopsy results. Based on the findings of surgical histopathology, dual phase 201Tl thyroid scan sensitivity, specificity, and accuracy were 100%, 90%, and 96%, respectively, in cases of 27 thyroid nodules with equivocal FNA biopsy results. In cost effectiveness analysis, the strategy B showed a cost saving of 16,340,480-27,574,560 US dollars in unnecessary diagnostic thyroidectomy cost. The total cost of strategy B showed a cost saving of 13,932,232-23,520,564 US dollars than that of strategy A. The preliminary data indicate that dual phase 201Tl thyroid scan can save the cost of unnecessary diagnostic thyroidectomy in Taiwanese patients with equivocal FNA biopsy results. In addition, we may provide a noninvasive diagnostic method--dual phase 201Tl thyroid scan, as the first priority for Taiwanese patients with equivocal FNA biopsy before diagnostic thyroidectomy under the coverage of the national health insurance system in Taiwan.

Effect of acupuncture stimulation on peripheral nerve regeneration using silicone rubber chambers

The purpose of this study was to determine whether acupuncture could affect the regeneration of a 10-mm gap of rat sciatic nerve created between the proximal and distal nerve stumps, which were sutured into silicone rubber tubes. Empty silicone rubber tubes with no further treatment were used as controls. Six weeks after implantation, the animals received the acupuncture or the electroneedling treatment exhibited a more mature ultrastructural nerve organization with significantly higher numbers in the axon density, the blood vessel area, and the percentage of blood vessel area occupied in total nerve area than the controls. In addition, the electroneedling could combine both the needling and the electrical stimulation to potentiate the nerve-growth promoting effect of the acupuncture treatment. These results showed that acupuncture treatment could elicit positive effects on regenerated peripheral nerves.

Utility and accuracy of template-directed dye-terminator incorporation with fluorescence-polarization detection for genotyping single nucleotide polymorphisms

There are little independent data available about how well single nucleotide polymorphism (SNP) genotyping technologies perform in the typical molecular genetics laboratory. We evaluated the utility and accuracy of a widely used technology, template-directed dye-terminator incorporation with fluorescence-polarization detection (FP-TDI), in a sample of 177 SNPs selected solely on the basis of map location. Genotypes were generated without optimization using standard protocols. Overall, 81% of the SNPs we studied generated readable genotypes by FP-TDI. Thirty-two SNPs were genotyped in duplicate by PCR-RFLP orfluorescent dye-terminator sequencing. Out of a total of 631 duplicate genotypes, no true discrepancies were detected. The true error rate has a 95% chance of lying between 0 and 6 out of 1000 genotypes. We also tested for deviations from Hardy-Weinberg Equilibrium in 33 SNPs genotyped in 50 unrelated individuals, and no significant deviations were detected. Our FP-TDI data were readily adaptable to automated genotype calling using our own method of cluster analysis, which assigns a probability score to each genotype call. We conclude that FP-TDI is both efficient and accurate. The method can easily fill the needs of SNP genotyping projects at the scale typically used for regional or candidate-gene association studies.

Treatment and recycling of incinerated ash using thermal plasma technology

To treat incinerated ash is an important issue in Taiwan. Incinerated ashes contain a considerable amount of hazardous materials such as dioxins and heavy metals. If these hazardous materials are improperly treated or disposed of, they shall cause detrimental secondary contamination. Thermal plasma vitrification is a robust technology to treat and recycle the ash residues. Under the high temperature plasma environment, incinerated ashes are vitrified into benign slag with large volume reduction and extreme detoxification. Several one-step heat treatment processes are carried out at four temperatures (i.e. 850, 950, 1,050 and 1,150 degrees C) to obtain various "microstructure materials". The major phase to form these materials is a solid solution of gehlenite (Ca2Al2SiO7) and åkermanite (Ca2MgSi2O7) belonging to the melilite group. The physical and mechanical properties of the microstructure materials are improved by using one-step post-heat treatment process after plasma vitrification. These microstructure materials with good quality have great potential to serve as a viable alternative for construction applications.

Effects of percutaneous electrical stimulation on peripheral nerve regeneration using silicone rubber chambers

The purpose of this study was to determine whether 0.8-1 mA, 2 Hz of percutaneous electrical stimulation could affect the regeneration of a 10-mm gap of rat sciatic nerve created between the proximal and distal nerve stumps, which were sutured into silicone rubber tubes. Six weeks after implantation, though the group receiving the electrical stimulation had a lower success percentage of regeneration (57%) compared with the controls receiving no stimulation (70%), quantitative histology of the successfully regenerated nerves revealed that the mean values of the axon density, blood vessel number, blood vessel area, and percentage of blood vessel area in total nerve area in the group with the electrical stimulation were all significantly larger than those in the controls (p < 0.05). These results showed that the electrical stimulation could elicit rehabilitating effects on the regenerated nerves.

Single imaging modality evaluation of living donors in liver transplantation: magnetic resonance imaging

BACKGROUND

Liver graft size, anatomy of the bile duct and the vascular inflow and outflow are essential for living related liver transplantation (LRLT). Preoperative delineation of those variations that would change the operative procedure to achieve a successful result especially in an emergency condition.

PURPOSE

Our aim was to develop a rapid and noninvasive imaging diagnostic method for the detection of anatomical variants that is mandatory for a safe operation when selecting potential liver transplant living donors. We used a different magnetic resonance (MR) imaging technique, which enabled to us to exploit the anatomical landmark of the liver, signal enhancement of blood flow in the abdomen, and the intrahepatic biliary routes inside the liver. Then, with the help of Advantage Window workstation reconstruction, the reconstructed single vascular or biliary systems were displaced in a three-dimensional fashion and the whole examination finished within 30 min.

METHODS

Modification of the standard MR technique was performed on a superconductive 1.5T whole body image scanner, MR arteriogaphy, venography, and cholangiography with three-dimensional reconstruction in evaluating the anatomy of the hepatic arteries, hepatic veins, portal venous system, bile ducts, and liver size in potential liver transplant living donors. These anatomical structures were compared with traditional imaging methods.

RESULTS

In all 38 cases, as well as delineation of the portal vein detail to the segmental level was satisfactorily obtained in this MR study. The images were well displayed in a three-dimensional fashion, which had good correlation with images from traditional imaging modalities and operative findings. In 86.8% cases, the MR arteriography was well matched with the celiac angiography. Of those 17 operative cases, estimation of liver volume was well correlated with the liver graft within 3.9-12.5% variation. In the major hepatic vein, we obtained 100% accuracy and 88.2% in the minor branches. Of 12 donors received intraoperative cholangiography during liver donation, good correlation of biliary anatomy was achieved. One donor was excluded from graft donation due to the complicated arterial supply to the left liver. According to the anatomical variation, surgical procedures in graft harvesting and anastomosis were readjusted and no major complications were found in those donors and all recipients survived after liver transplantation.

CONCLUSION

MR volumetry, venography, angiography, and cholangiography with three-dimensional reconstruction is sufficient for all major imaging evaluation. It may replace the traditional conventional catheter angiography, computed tomography, sonography and endoscopic retrograde cholangiography as a single investigation in the evaluation of the potential liver transplant donors. Angiography is only valuable in suboptimal cases and intraoperative cholangiography is only performed in biliary ductile variants.

Immediate abscess tonsillectomy--a safe procedure?

OBJECTIVE

Peritonsillar abscess is the most common infection involving deep neck planes to be treated by otolaryngologists with varying management strategies. In some countries, like Japan, immediate tonsillectomy is considered only for selected cases due to the risk of post-operative complications. Post-tonsillectomy bleeding is considered as the major complication following surgery and serves as a landmark for the safety of the operation. The purpose of this study was to evaluate if there is an increased risk of post-tonsillectomy haemorrhage following immediate tonsillectomy in non-selected patients.

METHODS

A retrospective study was performed on 6329 patients who underwent tonsillectomy, with or without adenoidectomy, in St. Anna Hospital, Duisburg, between January 1988 and August 2000 to evaluate the complication rate following 1481 immediate tonsillectomies (group A) compared to 4848 patients who underwent elective tonsillectomy (group B). 56.9% (group A) were male, the youngest patient was 18 months, the oldest 87 years old. Patients of group B were younger in general (mean age: 18.7 vs. 32.9 years), 49.9% were male, between 5 months and 93 years of age. Patients of both groups underwent surgery under general anaesthesia and were observed for 6 days. The incidence of post-tonsillectomy haemorrhage in both groups was compared using chi(2)-test, the age distribution was compared by Mann-Whitney U-test.

RESULTS

Bleeding occurred in 43 patients of group A (2.9%) and 138 patients (2.8%) of group B. Excessive bleeding requiring ligature of the external carotid artery became necessary in one patient of group A (0.13%) and four patients of group B (0.08%). A 42-month-old patient (group B) died due massive haemorrhage at home 6 days after surgery. The latest bleeding occurred 12 (group B) and 13 days (group A) after surgery. Statistical evaluation (Pearson chi(2)-test P=0.908) shows no significant difference of post-operative bleeding between the compared groups. Post-tonsillectomy haemorrhage occurred with statistical significance (P<0.001) in elder patients after immediate tonsillectomy.

CONCLUSIONS

We conclude, that immediate tonsillectomy can be recommended as a safe surgical procedure in non-selected patients to evacuate quinsy without an additional risk of bleeding thus making a second hospital stay unnecessary.

Transvenous permanent pacemaker implantation in children and adolescent

In pediatric patients cardiac pacing has been traditionally carried out by the epicardial approach in Taiwan. This study was to define the long-term results of transvenous endocardial pacemaker therapy in growing children. From 1994 to 1997, patients with sympatomatic bradycardia referred for permanent pacemaker were enrolled. Permanent pacemaker was implanted under propofol anesthesia and direct puncture of subclavian vein and creation of prepectoral pocket. A total of 10 patients ( 5 male, 5 female) aged from 5 to 17 years (13 +/- 4 yrs), constituted the study population. Follow-up period ranged from 14 to 48 months (29 +/- 14 months) . Underlying rhythm disturbances and pacemaker type implanted were: complete atrioventricular (AV) block 5 (VDD pacemaker in 3 and VVIR in 2), sick sinus syndrome 2 (DDDR pacemaker in both), sick sinus syndrome with abnormal AV conduction 1 (WIR), long QT syndrome 1 (VVIR) and hypertrophic cardiomyopathy 1 (DDDR). Pacemaker dysfunction occurred in only one patient in whom the endocardial lead was fixed by absorbable thread with an aim to have more flexibility of the lead. The endocardial lead was dislodged but properly reimplanted about 3 months after the initial implantation. All patients had satisfactory lead sensing and pacing threshold during the long-term follow-up. The pacing threshold was much better than that usually neededfor epicardial leads. With growing, none have the problems of lead length. Quality of life was reported to be improved in all. Tranvenous permanent pacemaker implantation is feasible in children aged 5 or older The long-term efficacy is satisfactory. Physiological pacing using a single lead (VDD) is recommended for younger patients with impaired AV conduction.

Possible site of decreased intestinal zinc absorption in chronic uremic rats

BACKGROUND/AIMS

Previous zinc tolerance tests in uremic patients indicated decreased intestinal zinc absorption. In the present study, a zinc tolerance test was initially applied to a uremic rat model and subsequently the possible site of malabsorption investigated.

METHODS

Chronic uremia was induced by five-sixths nephrectomy. Both control and nephrectomized rats were divided into three groups including animals with intact intestine, removal of the jejunum, and removal of the ileum. Each rat was orally loaded with zinc sulfate (80 mg/kg) in conscious state. Blood samples were drawn before and after zinc load at different intervals during 6 h for zinc analysis. The area under the plasma zinc curve (AUC) and the maximal increase of plasma zinc level (C(max)) were calculated.

RESULTS

Jejunectomy decreased both AUC and C(max) in control and nephrectomized rats, whereas ilectomized animals remained, interestingly, unchanged with regard to these two parameters. Significant decreases in both AUC and C(max) were observed in nephrectomized rats as compared with the control rats.

CONCLUSIONS

The jejunum is the main site of zinc absorption in response to a large oral load of zinc sulfate in both normal and uremic rats. The data further suggest that five-sixths nephrectomy reduces gastrointestinal zinc absorption in rats predominantly by the ileum.

Effects of blockade of cerebral lymphatic drainage on cerebral ischemia after middle cerebral artery occlusion in rats

This experiment aimed to investigate the effects of blockade of cerebral lymphatic drainage on cerebral ischemic damage. Seventy six Wistar rats were divided randomly into middle cerebral artery occlusion (MCAO) group and MCAO plus cerebral lymphatic blockade (MCAO+CLB) group for the experiment. The contents of water and electrolytes, the activity of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) in the ischemic brain tissue were detected at 24, 48 and 72 hours after the operation. The morphologic examination was also performed. In MCAO group, contents of water, sodium and calcium in the ischemic brain tissue increased significantly at any time after the operation. The SOD activity decreased while the MDA content increased markedly. The morphologic findings showed severe damage of ischemic brain tissue and neurons. In MCAO+CLB group, the above parameters were altered more obviously. The present observation suggests that blockade of cerebral lymphatic drainage may deteriorate ischemic brain damage after MCAO.