Radiofrequency ablation for recurrent hepatocellular carcinoma in postresectional patients: prognostic factors analysis

BACKGROUND

Percutaneous ablation therapies can be used for recurrent hepatocellular carcinoma (HCC) in postresectional patients not eligible for repeat surgery.

AIMS

To determine prognostic factors affecting the disease-free survival of postresectional patients after percutaneous ultrasound-guided radiofrequency ablation (RFA) for recurrent HCC.

METHODS

From August 2003 to December 2009, patients who had received previous hepatectomy because of HCC and suffered from tumor recurrence were included. Among them, 82 patients who received initial percutaneous ultrasound-guided RFA were included. Various host, treatment, and therapeutic-related factors were analyzed.

RESULTS

Eighty-two patients (64 men, mean age 64.27 years) were included. Sex (P=0.495), age (P=0.840), hepatitis marker (P=0.083), and Child-Pugh score (P=0.809) were not related to prognosis. Preresectional tumor number (P=0.502), recurrent tumor location (P=0.795), recurrent tumor number (P=0.533), pathology proved cirrhosis (P=0.889), and OKUDA stage of the primitive disease (P=0.865) were not related to prognosis, either. Survival rates were significantly related to the preresectional tumor size (P=0.008), microscopic portal vein invasion (P=0.001), recurrent tumor size (P<0.001), and preablation α-fetoprotein serum level (P=0.006). Ablation needle (P=0.373), ablation time (P=0.387), and postablation temperature (P=0.444) were not related to prognosis. Multivariate analysis revealed that microscopic portal vein invasion was the only factor that had a significant effect on patient survival.

CONCLUSION

In patients with postresectional HCC treated with percutaneous ultrasound-guided RFA for recurrent disease, those without microscopic portal vein invasion had a significantly higher probability of disease-free survival.

Renal calcification in very low birth weight infants

BACKGROUND

Renal calcification in preterm infants has been described frequently. The etiologic factors have not yet been fully clarified. The objective of this study was to evaluate the incidence of and risk factors for renal calcification in our population.

METHODS

We retrospectively reviewed the charts of very low birth weight preterm infants during a 1-year period. Renal ultrasound scans were performed at term or before discharge and at a corrected age of 1 year.

RESULTS

Six infants (6%) had renal calcification at term or before discharge compared with 96 who did not. Factors significantly associated with renal calcification included gestational age (26 weeks vs. 29 weeks, p=0.006), birth weight (851 g vs. 1141 g, p=0.004), duration of mechanical ventilation (69 days vs. 29 days, p=0.002), length of intensive care (72 days vs. 41 days, p=0.013), furosemide therapy (33% vs. 3%, p=0.027), and dexamethasone therapy (50% vs. 2% p=0.001). Birth weight and dexamethasone therapy had significant independent association after stepwise logistic regression analysis. Sex, oliguria, acidosis, duration of oxygen therapy, length of hospital stay, nutrition status, and nephrotoxic drugs did not differ between the two groups. Three of the six infants had spontaneous remission of renal calcification, whereas two patients without the finding in neonatal stage had renal calcification at a corrected age of 1 year.

CONCLUSION

The incidence of renal calcification in very low birth weight infants in this study was relatively low, and the calcification was transient in one-half of the infants. Extremely premature, sick infants requiring long-term ventilation, and those receiving furosemide or dexamethasone were more likely to have renal calcification. Clinicians should be aware that renal calcification may develop beyond the neonatal stage.

Applying model simulation and photochemical indicators to evaluate ozone sensitivity in southern Taiwan

Ozone sensitivity was investigated using CAMx simulations and photochemical indicator ratios at three sites (Pingtung City, Chao-Chou Town, and Kenting Town) in Pingtung County in southern Taiwan during 2003 and 2004. The CAMx simulations compared fairly well with the hourly concentrations of ozone. Simulation results also showed that Pingtung City was mainly a volatile organic compounds (VOC)-sensitive regime, while Chao-Chou Town was either a VOC-sensitive or a NOx-sensitive regime, depending on the seasons. Measurements of three photochemical indicators (H2O2, HNO3, and NOy) were conducted, and simulated three transition ranges of H2O2/HNO3 (0.5-0.8), O3/HNO3 (10.3-16.2) and O3/NOy (5.7-10.8) were adopted to assess the ozone sensitive regime at the three sites. The results indicated that the three transition ranges yield consistent results with CAMx simulations at most times at Pingtung City. However, both VOC-sensitive and NOx-sensitive regimes were important at the rural site Chao-Chou Town. Kenting Town, a touring site at the southern end of Taiwan, was predominated by a NOx-sensitive regime in four seasons.

Soft-tissue tumor differentiation using 3D power Doppler ultrasonography with echo-contrast medium injection

BACKGROUND

We aimed to evaluate the ability of 3-dimensional power Doppler ultrasonography to differentiate soft-tissue masses from blood flow and vascularization with contrast medium.

METHODS

Twenty-five patients (mean age, 44.1 years; range, 12-77 years) with a palpable mass were enrolled in this study. Volume data were acquired using linear and convex 3-dimensional probes and contrast medium injected manually by bolus. Data were stored and traced slice by slice for 12 slices. All patients were scanned by the same senior sonologist. The vascular index (VI), flow index (FI), and vascular-flow index (VFI) were automatically calculated after the tumor was completely traced. All tumors were later confirmed by pathology.

RESULTS

The study included 8 benign (mean, 36.5 mL; range, 2.4-124 mL) and 17 malignant (mean, 319.4 mL; range, 9.9-1,179.6 mL) tumors. Before contrast medium injection, mean VI, FI and VFI were, respectively, 3.22, 32.26 and 1.07 in benign tumors, and 1.97, 29.33 and 0.67 in malignant tumors. After contrast medium injection, they were, respectively, 20.85, 37.33 and 8.52 in benign tumors, and 40.12, 41.21 and 17.77 in malignant tumors. The mean differences between with and without contrast injection for VI, FI and VFI were, respectively, 17.63, 5.07 and 7.45 in benign tumors, and 38.15, 11.88 and 16.55 in malignant tumors. Tumor volume, VI, FI and VFI were not significantly different between benign and malignant tumors before and after echo-contrast medium injection. However, VI, FI and VFI under self-differentiation (differences between with and without contrast injection) were significantly different between malignant and benign tumors.

CONCLUSION

Three-dimensional power Doppler ultrasound is a valuable tool for differential diagnosis of soft-tissue tumors, especially with the injection of an echo-contrast medium.

Measurement and source characteristics of carbonyl compounds in the atmosphere in Kaohsiung city, Taiwan

The concentrations of eighteen atmospheric carbonyls species were measured by the LpDNPH-Cartridge and the microcomputer air sampling device at Nan-Chie (northern part) and Hsiung-Kong (southern part) sites in Kaohsiung city, southern Taiwan. These samples were then analyzed using a high performance liquid chromatography (HPLC). Measurements showed that the highest concentrations of carbonyls were formaldehyde (18.33 and 18.74 microg m(-3)) at the Nan-Chie and Hsiung-Kong site, followed by acetaldehyde (14.90 and 15.71 microg m(-3)). The concentrations of total carbonyls were higher at Hsiung-Kong site (66.96 microg m(-3)) than at Nan-Chie site (60.41 microg m(-3)). The concentrations of total carbonyls at Nan-Chie site (or Hsiung-Kong site) were 74.06 microg m(-3) (89.99 microg m(-3)) in summer and 37.14 microg m(-3) (46.50 microg m(-3)) in winter, due to the fact that photochemical activities are stronger in summer than in winter. The results of principal component analysis (PCA)/absolute principal component scores (APCS) suggest that the primary pollution sources at Nan-Chie were vehicle exhausts (gasoline and diesel engines), stationary emissions (petrochemical and food industry) and restaurant emissions, and the primary pollution sources at Hsiung-Kong were vehicle exhausts (gasoline and diesel engines), stationary emissions (metal assembly and petrochemical industry) and restaurant emissions.

Testicular microlithiasis: analysis of prevalence and associated testicular cancer in Taiwanese men

PURPOSE

To determine the incidence of testicular microlithiasis (TM) in Taiwanese males who were referred for scrotal sonography (US) and to evaluate the association between TM and cancer, with state-of-the-art equipment.

METHODS

This retrospective study included 513 males who underwent scrotal US in a period of 7 months. The US images and charts of each patient were reviewed to determine the presence of TM and note relevant clinical information.

RESULTS

The data for all 513 patients were analyzed. Their age was 0-91 years (mean, 54.3 years). The overall incidence of TM was 14.4% (74/513); 6.2% (32/513) had classic TM, and 8.2% had limited TM. The incidence of testicular cancer in this population was 1.6% (8/513). Six of eight (75%) patients who had testicular cancer at presentation had classic TM or limited TM. There was a significant difference (P < 0.01) between the rate of malignancy in subjects with TM (6/74) and that in subjects without TM (2/439).

CONCLUSION

The incidence of TM in Taiwanese people may be higher than previously reported, which may be due to the difference in methodology and increased awareness of the US findings. Although there was a significant difference in the rate of malignancy in males with TM compared with those without TM, the question remains whether TM independently increases the risk of testicular malignancy.

Magnetic resonance angiography and Doppler scanning for detecting atherosclerotic renal artery stenosis

BACKGROUND

Atherosclerotic renal artery stenosis (ARAS) is a progressive but potentially reversible chronic kidney disease. Although the high sensitivity and specificity of renal Doppler scanning (RDS) for ARAS has been reported in western countries, ARAS has not been detected by RDS. This study used magnetic resonance angiography (MRA) to evaluate the sensitivity and specificity of RDS for detecting ARAS among outpatients at a nephrology clinic, and to calculate the degree of underestimation of ARAS by RDS.

METHODS

A total of 257 outpatients, aged > 50 years were examined for ARAS by RDS and MRA.

RESULTS

Thirty-seven (14.4%) and 139 (54.1%) of 257 patients had stenosis detected by RDS and MRA, respectively. Among the 220 patients whose RDS results were negative, MRA detected stenosis in 111 (50.45%). Multivariate logistic regression analysis showed that age > 65 years, duration of smoking, coronary artery disease, and serum creatinine levels > 354 mmol/L (4 mg/dL) were significant and independent factors that influenced ARAS in patients with negative results by RDS.

CONCLUSION

RDS might still be the diagnostic procedure of choice for screening outpatients for ARAS because it is inexpensive, convenient, able to detect severity, and avoids the use of contrast media. When RDS is negative in aged people who have smoked longer than 20 years, with coronary artery disease or serum creatinine > 4 mg/dL, MRA is recommended for further evaluation of ARAS.

Computer-aided diagnosis of soft-tissue tumors using sonographic morphologic and texture features

RATIONALE AND OBJECTIVES

The aim of this study was to develop a computer-aided diagnosis (CAD) system in assessing the sonographic morphologic and texture features of soft-tissue tumors.

MATERIALS AND METHODS

The retrospective study involved 114 pathology proven cases including 73 benign and 41 malignant soft-tissue tumors. The tumor regions were delineated by an experienced radiologist who was unknown to the pathologic result. Then, we applied 10 morphologic features and 6 gray-level co-occurrence matrix texture features to analyze the tumor regions. To classify the tumors as benign or malignant, we used two methods, a linear discriminant analysis with stepwise feature selection and a multilayer neural network with the back-propagation algorithm as classifiers. The classification performances are evaluated by the area A(z) under the receiver operating characteristic. Furthermore, four radiologists provided malignancy grades for all tumors in the comparison of the CAD system.

RESULTS

In this analysis, the CAD system based on the combination of morphologic and texture feature sets can give the optimal CAD result by LDA with an accuracy of 89.5%, a sensitivity of 90.2%, a specificity of 89.0%, a positive predictive value (PPV) of 82.2%, negative predictive value (NPV) of 94.2%, and A(z) value of 0.96, and by the multilayer perception with an accuracy of 88.6%, a sensitivity of 90.2%, a specificity of 87.5%, a positive predictive value of 80.4%, negative predictive value of 94.2%, and A(z) value of 0.95. The A(z) values of the four radiologists were ranged between 0.74 and 0.86, and the optimal CAD results were shown the highest A(z) values than the four radiologists' rankings.

CONCLUSIONS

This study has shown that performing the CAD system with both morphologic and texture features on sonography, can successfully distinguish between benign and malignant soft-tissue tumors. Moreover, it can also provide a second opinion for the tumor diagnosis and avert unnecessary biopsy.

Measurement and receptor modeling of atmospheric polycyclic aromatic hydrocarbons in urban Kaohsiung, Taiwan

The concentrations of 21 individual polycyclic aromatic hydrocarbons (PAHs) and total suspended particles (TSPs) were measured using high-volume air samplers at Tzuo-Yin and Hsiung-Kong sites in Kaohsiung City, Taiwan, for four seasons from 2005 to 2006. The gaseous and particulate phases of individual PAHs were identified using a gas chromatograph with a flame-ionization detector (GC/FID). Measurements show that the concentrations of total (gas+particulate) PAHs generally followed the seasonal variations of the concentrations of TSP (107.2-117.1 microg m(-3)), being the highest in winter (143.9-182.9 ng m(-3)) and lowest in summer (81.4-95.2 ng m(-3)) at both sites. Most PAH species were low-weight PAHs (approximately 80.8-82.0%), followed by high-weight PAHs (10.5-14.6%) and medium-weight PAHs (6.5-6.8%). The fractions of gaseous PAHs decreased with molecular weight or ring number. The particle phase (60.2(73.5%) dominated the high-weight PAHs. Results of receptor model show that industrial combustions (49.1-63.7%) contributed most to ambient PAHs, followed by restaurant emissions (18.4-39.7%) and mobile sources (11.3-22.8%) at the Tzuo-Yin site. At the Hsiung-Kong, mobile sources (49.5-63.3%) contributed most to ambient PAHs, followed by restaurant emissions (19.8-36.6%) and industrial combustions (13.7-27.1%). The differences in the results at the two sites are mainly attributed to the different industries at each site.

Differentiation of benign and malignant superficial soft-tissue masses using grayscale and color doppler ultrasonography

BACKGROUND

This study was performed to evaluate the usefulness of high-resolution grayscale and color Doppler ultrasound to distinguish benign from malignant soft-tissue masses on the basis of ultrasonographic patterns.

METHODS

We enrolled 398 female and 420 male patients aged 1-104 years (mean, 49.8 years). All presented with a palpable nodule or mass located superficially in the body. Each lesion was examined by grayscale and color Doppler ultrasonography to assess its echogenicity, margin, shape, composition, acoustic transmission, size and other patterns. Spectral Doppler was applied in lesions with positive color flow signals. The nature of all masses was confirmed by aspiration cytology, biopsy, surgical pathology or long-term clinical follow-up.

RESULTS

There were a total of 693 benign and 125 malignant masses. Five malignant and 14 benign histologies (including 6 types with inflammation-related, hematoma or pseudoaneurysm) occurred that had more than 10 subjects with each histology. Eight benign histopathologies included cysts, neoplasms, vascular and miscellaneous. Five malignant histologies included metastases, osteogenic sarcomas, lymphomas, malignant fibrous histiocytomas and liposarcomas. There were significant differences (p < 0.05) between the benign and malignant soft-tissue tumors in terms of parameters including tumor margin, shape and size. Benign lesions did not have infiltrated margins or a scalloped shape and malignant tumors tended to be large. However, there was no significant difference (p > 0.05) between the benign and malignant soft-tissue tumors in terms of echogenicity, composition and color Doppler features.

CONCLUSION

Ultrasonography with color Doppler imaging is a good modality for characterizing most soft-tissue masses, and tumor size > 5 cm and having infiltrated margin highly suggests malignancy.

Ultrasonographic and MR findings of alveolar soft part sarcoma

Alveolar soft part sarcoma (ASPS) is a rare soft-tissue sarcoma, commonly occurring in children and adolescents. The tumor mostly involves the lower extremities. The prognosis of the patient depends on whether there is metastasis. We present a 19-year-old female with ASPS in her right lower leg. Grayscale and color Doppler ultrasound showed a well-defined hypoechoic lesion with hypervascularity and very low resistive index (RI). Magnetic resonance imaging revealed iso signal intensity to muscle on T1-weighted images, high signal intensity to muscle on T2-weighted images with signal voids, and good enhancement after gadolinium administration. In a mass with hypervascularity and very low RI on sonography and hypervascularity with flow voids on magnetic resonance imaging, ASPS should be considered.

Influence of rice straw burning on the levels of polycyclic aromatic hydrocarbons in agricultural county of Taiwan

Atmospheric particulate and polycyclic aromatic hydrocarbons (PAHs) size distribution were measured at Jhu-Shan (a rural site) and Sin-Gang (a town site) in central Taiwan during the rice straw burning and non-burning periods. The concentrations of total PAHs accounting for a roughly 58% (34%) increment in the concentrations of total PAHs due to rice-straw burning. Combustion-related PAHs during burning periods were 1.54-2.57 times higher than those during non-burning periods. The mass median diameter (MMD) of 0.88-1.21 microm in the particulate phase suggested that rice-straw burning generated the increase in coarse particle number. Chemical mass balance (CMB) receptor model analyses showed that the primary pollution sources at the two sites were similar. However, rice-straw burning emission was specifically identified as a significant source of PAH during burning periods at the two sites. Open burning of rice straws was estimated to contribute approximately 6.3%-24.6% to total atmospheric PAHs at the two sites.

Effects of open burning of rice straw on concentrations of atmospheric polycyclic aromatic hydrocarbons in central Taiwan

The sizes and concentrations of 21 atmospheric polycyclic aromatic hydrocarbons (PAHs) were measured at Jhu-Shan (a rural site) and Sin-Gang (a town site) in central Taiwan in October and December 2005. Air samples were collected using semi-volatile sampling trains (PS-1 sampler) over 16 days for rice-straw burning and nonburning periods. These samples were then analyzed using a gas chromatograph with a flame-ionization detector (GC/FID). Particle-size distributions in the particulate phase show a bimode, peaking at 0.32-0.56 microm and 3.2-5.6 microm at the two sites during the nonburning period. During the burning period, peaks also appeared at 0.32-0.56 microm and 3.2-5.6 microm at Jhu-Shan, with the accumulation mode (particle size between 0.1 and 3.2 microm) accounting for approximately 74.1% of total particle mass. The peaks at 0.18-0.32 microm and 1.8-3.2 microm at Shin-Gang had an accumulation mode accounting for approximately 70.1% of total particle mass. The mass median diameter (MMD) of 3.99-4.35 microm in the particulate phase suggested that rice-straw burning generated increased numbers of coarse particles. The concentrations of total PAHs (sum of 21 gases + particles) at the Jhu-Shan site (Sin-Gang site) were 522.9 +/- 111.4 ng/ml (572.0 +/- 91.0 ng/ml) and 330.1 +/- 17.0 ng/ml (or 427.5 +/- 108.0 ng/ml) during burning and nonburning periods, respectively, accounting for a roughly 58% (or 34%) increase in the concentrations of total PAHs due to rice-straw burning. On average, low-weight PAHs (about 87.0%) represent the largest proportion of total PAHs, followed by medium-weight PAHs (7.1%), and high-weight PAHs (5.9%). Combustion-related PAHs during burning periods were 1.54-2.57 times higher than those during nonburning periods. The results of principal component analysis (PCA)/absolute principal component scores (APCS) suggest that the primary pollution sources at the two sites are similar and include vehicle exhaust, coal/wood combustion, incense burning, and incineration emissions. Open burning of rice straw was estimated to contribute approximately 5.0-33.5% to the total atmospheric PAHs at the two sites.

Differentiation between schwannomas and neurofibromas in the extremities and superficial body: the role of high-resolution and color Doppler ultrasonography

OBJECTIVE

The purpose of this study was to verify whether high-resolution and color Doppler ultrasonography could distinguish schwannomas from neurofibromas.

METHODS

Seventy-six tumors in 71 patients were included in this study. There were 46 patients (50 tumors) with schwannomas and 25 patients (26 tumors) with nondiffuse neurofibromas in the extremities or superficial parts of the body. Ultrasonographic examinations were performed in all patients. The tumor size, shape, location, internal echogenicity, posterior acoustic phenomenon (eg, shadowing or enhancement), capsule, relationship with the adjacent nerve, and presence of cystic components were documented. Color Doppler studies (75 lesions) and spectral Doppler studies (44 lesions) were performed. All data were analyzed with statistical software to check the significance.

RESULTS

Both tumors presented as well-defined hypoechoic nodules on ultrasonography. They were oval or lobulated, showed posterior acoustic enhancement, and were hypervascular on color Doppler ultrasonography. There was no significant difference with respect to ultrasonographic morphologic characteristics. The rates of centric, eccentric, and undetermined associations with nerves were 40%, 20%, and 40% in the schwannomas and 46.2%, 0%, and 53.8% in the neurofibromas, respectively, showing a significant difference (P = .032). There was no significant difference in the chance of cystic changes between the schwannomas (30%) and neurofibromas (23%).

CONCLUSIONS

No ultrasonographic finding (gray scale, color Doppler, or spectral analysis) allows differentiation between neurofibromas and schwannomas of the extremities. A nerve eccentrically entering a mass was seen only in schwannomas, and that may allow differentiation between neurofibromas and schwannomas.

Spontaneous rupture with pseudoaneurysm formation in a nodular goiter presenting as a large neck mass

Acute airway obstruction caused by goiter hemorrhage is a rare but potentially life-threatening condition. We report a case of nodular goiter in which spontaneous rupture with active bleeding developed suddenly, presenting as a large neck mass with dyspnea. Sonographic examination revealed a large inhomogeneous soft tissue mass in the left thyroid lobe containing some hypoechoic areas. Color Doppler and spectral Doppler analysis were consistent with a large hematoma and pseudoaneurysm, which was subsequently confirmed at surgery.

Sonographic features of nonpalpable breast cancer: a study based on ultrasound-guided wire-localized surgical biopsies

The purpose of this study is to investigate the correlation between surgicopathological findings and ultrasonic images of nonpalpable breast lesions. The study was composed of 220 nonpalpable breast lesions from 193 patients. The breast lesions were classified into soft tissue type (185 lesions) and calcification type (35 lesions). Of the 220 lesions, 62 (28%) were malignant. For soft tissue type lesions, the sonographic features of sound attenuation (p < 0.001) and irregular border (p < 0.001) were significantly associated with the malignant diagnosis. For soft tissue-type and calcification-type lesions, the presence of increased vascularity (p < 0.001) or calcification (p < 0.001) was significantly associated with the malignant diagnosis. Of the 164 breast lesions with corresponding mammograms, 37 of 74 mammographically identifiable lesions were pathologically malignant, as compared with 16 of 90 lesions with negative mammograms (p < 0.001). In our study, the more sensitive sonographic features for predicting malignancy were irregular border and increased vascularity (sensitivity 88% and 82%, respectively), whereas the features of sound attenuation and presence of calcifications were more specific (specificity 88% and 80%, respectively). In conclusion, ultrasound-guided wire localization of breast lesions is not only useful in assisting surgical biopsy, but the sonographic findings obtained by this procedure correlate with pathologic diagnosis.

Interventional procedures in superficial lesions: the value of 2D with additional coronal reformatted 4D ultrasonography guidance

Objective

We wanted to assess the usefulness of four-dimensional (4D) ultrasonography (US), i.e., real-time three-dimensional US, as an adjunct for performing various US-guided interventional procedures in superficial lesions.

Materials and Methods

Thirty-three patients were referred for US-guided interventional procedures for superficial lesions, including core biopsy in 19, fine-needle aspiration in eight, therapeutic drug injection in four and needle puncture in two. The procedures were performed under 4D US guidance. We reviewed the pathologic/cytologic results of the core biopsies or needle aspirations, and also the outcomes of drug injection or needle puncture.

Results

For all the patients who underwent 4D US-guided core biopsy, the specimens were adequate for making the pathological diagnosis, and specimens were successfully obtained for those patients who underwent 4D US-guided aspiration. The patients treated with 4D US-guided therapeutic drug injection or needle puncture had a good response. No major procedure-related complications occurred. The procedural times were similar to those procedural times with using two-dimensional US.

Conclusion

Combining the two dimensional and 4D US techniques aids the physician when performing US-guided interventional procedures for the superficial lesions.

Apolipoprotein E, angiotensin-converting enzyme and kallikrein gene polymorphisms and the risk of Alzheimer's disease and vascular dementia

Lipoproteins and vascular factors may play roles in the development of Alzheimer's disease (AD) and/or vascular dementia (VaD). In this study, odd ratios (ORs) and 95% confidence intervals (CIs) for apolipoprotein E (APOE), angiotensin-converting enzyme (ACE), and kallikrein (KLK1) polymorphisms were computed to test their association with the disease by a case-control study. The risk of AD was significantly increased for individuals with APOE varepsilon4 allele (OR = 3.73, 95% CI = 2.38-5.98). The risk of AD was also significant for people with ACE DD genotype, D allele, or T-D haplotype [OR (95% CI) = 4.29 (1.96-10.23), 1.90 (1.35-2.70), or 2.91 (1.71-5.10), respectively]. The above association between ACE-VaD was also strong (p = 0.0012, 0.0050, 0.0007, respectively). Reporter constructs containing the -240 A or T allele displayed similar transcriptional activity in both HEK-293 and IMR-32 cells. Thus, another putative pathogenic marker that is linked with the Alu D allele might affect the risk of AD and VaD in Taiwan.