Urban-rural and regional differences in infant mortality in Taiwan

We analyzed data from death certificates for all infant deaths in Taiwan from 1981 to 1988. During this 8-year period, the crude infant mortality rate decreased from 8.9 to 5.3 per 1000 live births. Deaths due to infectious diseases, which constituted a major fraction of this mortality, also declined from 3.4 to 1.2 per 1000 live births. While infant deaths due to nearly all causes declined, deaths due to injury and accidents rose from 0.62 to 0.71 per 1000 live births, and the sudden infant death rate rose from 0.13 to 0.46. Notable geographic differences included a high death rate in the small islands off the coast and in the eastern mountainous counties (9.1-11.2/1000 live births); this rate was twice that in Taipei (4.5/1000 live births). In addition, the level of urbanisation was also an important determinant of death rate; urban areas had much lower rates than rural areas. The highest rate (15.4) was persistently observed in the rural areas where the aboriginal tribes reside. This differential rate between urban and rural areas was most prominent for the vaccine-preventable diseases; the aboriginal areas had rates that were 12.9 times those in the cities. Moreover, since neonatal deaths are severely under-reported in Taiwan, especially in less urbanized areas, our data presumably underestimate the urban-rural health differences. Our findings identify high risk areas for various causes of infant death, and indicate that more targeted intervention such as improving education and health care as well as environmental hygiene in some specific areas may be warranted.

[Preparation and antigenic characterization of rat monoclonal antibodies against hemorrhagic fever with renal syndrome virus]

11 hybridoma cell lines secreting monoclonal antibodies (McAbs) against hemorrhagic fever with renal syndrome virus (HFRSV) were obtained in our laboratory by immunizing LOU/C rats with HFRSV Chen strain. These rat McAbs were characterized by radio-immunoprecipitation and western blotting methods, 2 directed against glycoprotein G2, 9 against nucleocapsid protein (NP) of HFRSV. The results of neutralization (NT) and hemagglutination inhibition(HI) test showed that most of the McAbs specific for NP had neither NT nor HI activities, but 2 had obvious NT and/or HI activities. It was suggested that there may be some neutralizing and hemagglutinating determinants on NP of HFRSV. Two McAbs to G2 had HI or/and NT activities. These date indicated that distinct neutralizing and hemagglutinating epitopes were located on the G2. Comparative antigenic analysis of 20 strains of HFRSV was carried out by immune horseradish peroxidase technique using 11 anti-HFRSV rat McAbs. It was found that these McAbs can be classified into group, subgroup, apodemus type and subtype specificity to HFRSV.

Cytomegalovirus is not specifically associated with immunoglobulin A nephropathy

Cytomegalovirus (CMV) has been suspected to be involved in the pathogenesis of IgA nephropathy (IgAN). Whether CMV is present in renal tissue of IgAN, however, remains controversial. To determine the presence of CMV in IgAN, compared with other glomerulonephritis (GN) as disease control, polymerase chain reaction amplifying a 159-base-pair fragment of the immediate early gene of CMV and indirect immunofluorescence staining with anti-CMV monoclonal antibody were performed on 10 IgAN and 14 non-IgAN GN renal tissues. CMV DNA was detected in 6 of 10 IgAN tissues and 10 of 14 other GN by polymerase chain reaction, whereas no CMV antigen was detected in all renal tissues by immunofluorescence. This frequent observation of CMV DNA in various types of GN as well as in IgAN would suggest that CMV is not specifically associated with the pathogenesis of IgAN seen in endemic areas of CMV infection.

Clinical value of DMSA planar and single photon emission computed tomography as an initial diagnostic tool in adult women with recurrent acute pyelonephritis

Routine DMSA scintigraphy, ultrasound (US) of the kidney, intravenous pyelography (IVP) and voiding cystoureterography (VCU) were performed in 27 consecutive adult women with recurrent acute pyelonephritis (APN) during a 12-month follow-up. Both planar and single photon emission computed tomography (SPECT) images were obtained for DMSA scan. DMSA scans were repeated in those patients with abnormal initial scan. DMSA-SPECT showed normal findings in 2, single renal cortical detect (RCD) in 9 and multiple RCD in 16 (including nonvisualization in 2). Of the 11 kidneys with normal findings or single RCD on DMSA-SPECT, only 1 (9%) showed vesicoureteral reflux (VUR) on VCU (grade I). A large proportion of those with multiple RCDs showed abnormal findings on IVP (44%, 7/16), US (38%, 6/16) or VCU (31%, 5/16); 63% in any of these three studies. 5 of 6 patients with VUR had multiple RCDs on DMSA-SPECT, and 3 of these 5 showed no abnormality on IVP or US. 7 patients who needed other managements besides initial standard antibiotic treatment had multiple RCDs on DMSA-SPECT. 15 normal women were also studied and showed normal DMSA-SPECT, US and IVP, in all cases. Follow-up DMSA-SPECT was done in 16 patients (7 with single RCD, 9 with multiple RCD). All 7 patients with single RCD showed improvement, in those with multiple RCDs improvement was observed in 2, no change in 7 on follow-up studies. We conclude: (1) DMSA-SPECT is a useful initial diagnostic tool in adult women with recurrent APN to identify patients who need more extensive radiological studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification and characterization of human hepatic stimulator substance

Human hepatic stimulator substance (hHSS) was purified from fetal liver with 6,000-fold decrease in protein content and 840-fold increase in specific growth stimulative activity. Purification procedures included the heating of a homogenate in 35% (W/V) Tris-HCL at 95 degrees C for 20 min, high and ultra speed centrifugation, passage over Sephadex G100 gel filtration, DEAE-cellulose ion exchange, TSK G3000 SWG high performance liquid chromatography (HPLC) and YWG C-18 reverse phase HPLC techniques. The most purified material (HP-HSS) revealed cell-specific and dose dependent increase in 3H-TdR incorporation into cellular DNA. As little as 38 ng of the HP-HSS per ml of culture medium produced a 2.5-fold increase in DNA synthesis. Further studies indicate that HP-HSS in combination with insulin and epidermal growth factor stimulate DNA synthesis 16-fold compared with serum and hormone free controls and nearly 3-fold over hepatoma growth with HP-HSS alone. Sodium dedecyl sulfate polyacrylamide gel electrophoresis with silver stain and ultrascan XL laser densitrometer quantitative scanning revealed only one band at 12,800.

Causes and consequences of increase in child survival rates: ethnoepidemiology among the Hmong of Thailand

The Hmong "hill tribe" minority in Thailand has much higher exposure to factors usually associated with risk of child mortality (high fertility, low status of women, low education, less use of modern medical care for births, exposure to warfare, economic and physical disruption, and poor hygienic conditions) than the rural ethnic Thai population. Nonetheless, infant mortality has declined from over 120 per 1000 to under 50 per 1000 live births among both these populations in the past 30 years. The reason for the rapid increase in child survival among the Hmong appears to be better access to and more use of modern curative and preventive medical care associated with road construction rather than major changes in social or hygienic conditions. Conventional wisdom suggests that high fertility is both a cause and a consequence of high infant and child mortality and that parents will not reduce fertility until they see that mortality has declined. Most Hmong parents recognize the decline in child mortality and attribute it to better access to modern medical care. Most Hmong parents also say that, if they were starting to have children now, they would want to have fewer children. Fear of child death is infrequently mentioned as a motive for having more children, and the perceived decline in child mortality is rarely mentioned as a reason for reduced fertility. Most Hmong parents explain their desired family size in terms of economic conditions rather than perceived risk of child mortality. Results of this study suggest that fertility and child mortality can vary independently of one another and that major reductions in child mortality can be accomplished without waiting for major social changes (e.g., improved education or status of women) or major reductions in fertility.

Hepatic stimulator substance from human fetal liver for treatment of experimental hepatic failure

The authors previously reported the successful reversal of lethal D-Gal induced hepatic necrosis in rats by human hepatic stimulator substance (hHSS), a liver specific growth factor partially purified from human fetal liver cells, which promoted hepatocyte proliferation. In this study, they further investigated the mechanism of hHSS in improving survival of experimental acute hepatic failure. Our results demonstrated that the level of alanine transaminase and endotoxin in the plasma and lipid peroxides in the liver of chemically poisoned rats were reduced by hHSS to different extent at different periods of observation compared with the saline control group. The apparent recovery of liver function and the increase of 3H-TdR incorporation into hepatic DNA correlated with the morphologic changes observed under light and electron microscopes, showing that the damages inflicted on the cellular and subcellular structure in the liver of hHSS-treated rats were greatly alleviated and rapidly repaired. Therefore, hHSS, which can prevent liver deterioration and promote hepatocyte regeneration, may be a new hepatic stimulator factor readily available for clinical use.

Recall of AIDS public service announcements and their impact on the ranking of AIDS as a national problem

The efficacy of two public service announcements from Phase V of the "America Responds to AIDS" (ARTA) campaign was assessed at two sites. Participants were randomly assigned to view a local news program, one with an ARTA public service announcement appearing six times and the other with no AIDS public service announcements. During telephone interviews with 907 participants 1 to 3 nights after viewing, 21% at Site A and 59% at Site B could correctly recall the ARTA public service announcements. Absolute mentions of AIDS as an important national issue increased.

Therapeutic effect of guar gum in patients with non-insulin-dependent diabetes mellitus

Diets with a high-fiber content have been shown to produce some beneficial effects on metabolic factors in subjects with NIDDM. However, some controversies still exist. In this report, the long-term effect of guar gum (Guarina) on both glycemic and blood lipid profiles was assessed in a randomized, double-blind and cross-over study on 16 (seven male and nine female) subjects with NIDDM. Each subject received placebo (P) and Guarina (G) treatment for two eight-week periods separated by a four-week period to facilitate wash-out. Fasting plasma glucose levels showed significant improvement during G treatment but not during P treatment (151.7 +/- 7.9 vs 168.6 +/- 12.2 mg/dl, p less than 0.01 by paired Student's t test). Hemoglobin Alc levels decreased significantly during G treatment but not during P treatment (6.9 +/- 0.2 vs 7.2 +/- 0.8%, p less than 0.001). Fasting insulin concentrations also showed significant lowering during G treatment but not during P treatment (18.3 +/- 2.1 vs 23.1 +/- 2.9 U/ml, p less than 0.005). Other variables, including serum total cholesterol, triglyceride, HDLc, LDLc, sodium, potassium, chloride, magnesium and calcium levels showed no significant changes during G or P treatment. Ten out of the 16 patients (62.5%) suffered from side effects; these included abdominal cramps (one case), diarrhea (seven cases) and skin itching (one case). In conclusion, guar gum effectively lowers fasting plasma glucose and HbAlc levels in subjects with NIDDM. Hyperinsulinemia could also be ameliorated. The effectiveness and side effects of guar gum treatment should be cautiously evaluated in each NIDDM subject.

Effects of Hantaan virus on human endothelial cells and their significance in pathogenesis of hemorrhagic fever with renal syndrome

The effects of Hantaan virus (HTNV) on human endothelial cells (HECs) were investigated both in vivo and in vitro. The 76-118 strain or SR-11 strain of HTNV were inoculated into HECs monolayers respectively, and the virus antigens could be detected on the seventh day of the first passage after inoculation by immunofluorescent technique. The HTNV could also be isolated through cultures of Vero E-6 cells. HTNV particles and inclusion bodies together with various changes in the organelles were observed in the infected cells by transmission electronic microscopy (TEM), and the immunoenzyme positive virus particles were seen by immunoelectronic microscopy. Samples of skin biopsy were individually obtained from 14 cases of hemorrhagic fever with renal syndrome on the second to the fifth day after the onset of the illness. It was found that HTNV antigens were widely distributed in the cytoplasm of endothelial cells of the samples from 5 out of 14 cases by avidin-biotin-peroxidase complex staining, and morphologic changes of the endothelial cells similar to those observed in vitro, were also seen by TEM. The results indicated that HEC is one of the target cells susceptible to HTNV. The virus could invade and propagate in HECs, and could induce damage to the latter.

Localization and changes of hemorrhagic fever with renal syndrome virus in lymphocyte subpopulation

Double-labeled immunocytochemistry was used for studying the localization and distribution of hemorrhagic fever with renal syndrome virus (HFRSV) antigen in the peripheral blood lymphocyte subpopulations in HFRS patients and the quantitative changes of these subpopulations. It was found that HFRSV might infect different subpopulations of lymphocytes. The infection rate of B cells (31.3%) was significantly higher than that of T cells (8.5%), and the infection rate of CD8+ subpopulation (10.5%) was significantly higher than that of CD4+ subpopulation (6.1%). The infection rates of HLA-DR+ cells and Tac+ cells were 2.5% and less than 0.5%, respectively. From febrile to oliguric stage, the number of CD8+ cells increased gradually, leading to a decrease and reverse of CD4/CD8 ratio, while the number of CD4+ cells remained almost unchanged. The appearance and disappearance of HFRSV in lymphocytes were closely associated with the dynamic changes of CD4/CD8 ratio and HLA-DR and Tac expressions. The results suggested that there were certain differences in HFRSV infectivity of different lymphocyte subpopulations, which might be due to the disorders of immunoregulation and immunopathology of HFRS.

Human hepatic regenerative stimulator substance: partial purification and biological characterization of hepatic stimulator substance from human fetal liver cells

Current support or replacement therapies for fulminant acute hepatic failure are frequently very disappointing. In this study, human hepatic stimulator substance--a liver-specific growth factor--was partially purified from human fetal liver cells and characterized by its biological effects. Almost 70-fold protein content was purified with an approximately 80-fold increase in specific growth stimulator activity. Human hepatic stimulator substance proved to be heat-stable, protease-sensitive, organ-specific and species-nonspecific. Human hepatic stimulator substance produced a two- to threefold increase of 3H-thymidine incorporation into hepatic DNA when injected intraperitoneally into growing weanling mice (nonhepatectomized) or regenerating rats (34% hepatectomy). The effects of hHSS in reversing the lethality of D-galactosamine (1.6 gm/kg body weight)-induced hepatic necrosis in rats were further evaluated. A survival rate of 4% (n = 24), 41% (n = 12, p less than 0.05), 33% (n = 12, p less than 0.05), 31% (n = 13, p less than 0.05) and 18% (n = 11, p greater than 0.05) was observed when the rats were injected with 4 ml of saline intraperitoneally, 4 ml of human intact fetal hepatocytes (2.4 x 10(8] intraperitoneally, 4 ml of human hepatic stimulator substance intraperitoneally, 2 ml of twofold concentrated human hepatic stimulator substance intravenously and 1 ml of fourfold human hepatic stimulator substance intramuscularly, respectively, 20 hr after poisoning.(ABSTRACT TRUNCATED AT 250 WORDS)

[The study on the orthodontic patients who visited department of orthodontics, Seoul National University Hospital]

From 1965 to 1974, the total number of the orthodontic patients who visited Seoul National University Hospital was only about 1000. But in the last several years the number has been increasing so rapidly that we have about 1000 new orthodontic patients every year. This made it necessary to undertake an epidemiologic study on them so that we can accommodate their orthodontic needs adequately. Accordingly, the present study was done in an attempt to provide reliable quantitative information regarding the characteristics of malocclusion-Angle's classification etc.--of patients who visited Department of Orthodontics, Seoul National University Hospital from 1985 to 1989. The total number was 3305. This study sought to determine the annual trend in total number during 5 years, frequency in each age and sex group and distribution according to Angle's classification. It was found that: 1. Total number of orthodontic patients has been increasing and the number of female patients was 1.55 times as high as that of male. 2. Percentage of Class III malocclusion has been increasing, but that of Class I decreasing. Each percentage of Class I, Class II div. 1, Class II div. 2 and Class III was 35.92%, 13.40%, 1.54%, and 49.14%. 3. Percentages of 8 to 12-year-old group and 12 to 18-year-old group showed decreasing trends, but that of adult patients showed increasing trend.

Abnormalities of T cell immunoregulation in hemorrhagic fever with renal syndrome

The functions of spontaneous suppressor T cells and T lymphocyte subsets in patients with hemorrhagic fever with renal syndrome were compared. In the early stages of disease, decreased activity of spontaneous suppressor T cells was concurrent with increased numbers of CD8+ cells and a reversed CD4:CD8 ratio. These changes were related to abnormalities in serum C3 level and circulating immune complexes. In the recovery stages of the illness, spontaneous suppressor T cell activity and T cell subsets returned to normal levels.

[Soft X-ray study on fetal cranio-facial growth and development]

This study was undertaken to ascertain the changes of fetuses in craniofacial dimension and to evaluate the growth and development during fetal period. Lateral cephalograms by soft X-ray were taken from 64 fetuses and were measured in linear and angular aspects. The following conclusions were obtained. 1. The linear increase rates of anterior cranial base length exceeded those of the posterior cranial base length. 2. Growth increments on horizontal dimension were greater than vertical dimension in the maxilla. 3. The cranial base angle was almost constant after fetal period 13 weeks with the average angle of 130 degrees. 4. The angle between anterior cranial base and palatal plane was decreased gently during fetal period.

The distribution and duration of hantaan virus in the body fluids of patients with hemorrhagic fever with renal syndrome

The distribution and duration of Hantaan virus (HTNV) in the body fluids of patients were studied by immunofluorescence, reverse passive hemagglutination, and cell culture assays. Virus antigen of hemorrhagic fever with renal syndrome in peripheral blood mononuclear cells (PBMCs) was usually present before day 11 of the disease, especially from days 4-7. Virus isolates were more readily recovered from plasma early in the course of the illness and less frequently after day 7. The use of PBMCs rather than plasma enabled isolates to be recovered at a rate nearly twice that permitted by plasma and allowed the isolation peak of HTNV (days 4-7 after onset of disease) to extend an additional 2 or 3 d, thus prolonging the period of detectable viremia until days 8-11. PBMCs were especially useful in isolating viruses from patients with hemorrhagic fever with renal syndrome in whom antibody titers were generally high during the acute phase of the disease. HTNV was isolated from the cerebrospinal fluid of patients, but was difficult to recover from other body fluids.

The duration of viremia patients with epidemic hemorrhagic fever

The duration of viremia in patients with epidemic hemorrhagic fever (EHF) was studied using immunofluorescence technique and cell culture assays. The duration of virus in plasma of EHF patients was about 1 week, which was concomitant with the febrile phase of the disease. Comparatively, the separation rate of viruses in peripheral blood mononuclear cells (PBMC) was greater (1.8 times) than in plasma, while the detected peak of EHF (in 4-7 days after onset of the disease) was found to be 2 or 3 days less than that of plasma, thus the detectable viremia was prolonged until the 8th to 11th day of the disease. High titre EHF antibody of IgG, TgM was unable to neutralize the virus in human blood. The results revealed that a blood-cell-associated prolonged viremia is one of the characteristics of EHF infection.