Functional link between ataxia-telangiectasia and Nijmegen breakage syndrome gene products

Ataxia-telangiectasia (A-T) and Nijmegen breakage syndrome (NBS) are recessive genetic disorders with susceptibility to cancer and similar cellular phenotypes. The protein product of the gene responsible for A-T, designated ATM, is a member of a family of kinases characterized by a carboxy-terminal phosphatidylinositol 3-kinase-like domain. The NBS1 protein is specifically mutated in patients with Nijmegen breakage syndrome and forms a complex with the DNA repair proteins Rad50 and Mrel1. Here we show that phosphorylation of NBS1, induced by ionizing radiation, requires catalytically active ATM. Complexes containing ATM and NBS1 exist in vivo in both untreated cells and cells treated with ionizing radiation. We have identified two residues of NBS1, Ser 278 and Ser 343 that are phosphorylated in vitro by ATM and whose modification in vivo is essential for the cellular response to DNA damage. This response includes S-phase checkpoint activation, formation of the NBS1/Mrel1/Rad50 nuclear foci and rescue of hypersensitivity to ionizing radiation. Together, these results demonstrate a biochemical link between cell-cycle checkpoints activated by DNA damage and DNA repair in two genetic diseases with overlapping phenotypes.

Long-term effects of azathioprine therapy for juvenile rheumatoid arthritis

BACKGROUND AND PURPOSE

Juvenile rheumatoid arthritis (JRA) can result in disability, growth disturbance, and systemic complications. This study investigated the efficacy and adverse effects of azathioprine (AZA) therapy in children with JRA.

METHODS

Data from the medical records of 24 children with JRA treated with oral AZA during the period from 1988 to 1998 were retrospectively analyzed. All 24 patients had received two or more nonsteroidal anti-inflammatory drugs (NSAIDs) and 12 had received disease-modifying antirheumatic drugs (DMARDs) prior to the start of AZA. Of the 24 patients, 21 were corticosteroid-dependent prior to the onset of AZA therapy. The indication for AZA therapy was lack of efficacy of the current treatment regimen. The initial and maximal doses of AZA averaged 1.7 mg.kg-1.d-1 (range, 1-3 mg. kg-1.d-1) and 1.9 mg.kg-1.d-1 (range, 1-6 mg.kg-1.d-1), respectively. The mean duration of treatment was 13 months (range, 4-37 mo). The mean duration of follow-up was 45 months (range, 7-137 mo) from the start of AZA therapy.

RESULTS

Fifteen children (62.5%) showed clinical improvement, while the other nine (37.5%) achieved clinical remission. AZA treatment resulted in a more than 50% reduction in the required corticosteroid dose in seven children and complete discontinuation of corticosteroid administration in eight children. None of the patients treated with AZA doses of 1 to 3 mg.kg-1.d-1 developed AZA-related side-effects. Two patients suffered from AZA-related adverse effects due to AZA overdose (6 mg.kg-1.d-1). Both experienced pancytopenia and disseminated infection, which resolved following reduction of the AZA dose to 3 mg.kg-1.d-1.

CONCLUSIONS

AZA is an effective and well-tolerated steroid-sparing agent for JRA refractory to NSAIDs or DMARDs.

Cyanosis caused by a huge obstructive right ventricular fibroma

Cardiac fibromas are rare lesions which occur more often in infants and children than in adults. These tumors are benign proliferations of connective tissue most often found in the left ventricular myocardium or septum. In an 8-month-old infant with cyanosis and progressive exertional dyspnea, a huge cardiac tumor obstructing the right ventricular outflow tract (RVOT) was diagnosed by means of 2-dimensional echocardiography and cardiac catheterization. At surgery, a whitish gray solitary tumor measuring 5.0 x 4.5 cm could be well visualized. It was nearly totally resected, and the RVOT was reconstructed with an Equine pericardial patch. Histologic examination classified the tumor as a fibroma. Although surgical mortality in cardiac fibroma with RVOT obstruction is extremely high, early diagnosis and prompt excision of the tumor is mandatory in relieving its dangerous symptoms.

Insulin sensitivity in normotensive offspring of hypertensive parents

OBJECTIVES

To investigate the insulin sensitivity in normotensive offspring of hypertensive parents.

SUBJECTS

Fifteen young normotensive offspring of hypertensive parents were paired with 15 controls matched for age, sex and body mass index.

METHODS

The insulin sensitivity was investigated by 75 g oral glucose tolerance test (OGTT) and modified insulin suppression test. A high-fat mixed meal was administered to observe the changes of TG levels.

RESULTS

The plasma glucose and serum insulin responses to oral glucose challenge were comparable between both groups. High-fat mixed meal made no difference in the plasma glucose, serum triglyceride or insulin between the 2 groups. With the modified insulin suppression test, the steady-state plasma glucose levels (SSPG) were higher in the offspring of parents with essential hypertension (138+/-43 mg/dl) than in the control group (95+/-26 mg/dl). The diastolic blood pressure and heart rate of the offspring of hypertensive parents are also higher than the control group.

CONCLUSIONS

Insulin resistance exists in young normotensive offspring of hypertensive parents, and the impairment of insulin-mediated glucose uptake in these subjects develop before any alteration of fasting and postprandial triglyceride.

Vanidipinedilol: a vanilloid-based beta-adrenoceptor blocker displaying calcium entry blocking and vasorelaxant activities

Calcium channel and beta-adrenoceptor blockade have proved highly useful in antihypertensive therapy. Studies of the mechanisms of action of vanidipinedilol that combine these effects within a single molecule are described here. Intravenous injection of vanidipinedilol (0.1, 0.25, 0.5, 1.0, and 2.0 mg/kg) produced dose-dependent hypotensive and bradycardic responses, significantly different from nifedipine-induced (0.5 mg/kg, i.v.) hypotensive and reflex tachycardic effects in pentobarbital-anesthetized Wistar rats. A single oral administration of vanidipinedilol at doses of 10, 25, and 50 mg/kg dose-dependently reduced blood pressure with a decrease in heart rate in conscious spontaneously hypertensive rats (SHRs). In the isolated Wistar rat atrium, vanidipinedilol (10(-7), 10(-6), and 10(-5) M) competitively antagonized the (-)isoproterenol-induced positive chronotropic and inotropic effects and inhibited the increase in heart rate induced by Ca2+ (3.0-9.0 mM) in a concentration-dependent manner. The parallel shift to the right of the concentration-response curve of (-)isoproterenol and CaCl2 suggested that vanidipinedilol possessed beta-adrenoceptor-blocking and calcium entry-blocking activities. On tracheal strips of reserpinized guinea pig, cumulative doses of vanidipinedilol (10(-10) to 3x10(-6) M) produced dose-dependent relaxant responses. Preincubating the preparation with ICI 118,551 (10(-10), 10(-9), 10(-8) M), a beta2-adrenoceptor antagonist, shifted the vanidipinedilol concentration-relaxation curve significantly to a region of higher concentrations. These results implied that vanidipinedilol had a partial beta2-agonist activity. In the isolated thoracic aorta of rat, vanidipinedilol had a potent effect inhibiting high-K+-induced contractions. KCI-induced intracellular calcium changes of blood vessel smooth muscle cell (A7r5 cell lines) determined by laser cytometry also was decreased after administration of vanidipinedilol (10(-8), 10(-7), 10(-6) M). Furthermore, the binding characteristics of vanidipinedilol and various antagonists were evaluated in [3H]CGP-12177 binding to ventricle and lung and [3H]nitrendipine binding to cerebral cortex membranes in rats. The order of potency of beta1- and beta2-adrenoceptor antagonist activity against [3H]CGP-12177 binding was (-)propranolol (pKi, 8.59 for beta1 and 8.09 for beta2) > vanidipinedilol (pKi, 7.09 for beta1 and 6.64 for beta2) > atenolol (pKi, 6.58 for beta1 and 5.12 for beta2). The order of potency of calcium channel antagonist activity against [3H]nitrendipine binding was nifedipine (pKi, 9.36) > vanidipinedilol (pKi, 8.07). The ratio of beta1-adrenergic-blocking/calcium entry-blocking selectivity is 0.1 and indicated that vanidipinedilol revealed more in calcium entry-blocking than in beta-adrenergic-blocking activities. It has been suggested that vanidipinedilol-induced smooth muscle relaxation may involve decreased entry of Ca2+ and partial beta2-agonist activities. In conclusion, vanidipinedilol is a nonselective beta-adrenoceptor antagonist with calcium channel blocking and partial beta2-agonist associated vasorelaxant and tracheal relaxant activities. Particularly, the vasodilator effects of vanidipinedilol are attributed to a synergism of its calcium entry blocking and partial beta2-agonist activities in the blood vessel. A sustained bradycardic effect results from beta-adrenoceptor blocking and calcium entry blocking, which blunts the sympathetic activation-associated reflex tachycardia in the heart.

Conventional versus endoscopic free gracilis muscle harvest

Compared with conventional techniques, the endoscopically assisted harvest of free tissue has advantages such as minimal interference with cosmesis and reduced donor-site morbidity. However, the procedure also requires training and has an extensive learning period. In this series of 22 patients, the initial gracilis muscle flaps were harvested using a conventional method; the subsequent flaps were harvested with the aid of endoscopic instrumentation. Endoscopically assisted gracilis muscle harvest in 16 patients was compared with open method harvest in six patients. The endoscopically assisted group had an average incision length of 6.5 cm; that of the conventional group was 15.5 cm. There was one reexploration in the endoscopically assisted group, but all flaps were transferred successfully. Using this minimally invasive technique of vascular and muscular dissection, assisted by endoscopic instruments designed for distal muscle dissection and transection, the gracilis muscles can be harvested within 40 minutes. We consider endoscopically assisted harvest of free gracilis muscle to be safe, relatively simple, and cost-effective.

Photocatalytic oxidation of xenobiotics in water with immobilized TiO2 on agitator

A novel photocatalytic oxidation reactor, using Degussa P-25 TiO2 as a stationary phase with a thickness of 1.5-2.0 um on the blades of agitator, was developed to study the photocatalytic oxidation of xenobiotics. Particularly in this device, separation of photocatalyst from the purified water after oxidation reaction was not necessary, and no other aeration equipment was required to supply oxygen. To examine the efficiency of this device, photocatalytic degradation of xenobiotic organics such as carbofuran was studied as an example. Results indicated that carbofuran could be degraded completely with mineralization efficiency of 20% after 6 hours of oxidation under the imposed conditions. The mineralization rate of carbofuran was found to follow the pseudo-first order reaction kinetics. Moreover, the rate constant of mineralization was found to be proportional to TiO2 film area and the square root of UV light intensity. These results implied the mineralization efficiency of carbofuran could be improved through increasing TiO2 film area and UV light intensity. Accordingly, this novel device showed potential application for degrading xenobiotics in water.

Caries prevalence and bottle-feeding practices in 2-year-old children with cleft lip, cleft palate, or both in Taiwan

OBJECTIVE

The purposes of this study were to investigate the caries prevalence in cleft lip, cleft palate, or both in children under the age of 2 years and to evaluate parental attitudes toward bottle-feeding, dental care, and their relationship to baby bottle tooth decay (BBTD) in Taiwan.

DESIGN

Randomized and prospective study.

SETTING

Institutional setting.

PATIENTS AND METHODS

One hundred twenty-three 2-year-old children (68 boys and 55 girls) with cleft lip, cleft palate, or both were selected for this study. A questionnaire that asked questions about knowledge of oral health, knowledge and beliefs about BBTD, children's feeding habits, children's dental care, and parenting attitudes toward children with clefts was completed by the parents or caretakers. Children were divided into bottle-feeding and non-bottle-feeding groups according to the questionnaire responses of parents or caretakers. Each child was examined with a dental mirror and explorer under focused flashlight using defs index to determine the presence of BBTD.

RESULTS

Thirty-nine percent (48) subjects reported a bottle-feeding habit; the overall prevalence of BBTD was 15.4%. The habit of bottle-feeding was significantly related to BBTD (p = .019). The defs score for children who were bottle-fed was significantly higher than children who were not bottle-fed (p = .045). Parents or caretakers of both bottle-feeding and non-bottle-feeding children showed no significant differences in their attitudes toward bottle-feeding and feeding habits (p > .05). However, parents of non-bottle-fed children had significantly better dental care than parents of bottle-fed children in brushing frequency (p < .001) and brushing before bed (p < .001).

CONCLUSIONS

Children with clefts who took a bottle to bed showed an increased risk of developing BBTD. The parents or caretakers of bottle-fed children also showed a lack of motivation to perform regular preventive dental home care for their children. This suggests that oral health promotion programs should begin in infancy for children with clefts and their parents.

RNase E is required for the maturation of ssrA RNA and normal ssrA RNA peptide-tagging activity

During recent studies of ribonucleolytic "degradosome" complexes of Escherichia coli, we found that degradosomes contain certain RNAs as well as RNase E and other protein components. One of these RNAs is ssrA (for small stable RNA) RNA (also known as tm RNA or 10Sa RNA), which functions as both a tRNA and mRNA to tag the C-terminal ends of truncated proteins with a short peptide and target them for degradation. Here, we show that mature 363-nt ssrA RNA is generated by RNase E cleavage at the CCA-3' terminus of a 457-nt ssrA RNA precursor and that interference with this cleavage in vivo leads to accumulation of the precursor and blockage of SsrA-mediated proteolysis. These results demonstrate that RNase E is required to produce mature ssrA RNA and for normal ssrA RNA peptide-tagging activity. Our findings indicate that RNase E, an enzyme already known to have a central role in RNA processing and decay in E. coli, also has the previously unsuspected ability to affect protein degradation through its role in maturation of the 3' end of ssrA RNA.

Elevated second-trimester maternal serum hCG in patients undergoing haemodialysis

Prenatal Down syndrome screening with maternal serum alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG) has become common. High levels of maternal serum hCG and low levels of AFP have been associated with an increased risk of fetal Down syndrome. In this paper, we report five pregnancies in patients undergoing long-term haemodialysis, all of whom had false-positive second-trimester Down syndrome screening results. All of our five patients had extremely high levels of maternal serum hCG, but normal AFP values for their gestational age, and all had serious complications during pregnancy.

Nitrated nonivamide displaying a drawback of proton's role in capsaicin-associated sensory and neuronal activities

Nitrated nonivamide (NVANO)-induced triad hypotension, and biphasic bradycardia at 0.25-1.0 mg/kg (IV) was inhibited by capsazepine (1.0 mg/kg, IV), atropine (1.0 mg/kg, IV), and vagotomy in rats. NVANO also elicited a hypotensive spinal reflex at 5.0 mg/kg (IA). In the isolated rat vagus, NVANO (10.0-100.0 microM) revealed a sensory C-spike inhibition and membrane depolarization. NVANO (5.0 microM)-induced calcium influx in the isolated rat dorsal root ganglion cells (DRGs) was diminished by capsazepine (10.0 microM). In the isolated guinea pig atria, NVANO (1.0-50.0 microM)-induced positive inotropic and chronotropic activities were antagonized by capsazepine (1.0-10.0 microM) and human calcitonin gene-related peptide(8-37) (hCGRP(837); 0.1-1.0 microM).

Effects of veratrine and paeoniflorin on the isolated rat aorta

The interactions and mechanisms between veratrine and paeoniflorin on the isolated rat aorta were studied. Veratrine (1x10(-6) to 1x10(-4) g/ml) could induce contraction on the isolated rat aorta in a concentration-related manner. Paeoniflorin had no effect on the isolated rat aorta. Pretreatment with prazosin (1x10(-6) M) and nifedipine (1x10(-6) M) but not yohimbine (1x10(-5) M) could decrease the tension of contraction induced by veratrine (1x10(-4) g/ml). Sodium nitroprusside (1x10(-4) M) could inhibit the contraction induced by veratrine (1x10(-4) g/ml) with or without endothelium, whereas methylene blue (5x10(-5) M) could increase the contraction induced by veratrine (1x10(-4) g/ml). Treatment with veratrine (1x10(-4) g/ml) could decrease the tension of contraction induced by norepinephrine (1x10(-6) M) or phenylephrine (1x10(-4) M). The inhibition of veratrine on norepinephrine-induced contraction was potentiated by L-arginine (1x10(-4) M) and reversed by L-NAME (1x10(-5) M). Paeoniflorin (1x10(-4) M) could decrease the tension of contraction induced by veratrine (1x10(-4) g/ml) and methylene blue (5x10(-5) M). The inhibition of paeoniflorin on veratrine was more potent on rat isolated aorta with endothelium than without endothelium. Ryanodine (1x10(-5) M) and Ca2+ -free medium could inhibit methylene blue-induced contraction. From the above results, the relaxation of veratrine on the norepinephrine-induced contraction might be related to the increase of NO and cGMP. The contraction of veratrine on the isolated rat aorta was via the increase of intracellular calcium which was inhibited by paeoniflorin.

Sex differences in pediatric systemic lupus erythematosus: a retrospective analysis of 135 cases

A retrospective review of 135 patients with systemic lupus erythematosus (SLE) (24 boys and 111 girls) under age 18 at the National Taiwan University Hospital (NTUH) from 1989 to 1998 was done. The aim of this retrospective study was to compare the differences in the age at diagnosis, clinical, laboratory features and survival among both sexes. The female to male ratio was 4.6:1. The mean age at the time of diagnosis was 13.7 years (range, 8y5m-18y) for male patients and 13.7 years (range, 6y1m-18y) for female patients. There was no significant differences in the mean age of diagnosis between the sexes. It was found that there were no significant differences in the clinical and laboratory features between male and female patients except for the prevalence of oral ulcers, alopecia and anti-SSA antibodies which were more frequent in the female group. The cumulative 5- and 10-year survival rates were 80.2% and 65%, respectively; male patients appeared to have a better survival, yet it did not reach any statistical significance. Univariate analysis showed that gender is not a significant factor on prognosis in pediatric SLE. Although abnormal creatinine was associated with poor mortality, it was not statistically significant on multivariate analysis.

The relation between admission balance and functional outcomes following stroke rehabilitation: a medical center based study

This prospective study evaluated the clinical use of the Fugl-Meyer Balance Scale (FMBS) on stroke patients during hospitalization and assessed the relationship between balance score at admission to the rehabilitation program and functional outcome at discharge. One hundred and sixty-three stroke patients admitted to the in-patient rehabilitation department of a university-based medical center between January 1 and December 31, 1997 were recruited for this investigation. Functional ability was evaluated with the Functional Independence Measure (FIM) instrument, and balance was measured using the 7-item Fugl-Meyer Balance Scale. These measures were assessed both at admission to and discharge from the inpatient rehabilitation program. Pearson correlation and multiple regression analyses were used to determine the relationship between balance and functional ability scores at admission and rehabilitation outcomes at discharge, including length of stay, functional gain, and efficiency. The results demonstrated that the balance score at admission accounted for 6% of the variation in length of stay, once demographic influences were controlled. The FIM efficiency score could possibly be predicted by the balance ability at admission, which accounted for 3% of the variance. However, the balance score could not provide predictive information about the FIM gain beyond that already provided by the FIM score at admission, which accounted for 4% of the variance with demographic factors controlled. Overall, balance ability at admission, assessed by the Fugl-Meyer Balance Scale, had no or at least only little, contribution to account for the variance in rehabilitation outcomes. These findings suggest that the use of Fugl-Meyer Balance Scale at admission to stroke inpatient rehabilitation seemed not to enhance the ability to predict rehabilitation outcomes.

Eugenodilol: a third-generation beta-adrenoceptor blocker, derived from eugenol, with alpha-adrenoceptor blocking and beta2-adrenoceptor agonist-associated vasorelaxant activities

Eugenodilol, derived from natural eugenol, was first investigated with in vivo and in vitro models. In our in vivo study, eugenodilol (0.5, 1.0, and 1.5 mg/kg, i.v.) produced dose-dependent hypotensive and bradycardic responses in pentobarbital-anesthetized Wistar rats. Eugenodilol also inhibited the tachycardia and arterial pressor effects induced by (-)isoproterenol and phenylephrine, respectively. In our in vitro study, eugenodilol competitively antagonized (-)isoproterenol-induced positive inotropic and chronotropic effects and tracheal-relaxation responses on isolated guinea pig tissues in a concentration-dependent manner. The apparent pA2 values were 7.88+/-0.12 for right atria, 7.52+/-0.05 for left atria, and 7.33+/-0.15 for trachea, indicating that eugenodilol was a nonselective beta-adrenoceptor blocker. In thoracic aorta experiments, the apparent pA2 values of alpha-adrenoceptor blockade were 7.05+/-0.25 and 6.87+/-0.08 for eugenodilol and labetalol, respectively. In addition, eugenodilol produced cumulative relaxation responses on isolated guinea pig tracheal strips. The effects were competitively antagonized by ICI 118,551 (10(-8)-10(-6) M), a relatively selective beta2-adrenoceptor antagonist. In the radioligand-binding assay, the Ki values of [3H]CGP-12177 binding to rat ventricle and lung membranes were 9.72 and 48.29 nM, respectively, and the value of [3H]prazosin binding to rat brain membrane was 38.72 nM. These results further confirmed the alpha/beta-adrenoceptors-blocking activities of eugenodilol reported in the functional studies. We conclude that eugenodilol is a novel third-generation beta-adrenoceptor blocker with ancillary blocking activity at alpha-adrenoceptors and weak sympathomimetic activity at beta2-adrenoceptors.

Isoeugenolol: a selective beta1-adrenergic antagonist with tracheal and vascular smooth muscle relaxant properties

Isoeugenolol (1.0, 3.0, 5.0 mg/kg, i.v.) produced a dose-dependent bradycardia and a decrease in blood pressure in anesthetized Wistar rats. Isoeugenolol inhibited the tachycardia effects induced by (-)isoproterenol, but had no blocking effect on the arterial pressor responses induced by (-)phenylephrine. In isolated guinea pig tissues, isoeugenolol antagonized (-)isoproterenol-induced positive inotropic and chronotropic effects on the atria and tracheal relaxations in a concentration-dependent manner. The apparent pA2 values for isoeugenolol on right atria, left atria and trachea were 7.63+/-0.03, 7.89+/-0.12 and 6.12+/-0.05, respectively, indicating that isoeugenolol was a highly selective beta1-adrenoceptor blocker. On the other hand, isoeugenolol produced a mild direct cardiac depression at high concentration and was without intrinsic sympathomimetic activity (ISA). In isolated rat thoracic aorta, isoeugenolol relaxed more potently the contractions induced by (-)phenylephrine (10 microM) and 5-HT (10 microM) than those by high K+ (75 mM). In isolated guinea pig trachea, isoeugenolol attenuated the carbachol (1 microM)-con-tracted trachea more significantly than those contracted with high K+. Furthermore, the binding characteristics of isoeugenolol and various beta-adrenoceptor antagonists were evaluated in [3H]CGP-12177 binding to rat ventricle, lung and interscapular brown adipose tissue (IBAT) membranes. The -log IC50 values of isoeugenolol for predominate beta1-, beta2- and beta3-adrenergic receptor sites were 5.82+/-0.09, 4.74+/-0.05 and 4.73+/-0.12, respectively. In conclusion, isoeugenolol was found to be a highly selective beta1-adrenoceptor antagonist with tracheal and vascular smooth muscle relaxant activities, but was devoid of alpha-adrenoceptor-blocking action.

Second trimester maternal serum screening using alpha fetoprotein, free beta human chorionic gonadotropin and maternal age specific risk: result of chromosomal abnormalities detected in screen positive for Down syndrome in an Asian population

BACKGROUND

This study was to determine the incidence of chromosome abnormalities in Taiwanese women undergoing prenatal chromosome analysis after a second trimester Down syndrome screening by using maternal age and serum dual-marker testing (alpha-fetoprotein and free-beta unit human chorionic gonadotropin).

METHODS

A total of 10,098 Taiwanese women with pregnancy between 15 and 23 weeks' gestation received second-trimester Down syndrome risk evaluation by dual-marker and maternal age specific risk testing in a single medical center. The study took 22 months. Ninety-seven percent of this study population was less than 34 years old. Ninety-six percent of our cases were screened between 15-20 weeks of gestation. This population was included only after a routine ultrasonography scan for correction of gestational age and exclusion of major structural anomalies. By using an algorithm to detect Down's syndrome, with a risk of 1:270 as a cut-off value, 816 patients were screen-positive for Down syndrome (screen-positive rate 8.0%). Karyotypes were reviewed for 670 (82.1%) mothers who received prenatal karyotype analysis.

RESULTS

Twelve cases of Down syndrome were identified in the screen positive group with an estimated detection rate of 67% (false positive rate 8%). Three cases of Down syndrome were detected in late trimester among the screen-negative group. Seven other fetal chromosome abnormalities were also found among the screen-positive pregnancy. In addition, seven cases were screen-positive for trisomy 18; all of these patients received amniocentesis and only one case was confirmed.

CONCLUSION

These findings indicate that this screening program combining alpha-fetoprotein (AFP), free beta human chorionic gonadotropin (free-hCG) and maternal age-specific would achieve a screening efficiency in Taiwanese populations as comparable to those obtained in Caucasian populations. Our results also suggest that approximately 3% of pregnancies with a positive dual marker and maternal age-specific screen results will have a chromosome abnormality despite having a normal routine ultrasound scan. Mothers with positive screening results should be made aware of the implications of a positive result.

The influence of rehabilitation therapy on the prognosis for stroke patients--a preliminary study

The purpose of this prospective study was to investigate the influence of rehabilitation therapy on the prognosis for stroke patients. Sociodemographic and clinical factors were collected in a sample of 147 stroke patients (81 men and 66 women) admitted to the inpatient rehabilitation department at our university hospital over 10 days between January 1, 1997 and December 31, 1997. Functional Independence Measure (FIM) scores at discharge and gains during rehabilitation period were used as the prognosis index. Statistical techniques with univariate and multiple regression analyses indicated that significant predictors of discharge FIM scores include age, previous attacks twice or over, medical comorbidities, sensory and orientation impairments, and dementia. In addition, previous stroke attacks twice or over and sensory impairment were significant predictors of FIM gains during rehabilitation period. We concluded that: 1) age is a critical factor to determine the rehabilitation outcome, but may not be an important factor to predict the ability for the improvement through rehabilitation therapy; 2) the delay of rehabilitation therapy may not affect the potential for further improvement; 3) patients with low initial functional level may have poor final outcome, they may still have good rehabilitation potential to improve the functional level; 4) complications of stroke may affect the rehabilitation outcome and should be prevented; and 5) patients with impaired mental status should not routinely be excluded from rehabilitation programs.

Dens invaginatus in the maxillary lateral incisor: treatment of 3 cases

Nonsurgical treatment of 3 maxillary lateral incisors with dens invaginatus is reported. Invaginated teeth present technical difficulties with respect to their management because of complicated canal morphology. In the first case reported, apical abscess with incomplete root formation was found at the time of examination. Calcium hydroxide apexification provided favorable conditions for root closure and obturation. The other 2 cases were treated by conventional root canal treatment. Follow-up examinations showed successful clinical results, with osseous healing evident radiographically.

Treatment of an impacted dilacerated maxillary central incisor

Impacted Incisor With Dilaceration refers to a dental deformity characterized by an angulation between crown and root causing noneruption of the incisor. Surgical extraction used to be the first choice in treating the severely dilacerated incisor. In this article, a horizontally impacted and dilacerated maxillary central incisor was diagnosed radiographically. By combining two stages of the crown exposure surgery with light force orthodontic traction, the impacted dilacerated incisor was successfully moved into proper position. However, long-term monitoring of the stability and periodontal health is critical after orthodontic traction.

Clinical observations of erythema multiforme in children

Erythema multiforme (EM), a cutaneous or mucocutaneous disorder, occurs primarily in young adults. To evaluate the precipitating factors, clinical courses, and treatment of this disease in children, 30 cases aged from 1 month old to 15 years of age were studied retrospectively from Jan 1988 to Aug 1998. Twenty-three cases were diagnosed as minor type; the other 7 were of major type (Stevens-Johnson syndrome). Mycoplasma infection was identified in 4 patients, and adenovirus in one patient with EM minor. Cytomegalovirus was found in one EM major patient. Anticonvulsant administration before the skin lesions were recorded in 5 EM major patients and 2 EM minor patients. All cases received supportive treatment during admission. Besides, 6 of 7 patients with EM major, and 11 of 23 EM minor (Group A) received systemic corticosteroid at a dose equal to prednisolone 1-2 mg/kg/day for 3-14 days. One EM major patient and 11 patients with EM minor (Group B) received supportive care only. One EM minor patient with acute idiopathic thrombocytopenia purpura was treated with intravenous immunoglobulin. The mean duration of course of EM minor was 11.8 +/- 2.9 days, and it was 25.1 +/- 9.8 days for EM major. No mortality and no sequelae were noted. The average disease course and hospitalization time were not significantly different between Group A and B: (11.4 +/- 3.1 days vs 12.4 +/- 2.9 days, p = 0.45); (5.4 +/- 2.0 days vs 6.3 +/- 3.1 days, p = 0.47). This study demonstrated that infections, especially mycoplasma, and anticonvulsants play important roles in childhood EM. The skin lesions of EM minor subsided within 2 weeks, and EM major recovered completely within 6 weeks. Systemic corticosteroid may be beneficial to EM major, but probably is unnecessary for patients with EM minor.

Ratings of 830 jobs on 45 characteristics: factor and cluster analyses into age-enhanced, age-neutral and age-counteracted, and age-impaired categories

The current study measured the critical elements of jobs and characterized the jobs' suitability for aging workers based on ratings of those elements. The sample consisted of 830 job titles collected by the Employment and Vocational Training Administration in Taiwan. For each job the ratings of 45 specific variables, falling into three major classes, were factor analyzed, using principal components analysis with varimax rotation. A nine-factor solution explained 50.1% of the variance. Using a nonhierarchical clustering procedure, 830 jobs were classified into three homogeneous clusters which were significantly different on nine factors except for Manual Dexterity. Mapping the ratings on the 9 factors and the characteristics of aging workers, the four job clusters were defined as Age-enhanced, Age-neutral, and Age-counteracted, and Age-impaired to describe the suitability for aging workers.

Space changes after premature loss of the mandibular primary first molar: a longitudinal study

The purpose of this study was to evaluate the space changes after premature loss of the primary mandibular first molar. Twenty-one children (12 boys and 9 girls), with premature loss of the primary mandibular first molar, were selected from the children's dental clinic for this study. The age ranged from 5.1 to 7.2 years with an average of 6 years and 11 months. Mandibular study casts were made from alginate impression for each initial examination and a follow-up examination eight months later. Four measurements including D+E (first and second primary molars) space, arch width, arch length and arch perimeter were tested for comparisons between the initial examination and the follow-up examination eight months later. The D+E space of intact primary molars served as a control. The results showed that the D+E space on the extraction side after the follow-up examination eight months later was significantly shorter than the control side (p = 0.025) and less than the initial D+E space (p < 0.001). However, there were no significant differences on arch width, arch length, and arch perimeter between the initial examination and the follow-up examination eight months later (p > 0.05). It is concluded that the space change after the eruption of the first permanent molar in the mandible is mostly distal movement of the primary cuspid during the early stage of premature loss of the primary first molar.

Microbiologically induced corrosion of aluminum alloys in fuel-oil/aqueous system

To investigate the microbiologically induced corrosion of aluminum alloys in fuel-oil/aqueous system, aluminum alloys A356, AA 5052, AA 5083 and AA 6061 were chosen as the test alloys and Cladosporium and several fuel-oil contaminated microbes isolated in Taiwan were used as test organisms. Aluminum alloy AA 5083 in fuel-oil/aqueous system was the most susceptible material for microbial corrosion, then followed by aluminum alloys AA 5052 and A356, and AA 6061 was more resistant to microbial aggression. Mixed culture had high capability of corrosion, then followed by Penicillium sp. AM-F5, Fusarium sp. AM-F1, Pseudomonas aeruginosa AM-B5, Ps. fluorescens AM-B9, C. resinae ATCC 22712, Penicillium sp. AM-F2, Candida sp. AM-Y1 and Ps. aeruginosa AM-B11. From energy dispersive spectrometer analysis, aluminum and magnesium contents decreased in the corrosion area, while chlorine and sulfur contents increased. The major organic acid produced in fuel-oil/aqueous system was acetic acid, and the total organic acids content had a positive correlation with the degree of microbial corrosion.

Evolution of dilated cardiomyopathy from hypertrophic obstructive cardiomyopathy in a child

Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) are two different diseases and have distinct etiologies. HCM is rare in children and rarely progresses to DCM. We report a 5-year-old Taiwanese girl with a definite diagnosis of hypertrophic obstructive cardiomyopathy. The diagnosis was based on echocardiograms, cardiac catheterization, and endomyocardial biopsy. However, the clinical features progressed to a picture of nonobstructive HCM at age 9, and the patient developed dilated poorly contractile ventricles with intractable congestive heart failure at age 10. She died from ventricular tachycardia at age 13. This report emphasizes the importance of periodic reevaluation for children with HCM.