Energy loss function of samarium

We present a combined experimental and theoretical work to obtain the energy loss function (ELF) or the excitation spectrum of samarium in the energy loss range between 3 and 200 eV. At low loss energies, the plasmon excitation is clearly identified and the surface and bulk contributions are distinguished. For the precise analysis the frequency-dependent energy loss function and the related optical constants (n and k) of samarium were extracted from the measured reflection electron energy loss spectroscopy (REELS) spectra by the reverse Monte Carlo method. The ps- and f-sum rules with final ELF fulfils the nominal values with 0.2% and 2.5% accuracy, respectively. It was found that a bulk mode locates at 14.2 eV with the peak width ~6 eV and the corresponding broaden surface plasmon mode locates at energies of 5-11 eV.

pH-sensitive behavior of two-component hydrogels composed of N,O-carboxymethyl chitosan and alginate

A two-component pH-sensitive hydrogel system composed of a water-soluble chitosan derivative (N,O-carboxymethyl chitosan, NOCC) and alginate cross-linked by genipin, glutaraldehyde or Ca2+ was investigated. Preparation and structures of these hydrogels and their swelling characteristics and release profiles of a model protein drug (bovine serum albumin, BSA) in simulated gastrointestinal media are reported. At pH 1.2, the swelling ratios of the hydrogels cross-linked by distinct methods were limited. Of note is that the lowest swelling ratios of test hydrogels were found at pH 4.0. At pH 7.4, the carboxylic acid groups on test hydrogels became progressively ionized and led to a significant swelling. There was barely any BSA released from the glutaraldehyde-cross-linked hydrogel throughout the entire course of the study. The amounts of BSA released at pH 1.2 from the genipin- and Ca(2+)-cross-linked hydrogels were relatively low (approx. 20%). At pH 4.0, there was still significant BSA release from the Ca(2+)-cross-linked hydrogel, while the cumulative BSA released from the genipin-cross-linked hydrogel was limited due to its shrinking behavior. At pH 7.4, the amount of BSA released from the genipin- and Ca(2+)-cross-linked hydrogels increased significantly (approx. 80%) because the swelling of both test hydrogels increased considerably. The aforementioned results indicated that the swelling behaviors and drug-release profiles of these test hydrogels are significantly different due to their distinct cross-linking structures.

Oestrogen receptor-alpha polymorphism and risk of fracture: a meta-analysis of 13 studies including 1279 cases and 6069 controls

A meta-analysis was performed to evaluate the effect of oestrogen receptor-alpha (ESR1) gene PvuII polymorphism on fracture risk. It included published data from relevant studies (up to May 2010) identified from Medline, Embase and Current Contents. The 13 included studies contained 1279 fracture cases and 6069 controls. The combined results based on these studies showed no relationship between ESR1 gene PvuII polymorphism and fracture risk. No significant difference in genotype distribution was found when stratifying by race. When stratifying by fracture type, it was found that vertebral fracture cases had a significantly higher frequency of the PvuII pp genotype than controls in five studies (552 cases and 2350 controls). This meta-analysis suggests a modest but statistically significant association between the ESR1 PvuII pp genotype and vertebral fracture.

Shell-crosslinked Pluronic L121 micelles as a drug delivery vehicle

Pluronic block copolymers (PBCs) have been shown to reverse multidrug resistance (MDR) by inhibiting the P-glycoprotein (P-gp) pump in cancer cells. One of the problems encountered with the use of PBCs is that the micelles disassociate at low concentrations. The study focused on the stabilization of PBC L121 micelles by the formation of crosslinks within their outer shells. To form crosslinks, the two terminal alcohols on L121 were first chemically converted into aldehydes (L121-CHO) using the Dess-Martin periodinane. Diamine compounds were then used to bridge the converted aldehyde termini on L121-CHO via conjugated Schiff bases. After crosslinking, the morphology of the L121 micelles remained spherical in shape and the mean particle sizes of the micelles before and after crosslinking were comparable (100nm). After exposure of MDR KBv cells to free rhodamine-123 (R123), the accumulation of R123 in cells was limited due to the function of P-gp. In contrast, crosslinking of L121 micelles within their outer shells significantly reduced their critical micelle concentration and greatly enhanced their stability, while maintaining their ability to inhibit P-gp function in resistant cells. The results indicated that the L121 micelles with shell crosslinks may be useful as a drug delivery vehicle for cancer chemotherapy.

Solid-Phase Microextraction Coupled with Liquid Chromatography for Determination of -Carotene in Food

Beta-carotene in vegetables and nutritional products is analyzed using solid-phase microextraction (SPME) coupled with liquid chromatography (LC) to improve the speed of analysis and to reduce the consumption of organic solvents. The relative standard deviations (RSDs) of this analytical method for beta-carotene determinations in vegetables and nutritional products are approximately 10% and 5%, respectively. The amount of beta-carotene was found to vary from 0.35 +/- 0.05 ppm to 76.5 +/- 6.9 ppm for several vegetables in Taiwan. This method was linear over the range of 0.4-40 ppm with correlation coefficients higher than 0.997. The experimentally determined level of beta-carotene in nutritional products varied from 3.8 +/- 0.2 ppm to 24.6 +/- 1.1 ppm following SPME-LC. The recoveries of beta-carotene for these measurements following SPME were all higher than 97% +/- 2% (n = 3). The detection limits of beta-carotene for this method were from 0.027 to 0.054 ppm. Conventional solvent extractions take approximately 4-6 h for extraction and reconcentration but SPME takes approximately 1 h. From several tens to hundreds of milliliters, organic solvents can be saved using SPME. SPME provides better analyses on beta-carotene than conventional solvent extraction for nutritional products in terms of speed, precision, simplicity, and solvent consumption.

Preparation of nanoparticles composed of poly(gamma-glutamic acid)-poly(lactide) block copolymers and evaluation of their uptake by HepG2 cells

In the study, poly(gamma-glutamic acid) (gamma-PGA) and poly(lactide) (PLA) were used to synthesize block copolymers via a simple coupling reaction between gamma-PGA and PLA to prepare self-assembled nanoparticles. For the potential of targeting liver cancer cells, galactosamine was further conjugated on the prepared nanoparticles as a targeting moiety. gamma-PGA, a water-soluble, biodegradable, and non-toxic compound, was produced by microbial fermentation (Bacillus licheniformis, ATCC 9945a) and then was hydrolyzed. The hydrolyzed gamma-PGA with a molecular weight of 4 kDa and a polydispersity of 1.3 was used, together with PLA (10 kDa, polydispersity 1.1), to synthesize block copolymers. The prepared nanoparticles had a mean particle size of about 140 nm with a zeta potential of about -20 mV. The results obtained by the TEM and AFM examinations showed that the morphology of the prepared nanoparticles was spherical in shape with a smooth surface. In the stability study, no aggregation or precipitation of nanoparticles was observed during storage for up to 1 month, as a result of the electrostatic repulsion between the negatively charged nanoparticles. With increasing the galactosamine content conjugated on the rhodamine-123-containing nanoparticles, the intensity of fluorescence observed in HepG2 cells increased significantly. Additionally, the intensity of fluorescence observed in HepG2 cells incubated with the nanoparticles with or without galactosamine conjugated increased approximately linearly with increasing the duration of incubation. In contrast, there was no fluorescence observed in Hs68 cells (without ASGP receptors) incubated with the nanoparticles with galactosamine conjugated. The aforementioned results indicated that the galactosylated nanoparticles prepared in the study had a specific interaction with HepG2 cells via ligand-receptor recognition.

Radon, helium and uranium survey in some thermal springs located in NW Himalayas, India: mobilization by tectonic features or by geochemical barriers?

Radon, helium and uranium measurements have been carried out in hot water springs in the Parbati and Beas valleys of Himachal Himalaya. Most of these hot springs are known as famous pilgrimage centers. The activity of dissolved radon in the liquid phase is found to vary widely, by an order of magnitude, between 10 and 750 Bq L(-1), whereas, the dissolved helium content in these thermal springs varies between 10 and 100 ppm. The uranium contents are low and vary from <0.01 to 5 microg L(-1). The measured values of radon, helium and uranium are possibly controlled by structural geology, namely the presence of pervious fault systems, and by the lithology of the leached host rocks. Redox-potential geochemical barriers cause the mobilization of uranile ions in solution (UO2+); the most plausible hypothesis is when the conditions are oxidising, confirming the importance of physico-chemical conditions up to the supergenic environment, to control the fluid geochemistry of the U-He-222Rn system. Some evidence is available from both geothermometric considerations and geochemical data which will be reported elsewhere, whereas the present study is focused on U decay series-noble gas geochemistry. The first analysis of collected 3He/4He data is consistent with a crustal signature at the studied thermal springs.

Automatic optimum order selection of parametric modelling for the evaluation of abnormal intra-QRS signals in signal-averaged electrocardiograms

Abnormal intra-QRS potentials (AIOPs) in signal-averaged electrocardiograms have been proposed as a risk evaluation index for ventricular arrhythmias. The purpose of the paper was to develop an automatic algorithm for selecting the optimum parametric model order in the analysis of AIOPs to make the modelling approach clinically more feasible. A total of 130 normal Taiwanese subjects and 87 patients with ventricular premature contractions and 23 with sustained ventricular tachycardia were recruited. The unpredictable AIQP signal was estimated from the modelling residual. The cross-correlation coefficient between the original signal and the ORS estimate was employed to evaluate the accuracy of the estimate. A pre-selected threshold cross-correlation coefficient of 0.9999 was used to determine the optimum order. The mean AIQP in lead Y for ventricular tachycardia patients was 3.9 microV, which was significantly smaller than 4.9 microV for ventricular premature contraction patients (p < 0.01) and 6.3 microV for normal subjects (p < 0.001). The linear combination of AIQP in lead Y and the time-domain parameter RMS40 provided the best global performance (the area under the receiver operating characteristic curve was 89.1%). A higher risk of ventricular arrhythmias was associated with lower AIQP in lead Y, and the automatic modelling algorithm improved the clinical feasibility of AIQP analysis.

Power spectrum analysis of heart rate variability in children with epilepsy

OBJECT

Children with epilepsy have been found to be at increased risk of death during childhood. Sudden unexpected death (SUDEP) has accounted for at least 12% of deaths of children with epilepsy. The exact mechanisms of SUDEP are unknown; however, theories suggested have, to date, focused on autonomic instability. The purpose of this study was to investigate autonomic function in children with chronic epilepsy by means of power spectrum analysis of heart rate variability.

METHODS

Thirty patients with epilepsy and 30 control subjects, all between the ages of 4 and 10 years, were enrolled in this study. Power spectrum analysis of heart rate variability (HRV) was performed under standardized conditions after the patients had rested for 15 min. Each patient was tested in a supine position first and then again in a head-up tilted position, with 15 min between the two tests.

RESULTS

There was no significant difference between the low-frequency component (LF) and the high-frequency component (HF) of heart rate variability, or the LF/HF ratio, between the study and control groups, whether the test subjects were in the supine or the head-up tilt position. In the control group, however, the subjects showed a significantly greater LF component and a smaller HF component of heart rate variability, and a greater LF/HF ratio in the head-up position than in the supine position. This implies a normal sympathovagal balance. This phenomenon was not observed in the study group. This implies that the modulating effects on autonomic function deriving from the hemisphere were probably disturbed, owing to the brain lesions that each of the study group patients had already sustained.

CONCLUSIONS

A disturbed balance of activity between the sympathetic and parasympathetic nervous system might result from the loss of hemispheric influence in patients with epilepsy. Nevertheless, further investigation is clearly necessary to ascertain the possible association of this disturbed balance with SUDEP. Further investigation is also needed to establish the exact location of the region in the brain that gives rise to this modulating influence.

Electromyographic evaluation in children with spina bifida

BACKGROUND

It is controversial to predict ambulation potential using neurological level or specific pattern of muscle strength in patients with spina bifida. We attempted to analyze the relationship between the mobility outcome and its influencing factors utilizing electromyography to study motor unit activity in lower limbs. A subsidiary aim was to evaluate the external anal sphincter with electromyography and to determine the relevant factors of bowel and bladder functions.

METHODS

Among 156 patients with spina bifida who had received electromyographic examination and were followed at the out-patient clinic between 1998 and 2000, functional assessment with Pediatric Evaluation of Disability Inventory (PEDI) was applied in 47 randomly selected patients. Other assessments included clinical neurological examination, bowel and bladder function survey, and ambulation evaluation. We correlated the parameters of electromyography with the ambulatory ability and PEDI scores. The innervation of external sphincter was compared between groups with or without neurogenic bowel or bladder dysfunction.

RESULTS

The innervations of hip adductor and quadriceps were found to correlate with walking ability (p < 0.01); above muscles as well as anterior tibialis, and gastrocnemius were related to PEDI scores (p < 0.01). The neurological level still manifested correlation with walking ability (p < 0.05) and PEDI scores (p < 0.01). Both denervation potentials and recruitment pattern were important parameters for ambulation and mobility prediction. Significant difference was obtained in denervation patentials of sphincter within bowel groups (p = 0.036) and bladder groups (p = 0.016).

CONCLUSIONS

Both traditional neurological level and specific muscle innervation exert crucial influence on walking and mobility functions. Electromyographic assessment demonstrates its contribution in prediction of functional outcome in spina bifida.

Measurement of the bioactivity of interleukin and tumour necrosis factor in synovial fluid of Kashin-Beck disease

We studied the bioactivity of interleukin (IL-1) and tumour necrosis factor (TNF) in the synovial fluid of 12 patients with Kashin-Beck disease (KBD), 8 patients with osteoarthritis (OA) and 8 normal controls. C57 female mouse T cell proliferation method was used to test the bioactivity of IL-1, and lethality method with L929 cells to test the bioactivity of TNF. The bioactivities of IL-1 and TNF in the synovial fluid from patients with KBD were higher than those in the synovial fluid of osteoarthritis and normal controls, indicating the participation of IL-1 and TNF in the pathogenesis of KBD.

The outcome of shunted hydrocephalic children

BACKGROUND

Neurological sequelae and mental retardation may result from different etiological types of hydrocephalus. The aim of our study is to determine the intellectual development and the "shunt history" of these children with regard to the complications and revision rates.

METHODS

We reviewed the medical history of non-tumoral pediatric hydrocephalic patients who had received first shunt insertions between 1983 and 1997 and had been regularly followed up at the out-patient clinics of Taipei Veterans General Hospital. These patients were categorized into five different etiological groups. Their intelligence test scores and the surgical morbidity encountered over this period were used as the main outcome measures.

RESULTS

Out of the seventy-three patients, post-meningitis hydrocephalus patients had the significantly highest shunt revision rate (2.50 +/- 0.82, p = 0.01). They also showed retardation in IQ scores, but the different was not significant when compared with other groups. The results of IQ tests were not related to either the age of initial shunt insertion (p = 0.461) or revision rates (p = 0.292). For physical disabilities, post-meningitis hydrocephalic patients showed-highest incidence of epilepsy (40%) while hydrocephalic patients associated with myelomeningocele had the highest incidence of motor deficits (56.25%).

CONCLUSIONS

Childhood hydrocephalic patients had different developmental neuroimpairments with respect to different etiologies. This study provides information about the physical and mental outcome of post-operative hydrocephalic patients which is valuable to assist in counsel of their families.

Seizure outcomes after anterior callosotomy in patients with posterior-dominant and with anterior-dominant epileptiform discharges

OBJECTS

We wished to find whether there was any difference in the postoperative seizure outcome between patients with bisynchronous anterior-dominant and those with posterior-dominant EDs after anterior callosotomy.

METHODS

Seizure outcomes after anterior callosotomy in 7 patients with bisynchronous posterior-dominant epileptiform discharges and in 54 patients with anterior-dominant seizures were compared. All 61 cases had been followed up for more than 2 years after operation. One patient (14.3%) had become seizure free. Two patients (28.6%) had more than 50% reduction in seizure frequency, but 4 patients (57.2%) showed no improvement at all. The percentage of cases with significant improvement (more than 50% reduction of seizure frequency) was 43% (3 in 7), which is lower than in the patients with bisynchronous anterior-dominant EDs (64.8%).

CONCLUSIONS

Our preliminary results suggest that anterior partial callosotomy could still be helpful in cases with bisynchronous posterior-dominant epileptiform discharges but the prognosis may be less optimistic than for those with anteriorly located discharges.

Postcallosotomy seizure outcome in hemiconvulsion-hemiatrophy-epilepsy syndrome

Recently, three patients with hemiconvulsion-hemiplegia-epilepsy syndrome who underwent callosotomy were monitored for more than four years. All patients had atrophy of the right brain hemisphere with left hemiparesis and seizures. Two cases were probably the result of traumatic intracranial hemorrhage and one was due to an unknown cause. Wada tests were done in cases 1 and 2, which showed spared motor function of the atrophic hemisphere, supporting the choice of callosotomy instead of hemispherectomy. Patient 1 had atypical absence seizures and asymmetric generalized tonic seizures before surgery, the latter of which decreased by about 60% after callosotomy. Patient 2 had simple partial seizures of the motor type and complex partial seizures, the latter of which were also induced by touch (somatosensory-induced reflex epilepsy). This patient's complex partial seizures disappeared completely, but the simple partial seizures remained unchanged. Patient 3 had generalized tonic seizures, simple partial seizures of the sensory type and complex partial seizures. After surgery, the frequency of the generalized tonic seizures decreased more than 90%. The simple partial seizures of the sensory type remained unchanged. There were two new types of seizures after surgery, simple partial seizures of the motor type and brief generalized myoclonic jerks. All patients had significant reductions in numbers of seizures of more than 50%.

Postoperative seizure outcome after corpus callosotomy in reflex epilepsy

Flickering light and color patterns, reading, language, movement, decision making, eating, tapping and touching, hot water immersion and auditory stimulation can induce seizures in some epileptic patients. These are known as the "reflex epilepsies". The mechanism of reflex epilepsy is not clear. Recently, we performed anterior two-thirds corpus callosotomies in two reflex epilepsy patients (ages 12 and 14 years), with follow-up for more than three years. Patient 1 had Lennox-Gastaut syndrome with auditory-induced generalized atonic or tonic seizures (startle epilepsy), which decreased by 60% after callosotomy. Patient 2 had Lennox-Gastaut syndrome with somatosensory-induced generalized tonic seizures (tap epilepsy). He was seizure-free for one year immediately after callosotomy, but his seizures recurred with the same degree and frequency as before surgery. The nonsignificant postoperative seizure outcome suggests that the corpus callosum only plays a partial role in seizure generation. Our report also discusses the possible mechanisms of generation of reflex seizures.

Seizure outcome after corpus callosotomy: the Taiwan experience

From September 1989 to August 1996, we performed anterior corpus callosotomy in 83 patients. Unfortunately, 9 patients were lost to follow-up. Among the remaining 74 patients, 59 had Lennox-Gastaut syndrome (evolved from infantile spasms in 22), 9 had complex partial seizures with or without secondary generalized seizures, 1 had multifocal independent epileptogenic foci (MISF) syndrome, 3 had hemiconvulsion-hemiplegia-epilepsy (HHE), and 2 had infantile spasms. All cases were followed up for at least 2 years after surgery. The highest rate of significant improvement (more than 50% reduction in seizure frequency) was noted in the patients with generalized tonic-clonic seizures, 82.1% of whom experienced significant improvement, followed by those with generalized tonic seizures (76. 7%), atonic seizures (72.7%), myoclonic seizures (64.9%), atypical absences (58.6%), and complex partial seizure with or without secondary generalization (61.5%). Complete freedom from seizures was noted in 14 cases (18.9%). One patient had the anterior half of his right palm amputated following radial artery thrombosis complicated by insertion of an arterial line during anesthesia. Otherwise, there were no major postoperative complications except for brief mutism and multifocal jerks in some patients during the 1st postoperative week. Thus, we conclude that corpus callosotomy is a safe alternative treatment for all kinds of medically intractable seizures, especially generalized epilepsy.

Treatment of cerebral palsy with botulinum toxin: evaluation with gross motor function measure

The objective of this study was to investigate the effects of botulinum toxin A (BTA) injection in reducing muscular spasticity and improving locomotor function in children with cerebral palsy. Thirty-eight children with spastic cerebral palsy who were undergoing regular physical therapy were enrolled. Twenty-eight of these received BTA injection at the hip adductors and/or gastrocnemius, while the other 10, whose parents refused the BTA treatment protocol, served as the comparison group. The main outcome measures were: improvements in the severity of spasticity, walking distance, gross motor function (as assessed with the Gross Motor Function Measure, GMFM), and gait pattern (as assessed with the Physician Rating Scale, PRS), all measured 6 and 12 weeks after the start of BTA treatment. The severity of spasticity and walking distance at baseline did not differ significantly between the two groups. However, the severity of spasticity improved markedly in the BTA group, from 2.7 to 1.5 (Modified Ashworth Scale) at the hip adductor, and from 2.9 to 1.9 at the gastrocnemius at the 6-week follow-up. The walking distance improved from 46.17 m to 55.32 m at the 6-week follow-up, and to 66.6 m at the 12-week follow-up in the BTA group. Marked improvements in the quality of several gross motor functions were also noted in the BTA group. The improvements in spasticity, walking distance, and gross motor function were significantly greater in the BTA group than in the comparison group. The improvements in gait pattern did not differ significantly between the BTA and comparison groups. The findings of this study show BTA injection to be an effective treatment for reducing spasticity and improving gross motor function in children with spastic cerebral palsy. GMFM provides objective evidence regarding functional improvement after treatment in this patient population.

Comparison of patient-controlled analgesia (PCA) with tramadol or morphine

PURPOSE

To compared the clinical efficacy of tramadol and morphine using a patient-controlled analgesia (PCA) delivery system.

METHODS

In a prospective, randomized, double blind study, we evaluated 80 adult patients scheduled for elective hip or knee arthroplasty with general inhalational anesthesia. When patients complained of pain in the recovery room, patients were randomized to receive either tramadol or morphine by titration in 30 min to achieve analgesia (VAS < or =4). Equivalent volumes containing either 30 mg x ml(-1) tramadol or 1 mg x ml(-1) morphine were used for PCA with a lockout interval of 10 min. The patients were followed six-hourly for 48 hr for VAS, satisfaction rate, analgesic dose, and side effects.

RESULTS

Patients obtained adequate analgesia with either drug. More patients had very good satisfaction scores in the morphine group in the recovery room (43% vs. 23%, P<0.05) and at 24 hr (40% vs. 20%, P<0.05) than those in the tramadol group. More nausea was evident in the tramadol group (48% vs. 11% in recovery room and 28% vs. 12% in 24 hr, P<0.05) than in the morphine group. Vomiting was also more (28% vs. 5% in recovery room, 15% vs. 3% in 24 hr, P<0.05). Morphine produced more sleepiness (45% vs. 23% in recovery room, P<0.05 and 35% vs. 15% in 24 hr, P<0.05).

CONCLUSION

Tramadol PCA can provide effective analgesia following major orthopedic surgery provided sufficiently high doses are given for loading and by patient demand. However, the incidence of nausea/vomiting is also higher causing decreased satisfaction.

[Reconstruction of hip joint function: old fracture-dislocation of hip joint complicated with deformed healing of upper 1/3 of fractured femur--a case report]

OBJECTIVE

To explore a method of reconstruction of hip joint function after deformed healing of the upper 1/3 of fractured femur as a complication of old fracture dislocation of hip joint.

METHODS

A patient with loss of function in hip joint and fusion of knee joint was treated with lock for femur intra-medullary fixation in April 1997.

RESULTS

Before operation, the diseased hip joint lost its most functions and the entire lower extremity was disabled because the knee joint had been fused. One year after operation, the follow-up examination revealed that the patient could walk by crutches without discomfort, his daily life and work recovered to normal.

CONCLUSION

It is effective to treat a patient suffering old fracture-dislocation of hip joint complicated with deformed healing of the upper 1/3 of fractured femur by means of individualized artificial joint replacement and a prosthesis body with lock for femur intra-medullary fixation, and it is helpful for the development of a new clinical idea to reconstruct functions in the management of some particular cases.

Acute jaundice in pregnancy: acute fatty liver or acute viral hepatitis?

In this case, the difficulty in differential diagnosis between acute viral hepatitis and acute fatty liver of pregnancy was analyzed. These 2 conditions often raise controversal question regarding the decision making on emergency anesthesia for cesarean section to avert complications and optimize management. The dilemma in which an anesthesiologist is put is whether to promise the anesthesia straightaway in the face of a demonstrable acute jaundice in pregnancy to advise a postponement of surgery until a turn for the better. In this embarrassing situation, the authors suggest that a postpronement of surgery is rational to observe the development during which both the mother and the fetus should be closely monitored. Once the necessity of a cesarean section outweighs the benefit of transitional conservative treatment, it should be performed immediately.

Intradermal injection of tramadol has local anesthetic effect: a comparison with lidocaine

BACKGROUND

We observed that intravenous retention of tramadol with a pneumatic tourniquet on the arm inflated to 70 mmHg for one minute could effectively reduce the subsequent propofol injection pain. Tramadol is a central-acting analgesic. The local analgesic effect of tramadol on reducing propofol injection pain is not well known.

METHODS

To explore this problem we conducted a double-blind study on intradermal injections of tramadol 25 mg, lidocaine 5 mg and normal saline (all in 0.5 ml volume) which were given to each of the 10 healthy volunteers on the forearm at random. Pain on injections and the degree of local analgesia to pinprick, light touch and cold at each injection site were scored on a 0-4 scale at designated intervals.

RESULTS

5% tramadol, similar to 1% lidocaine, rendered loss of sensation to pin prick, light touch and cold for 30 min after intradermal injection as compared with normal saline (p < 0.01).

CONCLUSIONS

We concluded that intradermal injection of tramadol or lidocaine can produce local anesthetic effect.

Compound muscle action potential amplitude and area changes in normal subjects and patients with carpal tunnel syndrome

Lesions of mixed peripheral nerves are often diagnosed by means of electrodiagnostic tests, especially by motor and sensory conduction studies. In order to clarify the varying degrees of motor nerve involvement in patients with carpal tunnel syndrome (CTS), we designed this study for comparing the results of compound muscle action potential (CMAP) amplitude and area under the negative phase between normal persons (n = 662) and patients having CTS (n = 250). The CTS cases were categorized into two distinct groups, i.e., CTS-D (n = 120) having prolonged median sensory latency and normal needle examination, CTS-AD having prolonged median sensory latency and abnormal needle findings (n = 130). Subjects in the CTS-AD group showed significant reduction, both in CMAP amplitude and area from 3rd to 7th decades; however, in the CTS-D group there were significantly smaller CMAP amplitude from 5th to 7th decades but CMAP area demonstrated wide variations. These data indicate that CMAP amplitude and area are helpful in documenting motor nerve axonal loss, but care must be exercised when attempt is made to define axonal loss based either on area or amplitude because of the temporal dispersive effects.

Electrophysiologic evaluation of autonomic function in cerebral palsy

The presence of clinical autonomic dysfunction in patients with neurologic diseases, such as multiple sclerosis, Parkinson's disease, and cerebrovascular accident, has become increasingly recognized in the past decade. Very few autonomic tests have been done on pediatric patients thus far. The purpose of this study was to investigate the autonomic function in patients with cerebral palsy using two noninvasive tests: sympathetic skin response (SSR) and R-R interval variation (RRIV). Twenty-four patients with cerebral palsy and 24 control subjects between the ages of 4 and 12 yr were enrolled in this study. There was no significant difference of mean latency, amplitude, or amplitude ratio of SSR between the two groups under electric stimulus, startling stimulus, and deep breathing conditions. No significant difference in frequency of absent response and asymmetric response was also noted. Mean heart rate under relaxed sitting condition was significantly higher in the study group. Significant negative correlation between heart rate and age was noted in the control group but was not present in the study group. Also, there was no statistical difference of mean RRIV between the two groups. No objective evidence of autonomic disturbance in patients with cerebral palsy was found in this study.

Neuropsychological sequelae after treatment for medulloblastoma in childhood--the Taiwan experience

The purpose of this study was to investigate the functional independence, intellectual performance and academic achievement of children treated for medulloblastoma at the Veterans General Hospital-Taipei. Adverse factors that it was thought would result in significant intellectual impairment were also studied. Nineteen patients with medulloblastoma located over the posterior fossa were enrolled in this study. Their mean age at tumor removal was 6.16 +/- 3.30 (range 2-14) years. Mean full intelligent quotient (FIQ) was 86.00 +/- 22.66, performance intelligent quotient (PIQ) was 85.29 +/- 21.23, and verbal intelligent quotient (VIQ) was 90.50 +/- 23.50. In 11 cases academic achievement at school was poor. Sixteen patients received radiation therapy after tumor removal. Significant negative correlations were noted between IQ and whole-brain irradiation dose (r = -0.72) and between IQ and years after radiation therapy (r = -0.63). The results indicate a need for ongoing attention and intervention to prevent, remedy or minimize deficits produced by the tumor itself and by the cancer treatment.

Quantitative measurement of improvement in sitting balance in children with spastic cerebral palsy after selective posterior rhizotomy

Severe muscular spasticity encountered frequently in patients with spastic cerebral palsy not only affects patient locomotor function but also causes musculoskeletal complications. Significant reduction of spasticity over pelvis and lower limbs after selective posterior rhizotomy (SPR) results in improvement of trunk stability, locomotor function, and function of upper limbs also. The purpose of this study was to investigate the difference of sitting balance before and after SPR using a quantitative measurement in sitting stability represented as dispersion index provided by the Chattecx Balance System. Seventeen children with spastic cerebral palsy, ten boys and seven girls, with a mean age of 5.06 yr, underwent SPR. Their sitting stability under static and dynamic, visual and nonvisual testing conditions was assessed before SPR and three mo after SPR. Their sitting balance showed significant improvement at postoperative evaluation except for the static-nonvisual testing condition. Dispersion index under the dynamic testing condition was significantly higher than under the static testing condition, which implies that dynamic sitting balance was worse than static sitting balance in these patients. There was no statistical difference of sitting performance between visual and nonvisual condition both preoperatively and postoperatively. Quantitative measurement of dispersion index provided by the Chattecx Balance System offers an objective evidence of improvement in sitting balance for children after SPR.

Quality of life and life satisfaction in families after a child has undergone corpus callostomy

Epilepsy is a chronic neurological condition which can have a detrimen tal effect on patients' quality of life (QOL). We evaluated the overall satisfaction with QOL and changes in QOL in 25 families with children who had undergone corpus callostomy for severe epilepsy. The mean age of seizure onset was 3.4 years, and the mean period from seizure onset to operation was 5.2 years. Mean follow-up was 19.3 months. Twenty of 22 patients had various degrees of mental retardation. Mean reduction in severity of seizure activity was 64%. Nineteen of 25 (76%) parents were satisfied with the surgical result. Eighteen of 25 parents (72%) described a good level of satisfaction with their families QOL after callostomy. Reduction in severity of seizure activity was significantly correlated with how successful families considered the surgery to be and how satisfied they were with their QOL (r = 0.72 and 0.77, respectively). Life domains showing one greatest improvement after callostomy included level of self-care, family life, and school performance. Improvements in level of self-care, family life, and school performance were associated with higher levels of life satisfaction (r = 0.69, 0.60, and 0.59, respectively). Hyperactivity, attention span, and social skills improved significantly in 11 patients after surgery. Callostomy did not improve mental performance. We conclude that improved seizure control after callostomy is also associated with improved QOL.

Neonatal alloimmune thrombocytopenia in Taiwan due to an antibody against a labile component of HPA-3a (Baka)

We report on two siblings who developed severe neonatal alloimmune thrombocytopenia (NAIT) due to an alloantibody against a labile component or components of the HPA-3a (Baka) antigen. The antibody reacted only with fresh, unfixed platelets by the solid-phase red cell adherence test, immunofluorescence test and mixed passive haemagglutination test. In the latter method, weakly fixed platelets also gave a weak positive reaction. Monoclonal-antibody-specific immobilization of platelet antigens and immunoblotting tests gave negative results. Our findings may possibly help to explain why in some cases of NAIT no platelet-specific antibody is demonstrable in tests with fixed or solubilized platelets.

Inhibition of herpes simplex virus type 1 helicase-primase by (dichloroanilino)purines and -pyrimidines

Herpes simplex virus type 1 (HSV1) encodes a heterotrimeric helicase-primase comprised of the products of three of the seven DNA replication-specific genes. Several dihalo-substituted derivatives of N2-phenylguanines and 2-anilinoadenines weakly inhibited the intrinsic DNA-dependent NTPase activity of the HSV1 helicase-primase, and these compounds inhibited the DNA-unwinding activity of the enzyme. The primase activity of the enzyme was strongly inhibited by 3,4- and 3,5-dichloroanilino derivatives of adenine and 2-aminopyrimidines. These compounds and nucleoside analogs of 2-(3,5-dichloroanilino)purines inhibited viral DNA synthesis in HSV1-infected HeLa cells in culture but also inhibited cellular DNA synthesis, likely as a result of inhibition of cellular primase and/or DNA polymerases.

Haloanilino derivatives of pyrimidines, purines, and purine nucleoside analogs: synthesis and activity against human cytomegalovirus

2-Anilinopurines and 6-anilinopyrimidines bearing 3,4- or 3,5-dichloro substituents in the anilino ring inhibited virus-specific DNA synthesis by human cytomegalovirus (HCMV)-infected human embryonic lung (HEL) cells in culture. In general, active compounds had moderate to low selectivity for viral vs host cell DNA synthesis. Nucleoside and acyclonucleoside analogs of 2-(3,5-dichloroanilino)purines inhibited both HCMV and cellular DNA synthesis at similar concentrations. 2-Amino-4-chloro-6-(3,5-dichloroanilino)pyrimidine and several related compounds inhibited HCMV growth in yield reduction assays at concentrations that were nontoxic to HEL cells.

Normal limits of the derived vectorcardiogram in Caucasians

The derived vectorcardiogram (dVCG) can be obtained from three orthogonal leads X, Y, Z, which are synthesized from the conventional 12-lead ECG by one of a number of mathematical techniques. The application of the dVCG in routine cardiological practice has the advantage of not requiring extra recording electrode other than those used for the conventional 12 electrocardiographic leads, and offers the simultaneous availability of additional dVCG diagnostic information. In this study, the dVCGs were obtained using the inverse Dower method from 1555 apparently healthy Caucasian individuals (884 men and 671 women) and were analysed to determine the age and sex dependent normal ranges of vector measurements in a Caucasian population. The vectorcardiographic parameters measured included the directions of inscription of the QRS vector loops, the magnitude of initial 20 and 30 ms QRS vectors and the direction of the initial 20 ms QRS vector. The maximal spatial QRS vector magnitude, as well as the maximal QRS and T vector magnitudes in the frontal, horizontal, and right sagittal planes, were observed to decrease significantly with advancing age in both sexes (P < 0.001) and were significantly larger in men in all age groups (P < 0.001). The observations from the current study illustrate the significant age and sex dependent differences in the normal ranges of dVCG parameters. These are of potential importance for diagnostic applications.

Artificial neural networks for the diagnosis of atrial fibrillation

Different forms of artificial intelligence have been applied to pattern recognition in medicine. Recently, however, a relatively new technique involving software-based neural networks has become more readily available. Deterministic logic is currently applied to rhythm analysis in computer-assisted ECG interpretation methods developed in the University of Glasgow. The aim of the present study is to compare an artificial neural network with deterministic logic for separating sinus rhythm (SR) with supraventricular extrasystoles (SVEs) and/or ventricular extra-systoles (VEs) from atrial fibrillation (AF) at a particular point in the diagnostic logic of the Glasgow Program. A total of 2363 ECGs with 1495 AF and 868 SR + (SVEs and/or VEs) are used for training and testing a variety of neural networks, and the optimum design is selected. Methods for combining the results of the neural-network classification and the deterministic interpretation are also developed. A further 717 ECGs are used to test the selected network. The results show that the use of an artificial neural network can improve the sensitivity of reporting AF from 88.5% using the deterministic approach to 92%, without sacrificing specificity (92.3%).

Comparison of the derived vectorcardiogram in apparently healthy whites and Chinese

A total of 2,058 vectorcardiograms derived from the conventional 12-lead electrocardiogram (1,555 whites [884 men and 671 women], aged between 16 and 64 years, and 503 Chinese [248 men and 255 women], aged between 18 and 81 years) were analyzed. The results were assessed to demonstrate the importance of the impact of racial variation on vectorcardiographic appearances. The trend of the influence of age and sex on the magnitude and the direction of the QRS and T vectors was found to be similar in both races. In the groups aged younger than 40 years, the magnitude of the maximal spatial QRS vector was found to be greater in whites than in Chinese, while in the groups aged 40 years or older, it was greater in Chinese than in whites. Therefore, this indicates that it is necessary to take racial variation into consideration for interpretation of the derived vectorcardiogram. In conclusion, it has been shown in the present study that derived vectorcardiogram diagnostic criteria should not only be age and sex dependent but also race dependent.

New sex dependent normal limits of the signal averaged electrocardiogram

BACKGROUND

An earlier study of 1555 normal 12 lead electrocardiograms has shown that the mean QRS duration in men is 8 ms longer than in women.

OBJECTIVE

To establish the sex related normal limits of the signal averaged electrocardiogram. PEOPLE: 195 people (160 men and 35 women aged 40 to 69) with normal clinical history, physical examination, 12 lead electrocardiogram, and echocardiogram were recruited for this study.

METHODS

Signal averaged electrocardiograms were recorded by the Arrhythmia Research Technology 1200 EPX machine and analysed twice with bidirectional Butterworth filters with frequency ranges of 25-250 Hz and 40-250 Hz. Three time domain parameters of the QRS vector magnitude, namely filtered total QRS duration, duration of low amplitude signals under 40 microV (LAS40), and root mean square voltage of the last 40 ms (RMS40), were evaluated.

RESULTS

There were significant differences between the two sexes in QRS duration (mean (95% confidence interval (95% CI) (8.0 (3.1 to 13.0) ms, t = 3.29, degrees of freedom = 41, p = 0.0021 with the 25-250Hz filter; mean (95% CI) 10.2 (6.9 to 13.5) ms, t = 6.26, degrees of freedom = 53, p < 0.0001 with the 40-250Hz filter)) and in body surface area (mean (95% CI) 0.26 (0.21 to 0.31) m2, t = 10.63, degrees of freedom = 57). There was no significant correlation between age and QRS duration, LAS40, or RMS40, but there was a highly significant correlation between body surface area and QRS duration (correlation coefficient = 0.396, p < 0.0005) and RMS40 (correlation coefficient = -0.159, p < 0.025). Current sex independent criteria defining ventricular late potentials as the presence of any two of QRS duration > 114 ms, LAS40 > 38 ms, RMS40 < 20 microV, give a specificity of 85% for men and 91% for women in this normal population.

RECOMMENDATIONS

Ventricular late potentials should be regarded as present when (a) QRS duration exceeds 114 ms in men or 104 ms in women and (b) either LAS40 > 38 ms or RMS40 < 20 microV. This gives a specificity of 97% in men and 100% in women in the population studied.

Use of artificial neural networks within deterministic logic for the computer ECG diagnosis of inferior myocardial infarction

An investigation into the use of software-based artificial neural networks for the electrocardiographic (ECG) detection of inferior myocardial infarction was made. A total of 592 clinically validated subjects, including 208 with inferior myocardial infarction, 300 normal subjects, and 84 left ventricular hypertrophy cases, were used in this study. A total of 200 ECGs (100 from patients with inferior myocardial infarction and 100 from normal subjects) were fed to 66 supervised feedforward neural networks for training using a back-propagation algorithm. QRS and ST-T wave measurements were used as the input parameters for the neural networks. The best performing network using QRS measurements only and the best using QRS and ST-T data were selected by assessing a test set of 292 ECGs (108 from patients with inferior myocardial infarction, 84 from patients with left ventricular hypertrophy, and 100 from normal subjects). These two networks were then implanted separately into the deterministic Glasgow program for further study. After the implementation, it was found necessary to include a small inferior Q criterion to improve the specificity of reporting inferior myocardial infarction, thereby producing a small loss of sensitivity as compared with use of the network alone. The use of an artificial neural network within the deterministic logic performed better than either alone in the diagnosis of inferior myocardial infarction, producing a 20% gain in sensitivity with 2% loss in overall specificity compared with the original deterministic logic.

Effects of age, sex, and race on ECG interval measurements

The effects of age, sex, and race on the electrocardiogram (ECG) were studied using three separate populations: a pediatric group of 1,782 neonates, infants, and children, and adult white group of 1,555 individuals, and an adult Chinese cohort of 503 individuals. All ECGs were processed using the same computer program, and various interval measurements were derived, including QRS duration, heart rate, QT dispersion, and selected Q-wave durations. Also, a small subgroup of 195 white subjects had a signal-averaged ECG recorded. In the pediatric group, there was a clear link between age and QRS duration, which increased linearly from about 1 year of age to adolescence. In the adults, the principal differences were an increased QRS duration in men compared with women both in the standard and signal-averaged ECG. Upper limits of normal heart rate also tended to be higher in women than in men in the two adult populations. Small racial differences could be seen in some measurements, but were not thought to be of clinical significance.

Smoothing techniques for improving the repeatability of the automated diagnosis of inferior myocardial infarction

This study describes the implementation of novel techniques that have been designed with the aim of improving the repeatability of the diagnostic section of the Glasgow electrocardiographic (ECG) analysis program. Specific reference is made to the agreement in consecutive computer-assisted diagnoses of inferior myocardial infarction (IMI). Inherent repeat variation was estimated in ECG parameters of interest and used in conjunction with smoothing methods to produce a continuous Q-wave index ranging from 0 (no IMI) to 1 (IMI). A decision as to the presence or absence of IMI was then made on the basis of this smooth index. The sensitivity and specificity of the new approach remain unchanged from the conventional procedure when analyzing single ECGs. However, consistency in interpretation of day-to-day and minute-to-minute ECG interpretations was enhanced. Specific reference is made to the agreement between consecutive pairs of computer-assisted diagnoses of ECGs from the same patient with which one or both interpretations was that of IMI.

Normal limits of derived vectorcardiogram in Chinese

Derived vectorcardiograms from 503 healthy Chinese individuals (248 men and 255 women) were analyzed to determine the normal ranges of scalar and vector measurements in a Chinese population. In both sexes, the magnitude of the maximal spatial QRS and T vectors decreased significantly with age and was significantly smaller in women in all age groups. The results of this study were concordant with the results of previous studies using the Frank lead system in Caucasians, but the derived vectorcardiogram has the advantage of not requiring any leads additional to those used for recording the conventional 12-lead electrocardiogram. In conclusion, it was found that for healthy Chinese individuals there are significant age and sex related influences on the normal ranges of derived vectorcardiograms. Therefore, vectorcardiographic diagnostic criteria for Chinese individuals should be age-related and sex-related.

Frequency of platelet-specific antigens among Chinese in Taiwan

The frequencies of six platelet-specific antigens among Chinese in Taiwan are reported, which have not previously been well studied. HPA-1a (PlA1) antigen was positive in all 1100 Chinese tested. HPA-4b (Yukb) antigen was positive in all 100 persons tested. HPA-2b (Ko(a), Sib(a)) antigen was positive in 9 percent of 100 persons tested, HPA-3a (Bak(a)) in 77 percent, and NAKa in 96 percent. HPA-4a (Yuk(a)) antigen occurred in 0 percent in this study but is estimated to be present in 0.5 percent of the Taiwanese population.

Role of specific dopamine receptor subtypes in amphetamine discrimination

Biochemical, electrophysiological, and behavioral experiments suggest that the dopamine D-1 and D-2 receptor subtypes functionally interact. In rats trained to discriminate 1.0 mg/kg d-amphetamine, substitution with the D-2 agonist quinpirole (0.1-2.0 mg/kg) produces amphetamine-lever responding, whereas the D-1 agonist SKF 38393 (0.3-10.0 mg/kg) elicits only saline-appropriate responding. Combining either quinpirole (0.05-0.5 mg/kg) or SKF 38393 (0.5-10.0 mg/kg) with 0.3 mg/kg d-amphetamine results in dose-dependent increases in amphetamine-lever responding. Conversely, the D-1 antagonist SCH 23390 (0.02-0.1 mg/kg) antagonizes the discrimination produced by 0.7 mg/kg d-amphetamine. Additional combination studies examined the effect of DA receptor drugs on discrimination when quinpirole is substituted in d-amphetamine trained rats. SKF 38393 (0.5-7.0 mg/kg) fails to increase the amphetamine-appropriate lever response produced by either 0.05 or 0.2 mg/kg quinpirole. Similarly, SCH 23390 (0.01-0.1 mg/kg) fails to antagonize the amphetamine-lever responding produced by either 0.2 or 0.5 mg/kg quinpirole. Haloperidol (0.02-0.2 mg/kg) does antagonize the amphetamine-appropriate response produced by quinpirole substitution. The d-amphetamine discrimination studies indicate that stimulating D-2 receptors alone or D-1 receptors in the presence of d-amphetamine yields d-amphetamine-lever responding, and suggests that D-1/D-2 receptors can functionally interact to alter discrimination behavior. Quinpirole substitution, on the other hand, shows an insensitivity to D-1 receptor manipulations.

HLA antigens among Chinese in Taiwan: association of Cw1 and Cw3 on the same haplotype

HLA-A, B and C phenotypes and gene frequencies of Chinese living in Taiwan are presented. Cw1 and Cw3 were frequently found to segregate together on the same haplotype.