Real-world effectiveness and safety of edoxaban in patients with and without a history of ischaemic stroke: results from the ETNA-AF programme

Background

Atrial fibrillation (AF) patients with a history of ischaemic stroke (IS) have a higher risk for recurrent IS events and were largely excluded from the pivotal, randomised, controlled phase 3 trials on oral anticoagulants. Thus, the effectiveness and safety of edoxaban in these patients need to be studied in a real-world setting.

Purpose

To compare edoxaban real-world effectiveness and safety in AF patients with or without an IS history.

Methods

The Global ETNA-AF programme (EU: NCT02944019, Japan: UMIN000017011, South Korea/Taiwan: NCT02951039) integrates data from multiple prospective, observational, noninterventional regional studies of AF patients receiving edoxaban for stroke prevention. This snapshot analysis summarises baseline characteristics with medical history and 2-year annualised rates of all-cause death, cardiovascular (CV) death, stroke (haemorrhagic, ischaemic, any), and bleeding (including major bleeding [MB], major gastrointestinal [GI] bleeding, intracranial haemorrhage [ICH], clinically relevant nonmajor bleeding [CRNMB], and any bleeding) in patients with or without IS history.

Results

Data from 27,333 patients (3215 with prior IS and 24,118 without) from Europe, Japan, South Korea, and Taiwan were analysed. Patients with IS history were significantly older, more likely ≥75 years of age, and had a lower mean body weight and creatinine clearance (P<0.0001 for all; Table). Patients with IS history also had significantly higher baseline stroke (CHA2DS2-VASc) and bleeding (HAS-BLED) risk scores (P<0.0001 for both; Table). A significantly higher percentage of patients with IS history had previous transient ischaemic attacks (TIA), MB, and ICH (P<0.0001 for all; Table). Patients with IS history more likely received edoxaban 30 mg vs 60 mg at baseline (P<0.0001). Effectiveness and safety outcomes hazard ratios are shown in the Figure. Patients with IS history had significantly higher rates of all-cause death (4.5% vs 3.0%; P<0.0001), CV death (1.9% vs 1.4%; P=0.004), IS (2.5% vs 0.5%; P<0.0001), any stroke (3.1% vs 0.7%; P<0.0001), and TIA (0.5% vs 0.2%; P=0.0002). Patients with IS history had significantly higher annualised rates of MB (1.6% vs 1.0%; P<0.0001), major GI bleeding (0.8% vs 0.5%; P=0.003), ICH (0.6% vs 0.3%; P<0.0001), haemorrhagic stroke (0.5% vs 0.2%; P<0.0001), CRNMB (2.3% vs 1.3%; P<0.0001), and any bleeding (6.1% vs 4.1%; P<0.0001).

Conclusions

Patients with AF who have a history of IS are more likely elderly; have histories of MB, ICH, and TIA; and have high baseline stroke and bleeding risk scores. Patients with IS history receiving edoxaban have a considerably higher likelihood of experiencing IS or TIA, whereas the risk of experiencing any bleeding event (with the exception of ICH) is only modestly higher than in those without IS history.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo

Severe myocardial bridge presenting as paroxysmal atrioventricular block

Chest pain complicated with electrocardiographic changes is not an uncommon scenario in emergency departments, which should be examined cautiously. We describe a 51-years-old man with a myocardial bridge of coronary artery presenting with simultaneous Mobitz type I atrioventricular block on electrocardiography. Echocardiography excluded valvular abnormality and systolic/diastolic dysfunction. Coronary angiography confirmed the diagnosis of a myocardial bridge at the middle segment of the left anterior descending artery, involving the most dominant septal perforator branch with marked systolic compression. The patient underwent coronary artery bypass grafting surgery and was followed up uneventfully at the outpatient department with medical treatment of diltiazem and clopidogrel. The present case is being reported to highlight that clinicians should be alert to such a congenital abnormality as a potential cause of repeated myocardial infarction and conduction abnormality.

Brain death in children: a retrospective review of patients at a paediatric intensive care unit

PURPOSE

Among patients in paediatric intensive care units (PICUs), death is sometimes inevitable despite advances in treatment. Some PICU patients may have irreversible cessation of all brain function, which is considered as brain death (BD). This study investigated demographic and clinical differences between PICU patients with BD and those with cardiopulmonary death.

METHODS

All children who died in the PICU at a university-affiliated trauma centre between October 2002 and October 2018 were included in this retrospective study. Demographics and clinical characteristics were compared between patients with BD and patients with cardiopulmonary death.

RESULTS

Of the 2784 patients admitted to the PICU during the study period, 127 died (4.6%). Of these 127 deaths, 22 (17.3%) were BD and 105 were cardiopulmonary death. Length of PICU stay was shorter for patients with cardiopulmonary death than for patients with BD (2 vs 8.5 days, P=0.0042). The most common mechanisms of injury in patients with BD were hypoxic-ischaemic injury (40.9%), central nervous system infection (18.2%), and traumatic brain injury (13.6%). The combined proportion of accident and trauma-related injury was greater in patients with BD than in patients with cardiopulmonary death (27.3% vs 3.8%, P<0.001). Organ donation was approved by the families of four of the 22 patients with BD (18.2%) and was performed successfully in three of these four patients.

CONCLUSIONS

These findings emphasise the importance of injury prevention in childhood, as well as the need for education of the public regarding acceptance of BD and support for organ donation.

Creating virtual 3-dimensional models for teaching pre-clinical tooth preparation: Students' usages and perceptions

PURPOSE

This research aimed to evaluate the students' usage and perceptions of using smartphones in their general dental education and learning tooth preparation with the individually designed virtual 3D instructional models in the pre-clinical removable partial denture course.

MATERIALS AND METHODS

Second-year dental students were asked to voluntarily participate in a survey to investigate their demographic information, general usages of smartphones, perception of smartphones usage in dental education (construct 1) and perception of individually designed virtual 3D instructional models (construct 2). Students' responses of general usages of the smartphones were compared with their demographic and educational backgrounds using nonparametric Kruskal-Wallis test (for age) and Fisher's exact test (for sex, race and educational background). The sums of scores of the construct 1 and construct 2 were tested for associations with student's demographic and educational backgrounds using the Pearson product-moment correlation (for age), t test (for sex and educational background) or one-way ANOVA F test (for race) (α = .05).

RESULTS

A 75% response rate (N = 90) was achieved in this study, and all 90 participants owned smartphones. Students' responses to general usages of the smartphones were not significantly influenced by their demographic background. For the construct 1, more than 73% of participants responded either agree or strongly agree to the usage of smartphones in general dental education and pre-clinical setting; however, only 49% of participants responded the same way in the clinical setting. For the construct 2, 48 of 90 participants viewed the 3D models, and more than 73% of these 48 participants responded either agree or strongly agree to the usage of the 3D models in the pre-clinical course. Student's demographic background did not have significant influence on the sums of scores of the construct 1 and construct 2.

CONCLUSIONS

Within the limitations of this study, high usages and ownerships of smartphones were found amongst the students surveyed. The individually designed virtual 3D instructional models as supplemental teaching materials in the pre-clinical course were perceived positively by the students.

High temperature oxidation of iron–iron oxide core–shell nanowires composed of iron nanoparticles

The thermal oxidation of iron nanowires causes their breakdown due to void coalescence and formation of α-Fe₂O₃microparticles and microrods.

Dental student perception and assessment of their clinical knowledge in educating patients about preventive dentistry

In today's dental school curricula, an increasing amount of time is dedicated to technological advances, and preventive dentistry topics may not be adequately addressed. Freshman (D1) students participated in a new Introduction to Preventive Dentistry course, which consisted of didactic lectures, active learning breakout sessions and case-based studies. The goal of this study was to determine if D1 dental students completing the course had a better knowledge and comfort level with basic preventive dentistry concepts and caries risk assessment than the upcoming graduating senior dental students. Following the completion of the course, D1 students were administered a survey that assessed their comfort level describing preventive dentistry topics to patients. This was immediately followed by an unannounced examination over the same topics. Senior (D4) students, who had not taken a formal course, reported statistically significant higher comfort levels than D1 students. However, the D4s scored significantly lower in all of the examination areas than the D1 students. Higher scores in D1s may have been due to recent exposure to the course material. However, the basic nature of the content-specific questions should be easily answered by novice practitioners educating their patients on oral disease prevention. As the current data shows lower content-specific scores of basic preventive dentistry knowledge amongst graduating D4 students, this may indicate a need for more guidance and education of students during the patient care. This study showed that implementation of a formalised course for D1 students can successfully ameliorate deficiencies in knowledge of preventive dentistry topics.

Establishment of a prediction model for the miRNA-based heading date characteristics of rice in the booting stage

Rice (Oryza sativa L.) is one of the most important food crops in the world. In Taiwan, due to the warm climate, there are two harvests annually. However, the yield and quality of rice can vary between each crop season in any given year. Previous reports have shown that microRNAs (miRNAs) play a crucial role in many developmental and physiological processes in plants. In this study, the heading date characteristics of 167 rice cultivars from the second crop season were recorded, and 27 rice cultivars were selected for preliminary microarray analysis. A total of 14 miRNAs from different heading date characteristics in 21 cultivars were selected based on significant differences in their expression profiles. Using a correlation analysis between the heading date and selected miRNA expression obtained from real-time polymerase chain reaction (PCR) assays, we developed a heading date prediction model. The model includes nine miRNA genes with corresponding R2 values of 0.8. To confirm the model, a real-time PCR analysis was performed on an additional 27 rice cultivars and we found the model predicted the heading date with accuracy. Therefore, the developed prediction may be useful in further studies aimed at confirming the reliability of the use of miRNA in molecular breeding and to increase the selection efficiency of rice cultivars and breeding.

Digital workflow for virtually designing and milling ceramic lithium disilicate veneers: a clinical report

Laminate veneers have been routinely used to restore and enhance the appearance of natural dentition. The traditional pathway for fabricating veneers consisted of making conventional polyvinyl siloxane impressions, producing stone casts, and fabricating final porcelain prostheses on stone dies. Pressed ceramics have successfully been used for laminate veneer fabrication for several years. Recently, digital computer-aided design/computer-aided manufacturing scanning has become commercially available to make a digital impression that is sent electronically to a dental laboratory or a chairside milling machine. However, technology has been developed to allow digital data acquisition in conjunction with electronically transmitted data that enables virtual design of restorations and milling at a remote production center. Following the aforementioned workflow will provide the opportunity to fabricate a physical cast-free restoration. This new technique has been reported recently for all-ceramic IPS e.max full-coverage pressed-ceramic restorations. However, laminate veneers are very delicate and technique-sensitive restorations when compared with all-ceramic full-coverage ones made from the same material. Complete digital design and fabrication of multiple consecutive laminate veneers seems to be very challenging. This clinical report presents the digital workflow for the virtual design and fabrication of multiple laminate veneers in a patient for enhancing the esthetics of his maxillary anterior teeth. A step-by-step process is presented with a discussion of the advantages and disadvantages of this novel technique. Additionally, the use of lithium disilicate ceramic as the material of choice and the rationale for such a decision is discussed.

Predictable Restorative Work Flow for Computer-Aided Design/Computer-Aided Manufacture-Fabricated Ceramic Veneers Utilizing a Virtual Smile Design Principle

The purpose of this case report was to present the use of a contemporary digital photograph-assisted virtual smile design principle, an intraoral digital impression, and computer-aided design/computer-aided manufacture-fabricated lithium disilicate ceramic veneers to treat a patient with esthetic needs in the maxillary anterior region. By using the proposed digital restorative work flow, this case report demonstrated an effective communication pathway between the patient, clinician, and dental laboratory technician. Effective communication can help to achieve a more predictable and satisfactory esthetic outcome.

β-Phase poly(vinylidene fluoride) films encouraged more homogeneous cell distribution and more significant deposition of fibronectin towards the cell-material interface compared to α-phase poly(vinylidene fluoride) films

The piezoelectric response from β-phase poly(vinylidene fluoride) (PVDF) can potentially be exploited for biomedical application. We hypothesized that α and β-phase PVDF exert direct but different influence on cellular behavior. α- and β-phase PVDF films were synthesized through solution casting and characterized with FT-IR, XRD, AFM and PFM to ensure successful fabrication of α and β-phase PVDF films. Cellular evaluation with L929 mouse fibroblasts over one-week was conducted with AlamarBlue® metabolic assay and PicoGreen® proliferation assay. Immunostaining of fibronectin investigated the extent and distribution of extracellular matrix deposition. Image saliency analysis quantified differences in cellular distribution on the PVDF films. Our results showed that β-phase PVDF films with the largest area expressing piezoelectric effect elicited highest cell metabolic activity at day 3 of culture. Increased fibronectin adsorption towards the cell-material interface was shown on β-phase PVDF films. Image saliency analysis showed that fibroblasts on β-phase PVDF films were more homogeneously distributed than on α-phase PVDF films. Taken collectively, the different molecular packing of α and β-phase PVDF resulted in differing physical properties of films, which in turn induced differences in cellular behaviors. Further analysis of how α and β-phase PVDF may evoke specific cellular behavior to suit particular application will be intriguing.

High-dose versus low-dose esomeprazole-based triple therapy for Helicobacter pylori infection

BACKGROUND

This prospective, randomized, controlled study was conducted to compare the efficacies of high-dose and low-dose esomeprazole-based triple therapies for Helicobacter pylori eradication in Taiwan.

MATERIALS AND METHODS

From January 2004 to June 2006, 240 H. pylori-infected patients were randomly assigned to undergo high-dose (40 mg b.d.) or low-dose (40 mg o.d.) esomeprazole combined with clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for one week. Follow-up endoscopy was performed at eight weeks after the end of treatment to evaluate the response to therapy.

RESULTS

Intention-to-treat analysis demonstrated no differences between eradication rates of high-dose and low-dose groups (92% vs. 90%, respectively, P > 0.05). Per-protocol analysis yielded comparable results (95% vs. 93%). Both groups exhibited similar frequencies of adverse events (13% vs. 11%) and drug compliance (96% vs. 93%). Multivariate analysis indicated that only good compliance (odds ratio: 10.3, 95% CI, 3.0-35.7) was an independent predictor of treatment success.

CONCLUSIONS

This work demonstrates that low-dose esomeprazole-based triple therapy yields a similar eradication rate as high-dose esomeprazole-based therapy in Taiwan. Since the cost of the low-dose regime is lower than that of the high-dose regime, low-dose esomeprazole-based triple therapy can reasonably be recommended for the first-line eradication of H. pylori for Taiwanese and probably most Asians.

A simplified model to predict the thermal response of PLG and its influence on BLEVE

A simplified model has been developed to describe the thermal response of pressure liquefied gas (PLG) tanks subjected to fire. The development of the stratification layer is considered in this model. Comparison of results with available experimental data shows that our proposed model can reasonably predict the thermal response. The effect of stratification on the liquid energy is also summarized. Results show that the pressure in the tank rises faster as a result of thermal stratification, and for the same tank pressure the energy in the liquid is less when the liquid is stratified. Stratification can reduce the severity of hazards of boiling liquid expanding vapor explosion (BLEVE).

A new synnematous species of Penicillium from soil in Taiwan

A synnematous species of Penicillium, P. calidicanium, is described and illustrated. The fungus was isolated from soil in Taiwan. Penicillium calidicanium can be placed in subgenus Biverticillium because of its symmetrical, biverticillate penicilli, ampulliform to acerose phialides, and ability to produce abundant synnemata in Czapek yeast extract agar, malt extract agar, and Czapek's solution agar. It is close to P. duclauxii and P. vulpinum, but differs in colony morphology, growth rate, morphology of the synnemata, and ornamentation of the conidial wall.

Mechanisms of transition between double paroxysmal supraventricular tachycardias

INTRODUCTION

Coexistence of double tachycardias in one patient has been infrequently reported. Furthermore, the mechanisms of transition between double paroxysmal supraventricular tachycardias have not been well studied.

METHODS AND RESULTS

Thirty-five patients with two paroxysmal supraventricular tachycardias were studied. Group IA consisted of 3 patients with spontaneous transition between AV reciprocating tachycardia (AVRT) and AV nodal reentrant tachycardia (AVNRT). Group IB consisted of 13 patients without spontaneous transition between AVRT and AVNRT. Group IIA consisted of 5 patients with spontaneous transition between AVNRT and atrial tachycardia (AT). Group IIB consisted of 14 patients without spontaneous transition between AVNRT and AT. The absolute values of differences between the two tachycardia cycle lengths were significantly smaller in patients with than in those without transition between the two tachycardias (25+/-8 msec vs 90+/-46 msec, P < 0.05, IA vs IB; 21+/-25 msec vs 99+/-57 msec, P < 0.01, IIA vs IIB). The cutoff point of 25 msec had 80% positive predictive value for transition between the two tachycardias. Transition between two tachycardias occurred due to a spontaneous premature atrial complex (30%), conduction block at one limb of tachycardia (20%), or tachycardia-induced tachycardia (50%). Absence of transition between two tachycardias might be explained by the absence of a spontaneous premature atrial complex, longer cycle length of the first tachycardia, larger difference between two tachycardia cycle lengths, or induction of each tachycardia under different situations.

CONCLUSION

Double supraventricular tachycardias with similar tachycardia cycle lengths are vulnerable to transition between different tachycardias.

Effects of cavotricuspid isthmus ablation on atrioventricular node electrophysiology in patients with typical atrial flutter

BACKGROUND

The atrial musculature in the cavotricuspid isthmus is a part of posterior inputs to the AV node. In patients with typical atrial flutter, effects of radiofrequency ablation of this isthmus on AV node conduction are still unknown.

METHODS AND RESULTS

This study included 16 patients with clinically documented typical atrial flutter. Group 1 had 8 patients without and group 2 had 8 patients with dual AV nodal pathway physiology. Electrical pacing from the interatrial septum and low right atrium was performed to evaluate antegrade AV node function before and after ablation of the cavotricuspid isthmus. In group 1, the AV node conduction properties were similar before and after ablation. In group 2, the AV node Wenckebach cycle length and maximal AH interval during low right atrium (356+/-58 versus 399+/-49 ms, P=0.008; 303+/-57 versus 376+/-50 ms, P=0.008) and interatrial septum (365+/-62 versus 393+/-59 ms, P=0.008; 324+/-52 versus 390+/-60 ms, P=0.008) pacing were significantly longer after ablation. Elimination of the slow pathway after ablation was noted in 2 patients, including 1 with AV nodal reentrant echo beats.

CONCLUSIONS

Radiofrequency ablation of the cavotricuspid isthmus was effective in eliminating typical atrial flutter without injury of antegrade fast AV node conduction. The atrial musculature in the cavotricuspid isthmus significantly contributed to the slow AV node conduction.

Acquired pulmonary vein stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation

INTRODUCTION

Elimination of the initiating focus within the pulmonary vein (PV) using radiofrequency (RF) catheter ablation is a new treatment modality for treatment of drug-refractory atrial fibrillation. However, information on the long-term safety of RF ablation within the PV is limited.

METHODS AND RESULTS

In 102 patients with drug-refractory atrial fibrillation and at least one initiating focus from the PV, series transesophageal echocardiography was performed to monitor the effect of RF ablation on the PV. There were 66 foci in the right upper PV and 65 foci in the left upper PV. Within 3 days of ablation, 26 of the ablated right upper PVs (39%) had increased peak Doppler flow velocity (mean 130+/-28 cm/sec, range 106 to 220), and 15 of the ablated left upper PVs (23%) had increased peak Doppler flow velocity (mean 140+/-39 cm/sec, range 105 to 219). Seven patients had increased peak Doppler flow velocity in both upper PVs. No factor (including age, sex, site of ablation, number of RF pulses, pulse duration, and temperature) could predict PV stenosis after RF ablation. Three patients with stenosis of both upper PVs experienced mild dyspnea on exertion, but only one had mild increase of pulmonary pressure. There was no significant change of peak and mean flow velocity and of PV diameter in sequential follow-up studies up to 16 (209+/-94 days) months.

CONCLUSION

Focal PV stenosis is observed frequently after RF catheter ablation applied within the vein, but usually is without clinical significance. However, ablation within multiple PVs might cause pulmonary hypertension and should be considered a limiting factor in this procedure.

Pulmonary vein dilation in patients with atrial fibrillation: detection by magnetic resonance imaging

INTRODUCTION

The positive relationship between left atrial (LA) size and atrial fibrillation (AF) is well recognized; however, there is little information on the association of pulmonary vein (PV) diameter and AF. The purpose of this study was to investigate by magnetic resonance angiography the change of PV and LA size in patients with no history of AF, patients with paroxysmal AF (PAF), and patients with chronic AF (CAF).

METHODS AND RESULTS

The study included 47 patients. Group I included 15 patients with normal sinus rhythm and no history of documented AF. Group II included 24 patients with drug-refractory PAF who underwent electrophysiologic study and radiofrequency ablation of PV foci. Group III included 8 patients with CAF who were converted to sinus rhythm by external electrical cardioversion. Age and concomitant heart diseases were similar among the three groups. We measured the diameter of each PV at its junction with the LA in addition to LA dimensions by gadolinium-enhanced magnetic resonance angiography with three-dimensional reconstruction. Significant dilation of both superior PVs (P < 0.01) and transverse diameter of LA (P < 0.01) was seen in the three groups. There were no significant changes of both inferior PVs, corrected PV (PV/LA) diameter, or longitudinal diameter of LA among the three groups. Only 28% patients showed arrhythmogenic foci from the largest PV.

CONCLUSION

Significant dilation of both superior PVs with simultaneous LA enlargement was demonstrated i

Mechanism of spontaneous transition from typical atrial flutter to atrial fibrillation: role of ectopic atrial fibrillation foci

Paroxysmal AF has been known to be initiated by ectopic beats, especially in the pulmonary veins (PVs), and radiofrequency catheter ablation could cure it. We considered that the spontaneous transition from typical atrial flutter to AF also could be initiated by ectopic beats. Twenty patients (18 men, mean age 66 +/- 14 years) with episodes of spontaneous transition from typical atrial flutter to AF were included in this study. They underwent detailed mapping of both atria. All the patients had spontaneous AF initiated by ectopic beats, and all of them had typical atrial flutter and spontaneous transition from typical atrial flutter (12 patients with counterclockwise atrial flutter and 8 patients with clockwise atrial flutter) to AF. The transition was initiated by ectopic beats from the PVs (17 foci, 85%), crista terminalis (2 foci, 10%), and superior vena cava (1 focus, 5%). After successful ablation of AF foci, typical atrial flutter was induced again, but no spontaneous transition was found after at least 10 minutes of observation. We concluded that paroxysmal AF and spontaneous transition from typical atrial flutter to AF were initiated by ectopic beats, and successful catheter ablation of the ectopic foci can eliminate paroxysmal AF and spontaneous transition from typical atrial flutter to AF.

Effect of phenylephrine on focal atrial fibrillation originating in the pulmonary veins and superior vena cava

OBJECTIVES

This study was aimed at evaluating the effects of phenylephrine infusion on the occurrence of focal atrial fibrillation (AF).

BACKGROUND

Paroxysmal AF can be initiated by ectopic atrial beats originating in the pulmonary vein (PV) or superior vena cava (SVC). The effect of change in autonomic tone on this focal AF is unknown.

METHODS

This study included 12 patients with frequent bursts of AF documented by 24-h Holter monitoring. The number and coupling interval of spontaneous ectopic activity and bursts of AF were evaluated for 1 min before and after phenylephrine (2 to 3 microg/kg) injection.

RESULTS

After detailed mapping, four patients had a focus located in the left superior PV, six in the right superior PV and two in the SVC. In 10 patients with AF foci originating in the PVs, the frequency of ectopic activity (19.5 +/- 27.4 vs. 11.4 +/- 22.9 beats/min, p = 0.059) was reduced as well as AF bursts (14 +/- 3 vs. 1.8 +/- 2.7 bursts/min, p = 0.005) before versus after phenylephrine injection; the minimal coupling interval of ectopic activity and AF bursts became longer compared with baseline. The maximal percent increase in sinus cycle length after phenylephrine injection was significantly greater in patients with complete suppression of AF compared with those with partial suppression (43 +/- 19 vs. 14 +/- 5%, p = 0.01). However, no significant effect of phenylephrine on AF originating in the SVC was found.

CONCLUSIONS

Change in autonomic tone induced by phenylephrine injection was effective in suppressing focal AF originating in the PVs but not in the SVC.

Effect of suppression of TGF-beta1 expression on cell-cycle and gene expression of beta-1,4-galactosyltransferase 1 in human hepatocarcinoma cells

beta-1,4-galactosyltransferase 1 (beta1,4-GT 1) is localized both in the Golgi complex where it catalyzes the transfer of galactose from UDP-galactose to terminal N-acetylglucosamine forming Galbeta1 --> 4GlcNAc structure, and on the cell surface where it serves as an adhesion molecule. It has previously been reported that the expression of beta1,4-GT 1 was cell-cycle-specific, regulated by cell growth. Transforming growth factor-beta1 (TGF-beta1) could regulate cell G1/S phase transition and modulate cell growth in many types of cells. In this study, we introduced the antisense-TGF-beta1 into SMMC-7721 cell, a human hepatocarcinoma cell line, for blocking its intrinsic TGF-beta1 expression, and changing its cell-cycle, and then analyzed the gene expression of beta1,4-GT 1 together with the beta1,4-GT activity. The result showed that the antisense-TGF-beta1 transfected SMMC-7721 cells (AST/7721) were growth enhanced, with more cells in S phase and less cells in G2/M phase compared with the mock transfected cells (pcDNA3/7721). At the same time, it was found that the gene expression of beta1,4-GT 1 in AST/7721 was decreased to one fifth that of pcDNA3/7721, and the cell surface beta1,4-GT activity was reduced to one fifth of the control, while the total activity of beta1,4-GT was decreased to one half that of the control. The results indicate that suppression of TGF-beta1 expression resulted in change of cell-cycle together with the decreased gene expression of beta1,4-GT 1 and beta1,4-GT activity in human hepatocarcinoma cells.

Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: electrophysiological characteristics and results of radiofrequency ablation

BACKGROUND

The superior vena cava (SVC) has cardiac musculature extending from the right atrium. However, no previous study in humans has given details regarding the ectopic foci that initiate paroxysmal atrial fibrillation (PAF), which may originate from the SVC.

METHODS AND RESULTS

A total of 130 patients with frequent attacks of PAF initiated by ectopic beats were included. Eight patients (6%) had spontaneous AF initiated by a burst of rapid ectopic beats from the SVC (located 19+/-7 mm above the junction of the SVC and right atrium), which was confirmed by multiplane angiographic and intracardiac echocardiographic visualization and was marked by a sharp SVC potential preceding atrial activity. During initial repetitive discharges, the group with SVC ectopy had a higher incidence of intravenous conduction block than the group with pulmonary vein ectopy (75% versus 37%; P=0.03). The activation time of the earliest intracardiac ectopic activities relative to ectopic P wave onset was significantly shorter in the SVC ectopy than the pulmonary vein ectopy group (37+/-15 versus 84+/-32 ms; P<0. 001). After 5+/-3 applications of radiofrequency energy, AF was eliminated. SVC angiography after ablation revealed a local indentation of the venous wall in one patient. Two patients manifested coexisting sinus rhythm and a "focal" fibrillating activity confined inside the SVC after radiofrequency ablation. During a follow-up period of 9+/-3 months, all 8 patients were free of antiarrhythmic drugs, without tachycardia recurrence or symptoms of SVC obstruction.

CONCLUSIONS

Ectopic beats initiating PAF can originate from the SVC. A radiofrequency current delivered to eliminate these ectopies is a highly effective and safe way to prevent PAF.

Predicting the arrhythmogenic foci of atrial fibrillation before atrial transseptal procedure: implication for catheter ablation

INTRODUCTION

Use of endocardial atrial activation sequences from recording catheters in the right atrium, His bundle, and coronary sinus to predict the location of initiating foci of atrial fibrillation (AF) before an atrial transseptal procedure has not been reported. The purpose of the present study was to develop an algorithm using endocardial atrial activation sequences to predict the location of initiating foci of AF before transseptal procedure.

METHODS AND RESULTS

Seventy-five patients (60 men and 15 women, age 68 +/- 12 years) with frequent episodes of paroxysmal AF were referred for radiofrequency ablation. By retrospective analysis, characteristics of the endocardial atrial activation sequences of right atrial, His-bundle, and coronary sinus catheters from the initial 37 patients were correlated with the location of initiating foci of AF, which were confirmed by successful ablation. The endocardial atrial activation sequences of the other 38 patients were evaluated prospectively to predict the location of initiating foci of AF before transseptal procedure using the algorithm derived from the retrospective analysis. Accuracy of the value <0 msec (obtained by subtracting the time interval between high right atrium and His-bundle atrial activation during atrial premature beats from that obtained during sinus rhythm) for discriminating the superior vena cava or upper portion of the crista terminalis from the pulmonary vein (PV) foci was 100%. When the interval between atrial activation of ostial and distal pairs of the coronary sinus catheter of the atrial premature beats was <0 msec, the accuracy for discriminating left PV foci from right PV foci was 92% in the 24 foci from the left PVs and 100% in the 19 foci from the right PVs.

CONCLUSION

Endocardial atrial activation sequences from right atrial, His-bundle, and coronary sinus catheters can accurately predict the location of initiating foci of AF before transseptal procedure. This may facilitate mapping and radiofrequency ablation of paroxysmal AF.

Dependence of electrogram duration in right posteroseptal atrium and atrium-pulmonary vein junction on pacing site: mechanism and implications regarding atrioventricular nodal reentrant tachycardia and paroxysmal atrial fibrillation

INTRODUCTION

The fractionated atrial electrogram, a signal helpful in identifying the target site for radiofrequency catheter ablation of the slow AV nodal pathway, is considered to arise from nonuniform anisotropic electrical activity. However, the effects of pacing sites and radiofrequency ablation on these electrograms are not clear. Similarly, the nature of the fractionated atrial electrogram in the atrium-pulmonary vein junction has yet to be determined.

METHODS AND RESULTS

Two experiments were performed in this study. Experiment 1 evaluated the fractionated atrial electrogram at target sites before and after slow AV nodal pathway ablation during sinus rhythm or during pacing from different sites. Group 1A consisted of 16 patients with dual AV nodal pathway physiology and AV nodal reentrant tachycardia who underwent successful ablation without residual slow AV nodal pathway. Group 1B consisted of 7 patients who underwent successful elimination of AV nodal reentry but with residual dual AV nodal pathway physiology. Group 1C consisted of 6 patients who still had AV nodal reentrant tachycardia after two applications of radiofrequency energy. In group 1D, there were 16 patients with dual AV nodal pathway physiology, but without inducible AV nodal reentrant tachycardia. In group 1E, there were 15 patients without dual AV nodal pathway physiology. Experiment 2 investigated the fractionated atrial electrogram in the ostium of the left and right superior pulmonary veins in 18 patients with paroxysmal atrial fibrillation (2A) and in 8 patients without paroxysmal atrial fibrillation (2B). Before radiofrequency ablation, electrogram duration in the right posteroseptal atrium during pacing from the middle coronary sinus or the right posterolateral atrium was shorter than that during pacing from the high right atrium (HRA) in all group 1 patients. After the successful elimination of the slow AV nodal pathway conduction in group 1A, atrial electrogram duration during HRA pacing was shorter than that before ablation. In experiment 2 patients, electrogram duration during pacing from the proximal or distal coronary sinus was shorter than that during pacing from HRA or sinus rhythm.

CONCLUSION

These findings suggest that the fractionated atrial electrograms in the right posteroseptal atrium and ostium of left or right superior pulmonary veins are potentially consistent with nonuniform anisotropic propagation. Alternations of electrogram characteristics after successful radiofrequency ablation of the slow AV nodal pathway may arise from the changes of nonuniform anisotropic activity in the right posteroseptal atrium.

Pulmonary vein morphology in patients with paroxysmal atrial fibrillation initiated by ectopic beats originating from the pulmonary veins: implications for catheter ablation

BACKGROUND

Successful ablation of ectopic beats originating from the pulmonary veins (PV) could eliminate paroxysmal atrial fibrillation (PAF). However, information about the structure of the PV in patients with PAF that is initiated by PV ectopic beats has not been reported.

METHODS AND RESULTS

We studied the morphology of the PVs and measured their diameters in 3 groups of patients. Group I included 52 patients (aged 66+/-14 years; 44 men) with focal atrial fibrillation (AF) from the PVs. Group II included 8 patients (aged 50+/-10 years; 3 men) with focal AF from the superior vena cava or cristal terminalis. Group III included 23 control patients (aged 55+/-16 years; 17 men). Of the control patients, 11 had AV node and 12 had AV reentrant tachycardia. After an atrial transseptal procedure, selective PV angiography using a biplane system with a right anterior oblique view of 30 degrees, a left anterior oblique view of 60 degrees, and a cranial angle of 20 degrees was performed. The ostial and proximal portions of the right and left superior PVs (RSPV and LSPV) were significantly dilated in group I patients compared with those in groups II and III. Furthermore, the ostia of the RSPV and LSPV were significantly dilated in group II compared with group III patients. However, the mean diameters of the inferior PVs were similar between the 3 groups. Comparisons of the individual PV diameters among the 3 subgroups of group I (which was divided according to where the ectopic focus was located) showed nonselective dilatation of the PV.

CONCLUSIONS

Nonspecific dilatation of the ostia and proximal portion of superior PVs were found in patients with PAF initiated by ectopic beats from the superior PVs.

Comparative physical and genetic maps of the virulence plasmids of Salmonella enterica serovars typhimurium, enteritidis, choleraesuis, and dublin

Using fragment profiling, PCR, and Southern hybridization, we found that Salmonella enterica serovar Choleraesuis harbored virulence plasmids of various sizes, whereas serovars Typhimurium, Enteritidis, and Dublin carried a plasmid of a unique size. Also, the virulence plasmid of Typhimurium contained genes in the same order detected in the other three plasmids, all of which contained deletions.

The status of physical growth in Chinese children

This paper reports the physical growth status of about a half million Chinese children covering 28 nationalities in 1985. There are 4 items (height, weight, sitting-height, and chest circumference) that have been analyzed. Results are as follows: Han children display comparatively high physical growth levels. A growth difference emerges between Han Children who live in different social and geographical environments. The growth of urban children is better than that of rural children; the growth of children living in north China is better than that of children in south China. Differences between administrative regions are rather large. Beijing, Tianjin, Shanghai, Shandong, Liaoning and Heilongjiang display high-level growth; Guizhou, Qinghai, Sichuan, Yunnan, Fujian provinces and Guangxi autonomous region display low-level growth. The growth differences between minority nationalities are noticeable. Uighur, Kazak, Khalkhas, Hui, Mongol, and Korean, nationalities demonstrate relatively high growth level; Lahu, Wa, Yao, Tong, Miao, Puyi and She nationalities appear to maintain a low growth level. The probable reasons for the differences are discussed.

Maximal aerobic capacity and its relationship with physical growth in Chinese children

Maximal aerobic capacity and its relationship to physical growth in 463 Chinese children and adolescents aged 10-19 is reported. Results show that VO2max, VO2max/height and VO2max/HRmax positively relate to measures of physical growth such as height, weight and lean body mass (LBM). Correlation of VO2max/weight with physical growth variables is high and positive in boys and low and negative in girls. The sample is divided to two groups on each variable: well-developed and relatively poorly-developed according to height, weight and LBM. SDS values of VO2max, VO2max/height and VO2max/HRmax are higher in the first group than in the second group. In contrast, SDS values of VO2max/weight and VO2max/LBM are greater in second group. The similarity of results between SDS values with correlation analysis suggest that weight and LBM are probably the decisive factors that influence VO2max.

[Clinical and experimental study on bushen cong-er tablet in treating sensorineural hearing loss]

According to the "Kidney has its orfice in the ear" in TCM theory, the authors adopted Bushen Cong-er tablet, a TCM preparation with the treating principles of the Kidney reinforcing and blood circulation promoting to remove stasis as well as to open up the apertures in treating 310 cases of sensorineural hearing loss. The results showed that therapeutical effect was satisfactory. The total effectve rate was 71.9%. Animal experiment also demonstrate the drug could prevent and cure the aminoglycoside antibiotic ototoxic hearing loss, could adjust the cochlear cyclic neucleotides as well as its SOD level and reduce the LPO level, raise the thyroid function and the function of sexual gland.

Superoxide and traditional Chinese medicines

In traditional Chinese medicinal practices, herbs are classified as 'cold', 'neutral', or 'hot'. Fluorometric analysis of herbs with 'cold' properties revealed that these herbs produce large amounts of superoxide. In contrast, herbs with 'hot' properties have scavenging activities. We believe that this electron transfer to form superoxide and the scavenging of superoxide may elucidate the phenomena of the 'yin' (represented by 'cold') and 'yang' (represented by 'hot') respectively.

Prednisolone non-compliance and its related factors in patients with systemic lupus erythematosus

BACKGROUND

The combination of western medicine and traditional Chinese medicine is still exerting a pervading influence on symptom relief in Chinese society. The Medical behavior pattern may influence medication non-compliance by patients with chronic illness.

METHODS

The study was designed to investigate prednisolone non-compliance and its related factors for patients with systemic lupus erythematosus (SLE) under giving patients' health beliefs, the influence of prednisolone and Chinese culture. All patients of the SLE Mutual Aid Group (N=570) participated in this study. A questionnaire which included medical behavior and individual attitudes was sent each by mail. The response rate was 63.7% (N=363); 329 responses were useable in the study.

RESULTS

Of the 329 patients, 27.9% had taken traditional medicine or a combination of traditional medicine with western medicine within the past month; 25.4% patients were non-compliant with prescribed prednisolone during the past week. The important reasons for non-compliance were feeling better, fearing side effects and treatment by Chinese medicine. The predicting factors for prednisolone non-compliance were the effects of the prednisolone, medical feasibility, patterns of medical behavior and perceived seriousness of the disease. Physician-patient relationship served as modifying factors which influenced individual attitudes toward prednisolone non-compliance and choice of medical behavior. Traditional beliefs, influenced by Chinese culture, indirectly affected prednisolone non-compliance, but through medical behavior patterns.

CONCLUSIONS

Predisolone non-compliance is quite essential for SLE patients. Findings suggested that the attributes of prednisolone and the influences of Chinese traditional medicine should be considered as well as a health belief model, when trying to improve prednisolone compliance for SLE patients in Taiwan society.

Sequence analysis and molecular characterization of genes required for the biosynthesis of type 1 capsular polysaccharide in Staphylococcus aureus

We previously cloned a 19.4-kb DNA region containing a cluster of genes affecting type 1 capsule production from Staphylococcus aureus M. Subcloning experiments showed that these capsule (cap) genes are localized in a 14.6-kb region. Sequencing analysis of the 14.6-kb fragment revealed 13 open reading frames (ORFs). Using complementation tests, we have mapped a collection of Cap- mutations in 10 of the 13 ORFs, indicating that these 10 genes are involved in capsule biosynthesis. The requirement for the remaining three ORFs in the synthesis of the capsule was demonstrated by constructing site-specific mutations corresponding to each of the three ORFs. Using an Escherichia coli S30 in vitro transcription-translation system, we clearly identified 7 of the 13 proteins predicted from the ORFs. Homology search between the predicted proteins and those in the data bank showed very high homology (52.3% identity) between capL and vipA, moderate homology (29% identity) between capI and vipB, and limited homology (21.8% identity) between capM and vipC. The vipA, vipB, and vipC genes have been shown to be involved in the biosynthesis of Salmonella typhi Vi antigen, a homopolymer polysaccharide consisting of N-acetylgalactosamino uronic acid, which is also one of the components of the staphylococcal type 1 capsule. The homology between these sets of genes therefore suggests that capL, capI, and capM may be involved in the biosynthesis of amino sugar, N-acetylgalactosamino uronic acid. In addition, the search showed that CapG aligned well with the consensus sequence of a family of acetyltransferases from various prokaryotic organisms, suggesting that CapG may be an acetyltransferase. Using the isogenic Cap- and Cap+ strains constructed in this study, we have confirmed that type 1 capsule is an important virulence factor in a mouse lethality test.

Transfusion-associated respiratory distress in Taiwan

Transfusion-associated respiratory distress occurred more often in the past in Taiwan but recently only very rarely. From the results of our studies it would appear that the former cases did not represent immune reactions involving red blood cells, serum proteins (especially IgA), HLA or granulocyte-specific antigens. Other causes, such as improper handling of the blood units may have been involved, but further study is also needed to investigate the possibility of the role of cytokine release from leukocytes or other factors. In addition, it appears that both plasma and serum obtained by recalcification of plasma may cause false-positive reactions in the granulocyte microagglutination test.

Accumulation of reactive oxygen species and oxidation of cytokinin in germinating soybean seeds

Seed germination is an important developmental switch when quiescent seed cells initiate oxidative phosphorylation for further development and differentiation. During early imbibition of soybean seeds (Glycine max L. cv. Weber), a superoxide dismutase (SOD) activity peak was observed, in embryonic axes, after 6 h imbibition. Peroxidase activities, including catalase, were significantly increased after 12 h inhibition and during germination phase III. Catalase was the most efficient enzyme in catabolizing H2O2 in embryonic axes. When stored at 42 degrees C and 100% relative humidity, seeds were stressed and lost their viability in a time-dependent manner. A significant increase in the Cu, Zn-superoxide-dismutase activity, and to a lesser extent, Mn superoxide dismutase activity was observed during germination in low-viability (stressed) seeds as compared to high-viability (unstressed) seeds. Northern blot analysis confirmed that superoxide dismutase induction resulted from an accumulation of its transcripts in response to the production of O2-. The induction of catalase did not occur in low-viability seeds, resulting in dramatic accumulation of H2O2. Using capillary electrophoresis, HPLC and NMR we found that the endogenous cytokinin, zeatin riboside, was present in large quantities in the high-viability seeds, but it was oxidized into adenine in the low-viability seeds. In vitro superoxide anion could also oxidize the cytokinin. Zeatin riboside, but not adenine, was found to act as a scavenger of superoxide anions and may help to maintain seed viability by detoxifying reactive oxygen species. Germination of stressed seeds was partially restored by the addition of exogenous cytokinin (zeatin riboside). Protection against oxidative stress by cytokinin seemed to be a general phenomenon, as Escherichia coli cells were also protected against superoxide stress in the presence of cytokinin.

Role of polyamines on de novo shoot morphogenesis from cotyledons of Brassica campestris ssp. pekinensis (Lour) Olsson in vitro

The promotive effect of ethylene inhibitors (Els), i.e. AgNO3 and aminoethoxyvinylglycine (AVG) on de novo shoot regeneration from cultured cotyledonary explants of Brassica campestris ssp. pekinensis cv. Shantung in relation to polyamines (PAs) was investigated. The endogenous levels of free putrescine and spermidine in the explant decreased sharply after 1-3 days of culture, whereas endogenous spermine increased, irrespective of the absence or presence of Els. AgNO3 at 30 μM did not affect endogenous PAs during two weeks of culture. In contrast, explants grown on medium containing 5 μM AVG produced higher levels of free putrescine and spermine which increased rapidly after three days and reached a peak at 10 days. An exogenous application of 5 mM putrescine also resulted in a similar surge of endogenous free spermine of the explant. More strikingly, shoot regeneration from explants grown in the presence of 1-20 mM putrescine, 0.1-2.5 mM spermidine, or 0.1-1 mM spermine was enhanced after three weeks of culture. However, exogenous PAs generally did not affect ethylene production, and endogenous levels of 1-aminocyclopropane-1-carboxylate (ACC) synthase activity and ACC of the explant. This study shows the PA requirement for shoot regeneration from cotyledons of B. campestris ssp. pekinensis in vitro, and also indicates that the promotive effect of PAs on regeneration may not be due to an inhibition of ethylene biosynthesis.

Transnasal endoscopic surgery of sphenoid sinus aspergillosis

Aspergillus sp. are the most common contaminants of the paranasal sinuses with the maxillary sinus as the site most frequently involved. Fungal sphenoid sinusitis can be a life-threatening situation, thus aggressive therapy is indicated. The treatment is primarily surgical. The transnasal endoscopic technique offers excellent visualization and an atraumatic approach to the sphenoid sinus. Surgical exteriorization and aeration of the involved sinus, without using antifungal chemotherapeutic agents is curative. A rare case of sphenoid sinus aspergillosis which was successfully treated by transnasal endoscopic sphenoidotomy is reported.

The menarcheal age of Chinese girls

The menarcheal age of Chinese girls was analysed based on a national survey in 1985. A total of 162,902 girls, aged 7-22 years, of Han nationality and 34,232 girls, aged 7-18, of 27 minority nationalities were sampled. Data were further subdivided into urban and rural areas. It was found that the curves of menstruating percentage in each of the subgroup were in long sigmoid shapes. The menstruating rate (MR) of Han girls was higher than that of the minority girls in almost every age group. The median menarcheal age (MMA) of Han girls was significantly lower than that of the minority girls. In Han nationality the urban girls showed higher MR and lower MMA than the rural girls. The influence of hereditary, cultural and economical factors on menarcheal age in Chinese girls is discussed. The data of this study were also compared with research reports from other world literature.

Increase in superoxide production by heat-shocked cells of Neurospora crassa, demonstrated by a fluorometric assay

1. Increase in superoxide production by heat-shocked cells of Neurospora crassa was demonstrated by a fluorometric assay. 2. A sensitive fluorometric assay for the estimation of superoxide anion radical--based on the liberation of 4-methylumbelliferone from 4-methyl-beta-D-umbelliferyl glucopyranoside--is described. 3. Using this system the level of superoxide in the medium of heat-shocked Neurospora crassa cells was found to be consistently higher, in comparison with that of non-shocked cells, cultured at the normal growth temperature of 28 degrees C. 4. Addition of superoxide dismutase to the culture media suppressed the production of 4-methylumbelliferone.

Developmental perspective of pulse rate, blood pressures and vital capacity in Chinese children

Physiological development in Chinese children was analysed based on a national survey sample. Close to half a million children and adolescents, aged 7-18 years, from Han and 27 minority nationalities were assessed for pulse rate, systolic and diastolic blood pressure, and forced vital capacity in these 12 age groups. The factors of age, sex, race, and region (urban/rural, north/south) were analysed. P95 hypertension screening standard was established for each age group. These results were compared with research reports from world literature.

Secular change in the growth and development of Han children in China

This paper reports the secular change in physical growth and development of Han children in 12 Chinese metropolitan cities including Beijing, Tianjing, Shanghai, Jinan, Harbin, Shenyang, Changchun, Nanjing, Hangzhou, Wuhan, Guangzhou, and Chengdu. Based on a recent national survey of 14,688 healthy schoolchildren, aged 7-18 years, and together using the historical records of healthy schoolchildren as secondary data source, this study found a secular change in the growth and development of Chinese children and youth. In every decade between the 1950s and 1985 the average height increased by 2.66 cm (range 1.78-3.77) for boys and 2.40 cm (range 1.72-3.76) for girls, and the average weight increased by 1.64 kg (range 1.28-2.63) for boys and 1.14 kg (range 0.63-2.01) for girls in the 12 cities. In the last decade from the 1970s to 1985, the height and weight increments were highest in Beijing, Jinan, Shenyang and Shanghai. In addition, the increments were higher during the peak growth years than during other periods of growth. In the 30 years studied, the ages of maximum growth velocity were advanced, and they were 1 or 2 years earlier in 1985 than in the 1950s in most cities. When compared with the data from the 1930s the results indicate that, during the last half-century, height increased by 1.12-2.66 cm per decade for boys and 1.42-2.67 cm/decade for girls, while weight increased by 0.56-1.27 for boys and 0.65-1.18 kg for girls in Beijing, Shanghai, Nanjing, Hanzhou and Guangzhou.

Physical growth of Chinese school children 7-18 years, in 1985

Physical development in Chinese school children was analysed based on a national survey in 1985. Close to half a million children and adolescents, aged 7-18, from Han ethnic group and 27 minority ethnic groups were assessed for height, weight, sitting-height, chest circumference, biacromial and biiliac diameters. Growth in Han children was greater than that in minority ethnic group children. The growth differences among minority ethnic groups were large. Growth in urban children was greater than that in rural children except in a few age groups of girls. A significant difference in children's growth was found between northern and southern divisions of China, it being greater in the north. The growth curves of physical characteristics demonstrated systematic regularity. Finally, the results of this study were compared with research reports from other world literature.

[An epidemiological study of otolaryngologic emergency diseases]

We studied 2561 cases of otolaryngologic emergencies in the Far Eastern Memorial Hospital from January 1, 1985, to December 31, 1989, looking for the distribution and epidemiology of these emergency diseases. Our conclusions were as follows: 1. Total emergency otolaryngologic cases [otologic cases and pharyngolaryngologic cases] demonstrated a tendency to increase from year to year. 2. Acute otitis media and foreign bodies of the nose also showed an increase from year to year. 3. The "top five" emergency otolaryngologic diseases in order of frequency were: epistaxis (22.7%), foreign bodies of the throat (18.7%), acute tonsillitis (11.4%), acute otitis media (7.7%), and foreign bodies of the ear (6.4%). 4. Patients admitted to the emergency department (7.2%) ranked in order of frequency were: epistaxis (29%), acute tonsillitis (24.5%) and esophageal foreign bodies (14.1%). 5. Emergency visits occurred most frequently between 20-24 o'clock (26.5%) daily; the least from 4-8 o'clock (9.3%).

[Diagnostic value of Rhizoma alismatis mixture in Menière's disease]

Rhizoma Alismatis Mixture (RAM), which can promote diuresis to eliminate wetness-evil and activate blood circulation, is a pure TCM preparation composed of Rhizoma Alismatis, Semen Plantaginis, Rhizoma Ligustici Wallichii and Herba Leonuri. After clinical observation, it showed that RAM can greatly case the inner ear edema of patients with Menière's disease and therefore improved their hearing threshold (63.7%). RAM can also diminish SP amplitude or reduce the SP/AP ratio on the cochleogram. As compared with glyceral test, there was no statistically significant difference, while the side effect of RAM group (5%) was lower than that of glyceral group (87.3%) significantly, therefore RAM test can replace glycerin test in the diagnosis of Menière's disease. The animal experiment results indicated that RAM did not affect stria vascularis permeation but it probably dehydrates the inner ear by changing the osmotic pressure between endolymphatic and perilymphatic or increasing the absorption of the endolymphatic sac.