[Contamination Characteristics and Source Apportionment of Potentially Toxic Elements in Soil around the Coal-fired Power Plant Using APCS-MLR and PMF Models]

To investigate the characteristics and sources of potentially toxic elemental contamination in soils around the coal-fired power plant, we selected the soil around the Jingyuan power plant as the object of investigation. Thirty-six and 27 soil samples collected from the urban and farmland areas were analyzed for PTEs (As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn), respectively. We employed the geoaccumulation index, single-factor pollution index, and improved Nemerow integrated pollution index to evaluate the contamination characteristics of PTEs, and combined correlation analysis with absolute principal component scores-multiple linear regression (APCS-MLR) and positive matrix factorization (PMF) receptor models were used to quantitatively analyze the pollution sources of PTEs. The results revealed that all the average concentrations of other soil metals around Jingyuan power plant exceeded their corresponding background values of Gansu Province, except for As, in agricultural soil, and Hg exhibited significant spatial non-homogeneity, and thus it was visibly affected by anthropogenic activities. The values of the single-factor pollution and geoaccumulation indices indicated that the soils of both sites were mainly contaminated with Cd, Cr, Ni, and Pb, and Hg contamination was reflected in wide areas for both sites. Additionally, the results of the improved Nemerow index demonstrated that the investigated soil was between moderately contaminated and heavily contaminated. Further, the comprehensive pollution degree of urban soil was higher than that of agricultural soil. Moreover, source apportionment revealed that PTEs in urban soil were derived from mixed sources of traffic activities and coal combustion, mixed sources of traffic activities and industrial and mining activities, and atmospheric deposition from industrial activities, with contribution rates of APCS-MLR of 35.2%, 25.1%, and 23.4%, respectively. The PMF contribution rates were 40.2%, 12.4%, and 47.7%, respectively. PTEs in agricultural soil were from one mixture source of industrial, mining, agricultural, and traffic sources, and the other mixed source was of traffic activities and coal combustion, with a APCS-MLR contribution rate of 40.3% and 35.9% and a contribution rate of PMF of 36.2% and 18.0%, respectively. In addition, another mixed source of agricultural activities and coal combustion was obtained using the PMF model, with a contribution rate of 48.5%.

[Spatial Distribution Characteristics and Source Analysis of Heavy Metals in Urban River Surface Sediments from the Lanzhou Reach of the Yellow River]

In order to investigate the contamination characteristics and potential sources of heavy metals from the urban river surface sediments in the Yellow River Basin, we selected the Lanzhou reach of the Yellow River as the object of investigation. A total of 46 surface sediment samples were collected along the Lanzhou reach of the Yellow River, and the contents of eight heavy metals, Cr, Ni, Cu, Zn, As, Cd, Hg, and Pb, were determined by using inductively coupled plasma mass spectrometry and an atomic fluorescence spectrometer. Contamination indexes including single factor pollution index (P_i) and geo-accumulation index (I_geo), together with the sediment pollution index (SPI), were used to assess heavy metal pollution characteristics and ecological risk levels in the urban river surface sediments of the Lanzhou reach of the Yellow River. Pearson's correlation analysis (CA), positive matrix factorization (PMF), and principal component analysis/absolute principal component score (PCA/APCS) were jointly employed to quantitatively analyze pollution sources of heavy metals. The results showed that the mean concentrations of the majority of heavy metals exceeded their corresponding background values of Gansu Province and Lanzhou City with the exception of As, and the spatial distribution of high concentrations of heavy metals was mainly concentrated in the corner of the river. Based on the single factor pollution and geo-accumulation indexes of the eight heavy metals, in the Lanzhou reach of the Yellow River, Cr was the dominant pollution element in the urban river surface sediments, followed by Cd and Ni. Additionally, the SPI values for the eight heavy metals in the surface sediments ranged from 0.48 to 8.56, presenting natural to low ecological risk level. Furthermore, source apportionment revealed that a mixture source of industrial and agricultural activities (77.6%) was the largest contributor of Cr, Ni, Zn, As, Cd, and Pb in the urban river surface sediments, followed by natural sources (11.4%) and a mixed source of industrial and traffic activities (11%).

[Evaluation on application of 3D printing digital positioning guide in root canal retreatment]

PURPOSE

To explore the application of 3D printing digital positioning guide in root canal retreatment.

METHODS

Eighty-two isolated teeth collected in Chifeng College Affiliated Hospital from January 2018 to December 2021 were selected, and divided into experimental group and control group by random number table method, with 41 teeth in each group. Both groups were given root canal retreatment. The control group underwent traditional pulpotomy, while the experimental group underwent precise pulpotomy under 3D printing digital positioning guide. The damage of the coronal prosthesis caused by pulpotomy was compared between the two groups, the time of pulpotomy was recorded, removal of root canal fillings in the two groups was counted, fracture resistance of the tooth tissue in the two groups was compared, and the incidence of complications in the two groups was recorded. SPSS 18.0 software package was used for statistical analysis of the data.

RESULTS

The ratio of pulp opening area to total dental and maxillofacial area in the experimental group was significantly lower than that in the control group (P＜0.05). The pulp opening time in the experimental group was lower than that in the control group(P＜0.05), and the root canal preparation time in the experimental group was significantly higher than that in the control group(P＜0.05). There was no significant difference in the total time between pulp opening and root canal preparation between the two groups(P＞0.05). The removal rate of root canal filling in the experimental group was higher than that in the control group (P＜0.05). The failure load value of the experimental group was significantly higher than that of the control group (P＜0.05). There was no significant difference in the incidence of total complications between the two groups (P＞0.05).

CONCLUSIONS

Application of 3D-printed digital positioning guides in root canal retreatment can achieve precise and minimally invasive pulp opening, reduce damage to coronal restorations, preserve more dental tissue, and improve the removal efficiency of root canal fillings and the fracture resistance of dental tissue, as well as performance, safety and reliability.

[Phacoemulsification combined with goniosynechialysis under a gonioscope in the treatment of angle-closure glaucoma: the effect of reopening the synechial anterior chamber angle]

A total of 170 consecutive patients (181 eyes) who were diagnosed with primary angle-closure glaucoma (PACG) and underwent phacoemulsification and intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) with an instrument under a gonioscope in the Eye Hospital, Wenzhou Medical University from January 1, 2017 to December 31, 2019 were observed. Anterior chamber angle synechiae of 0 (0, 2) clock hour were released after PEI, while after combined goniosynechialysis, synechiae of 6 (3, 8) clock hours were further released. No matter in chronic PACG and acute PACG with cornea edema, the extent of anterior chamber angle synechiae was different before surgery and after PEI, and so was it in post-PEI and PEI-GSL prospectively (all P<0.01). Phacoemulsification alone can reopen the synechial anterior chamber angle in both chronic PACG and acute PACG in part, but not sufficiently. Combined goniosynechialysis under a gonioscope with an instrument is essential and effective.

Effects of socioeconomic status on the control of hypertension in patients <65 and ≥65 years of age in Taiwan: a nationwide cross-sectional study

OBJECTIVE

Implementation of National Health Insurance in 1995 improved the control of hypertension due to comprehensive coverage of medical costs for all residents in Taiwan. However, the role of individual socioeconomic status (iSES), namely, education and personal income, in awareness, treatmen, and control of blood pressure, has not been well studied in Taiwan.

DESIGN

A nationwide cross-sectional survey was executed in this study.

SETTING

A systematic, multistage sampling scheme from a nationwide cohort in Taiwan was adopted to select adult participants. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or the use of antihypertensive medications.

PARTICIPANTS

A total of 4599 subjects completed door-to-door household interviews and physical examinations.

PRIMARY AND SECONDARY OUTCOME MEASURES

A summing z score of iSES was constructed by two domains of the iSES, namely, income and education, through which participants were classified into three SES levels. Logistic regression models were used to assess associations of awareness, treatment, and control in younger (<65 years) and older (≥65 years) participants with hypertension.

RESULTS

Younger people in the highest tertile of iSES were less likely to be aware of their hypertension (OR: 0.48, 95% CI: 0.37 to 0.64, p<0.0001) or to have it treated (OR: 0.49, 95% CI 0.37 to 0.64, p<0.0001) but more likely to have their hypertension controlled (OR: 1.52, 95% CI 1.19 to 1.94, p=0.0009). We did not detect an association in people aged >65 years.

CONCLUSION

Health education to improve awareness and treatment of hypertension should focus on younger people with higher iSES in Taiwan.

[Analysis of treatment modalities and prognosis of patients with gallbladder cancer in China from 2010 to 2017]

Objective: To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China. Methods: This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed. Results: Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn't be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%. Conclusions: More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.

Lower-caloric intake but different nutrient profiles in cognition impaired and in frail elderlies

Background

Frailty and dementia are two common geriatric syndromes associated with poor nutritional status. The nutritional role in the pathogenesis of frailty and dementia remains unclear. We examined the associations between energy intake and frailty/cognition impairment and also compared the nutrient intake between frail and cognition impaired elderlies by sex.

Methods

Data of 1,920 elderly adults (≧65y) from the 2014-2017 Nutrition and Health Survey in Taiwan was used. Frailty was defined using modified L. Fried criteria. The Chinese Mini-Mental State Examination score was grouped into tertiles: cognitive impairment (score ≦ 23), mild cognitive impairment (score = 24-27), and the normal (score ≧28). Total energy intake was grouped into tertiles. Logistic regression adjusted for age, sex, and sampling strata was used for association test. The trend test was performed using generalized linear model with age adjustment to examine whether various nutrient intake indicators had an ordered relationship with the severity of frailty and cognitive impairment.

Results

Lower energy intake (men &lt;1540 Kcal or women&lt;1182 Kcal) was significantly associated with frailty (odds ratio [OR]: 1.97; 95% confidence interval [CI]: 1.45-2.66) and cognition impairment (OR: 1.88; 95%CI: 1.43-2.47), respectively. Larger number of micronutrients and food substances per Kg body weight exhibited decreasing trends with MCI (protein, fat, carbohydrate, vitamins B1, B2, B3, B6, B12, C, E, Ca, P, Fe, Mg, K, Zn, dietary fiber, and cholesterol) than with frailty (protein, vitamin B1, B3, B6, C, P, Mg, K, Zn, polyunsaturated fatty acids, and dietary fiber).

Conclusions

The lower the energy intake, the higher the odds ratio for frailty and for dementia. Dietary quality expressed by nutrient intake per Kg body weight was poorer in elderlies with cognition impairment than those with frailty.

Key messages

Lower energy intake is associated with MCI and with frailty, respectively. The MCI elderlies involve more micronutrient deficiencies than the frail counterpart.

[Effect of individualized healing abutment on patients with posterior implant prosthesis and improvement of food impaction symptoms]

PURPOSE

To observe the effect of individualized healing abutment on patients with posterior dental implant prosthesis and its influence on implant stability and food impaction.

METHODS

Eighty patients who received posterior dental implants in Jiangsu Stomatological Hospital from June 2013 to June 2018 were selected as the study subjects. According to the different healing abutment, they were divided into traditional operation group (40 cases) and experimental group (40 cases). Patients in the experimental group used personalized healing abutment on the basis of traditional dental implants. Differences in dental implant stability, food impaction score, masticatory efficiency and incidence of complications between the two groups after implant restoration were compared. SPSS 13.0 software package was used to analyze the data.

RESULTS

At 1, 3 and 6 months after operation, the stability of implants in the experimental group was significantly higher than that in the control group (P<0.01); One, 3 and 6 months after operation, the food impaction score in the experimental group was significantly lower than that in the traditional operation group(P<0.01); There was no significant difference in masticatory ability between the two groups before operation; After treatment, the occlusive force and masticatory efficiency in the experimental group were significantly higher than those in the traditional operation group (P<0.05). The incidence of complications such as tooth loosening and periodontitis in the experimental group was significantly lower than in the traditional operation group (P<0.05).

CONCLUSIONS

Individualized healing abutment has a good therapeutic effect on patients with posterior implant prosthesis, and can significantly improve the incidence of food impaction and complications with a good application value.

Energy intake at different times of the day: Its association with elevated total and LDL cholesterol levels

BACKGROUND AND AIMS

This study examined the association between macronutrient intake at different times of the day and blood lipid levels.

METHODS AND RESULTS

The study was based on the Nutrition and Health Survey in Taiwan, a cross-sectional study of non-institutionalized and non-pregnant healthy adults (≥19-years-old). A one-day (24 h) dietary recall assessed participants' food intake. Fasting plasma triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol were determined. Low-density lipoprotein (LDL) cholesterol was estimated based on the Friedewald formula. According to the data of eligible subjects (n = 1283), the time of energy intake was categorized into three meal times 0500-0929 (morning), 1130-1329 (noon), and 1730-2029 (evening), along with three snack times 0930-1129 (mid-morning), 1330-1729 (afternoon), and 2030-0459 (night). Energy and macronutrient intake were calculated for the 6 time periods, based on 24 h recall data. An adjusted regression model showed that by transferring 100 kcal intake at night to the morning or noon, LDL cholesterol would be lower by 1.46 (95% CI: 2.42-0.50) and 1.27 mg/dL (95% CI: 2.24-0.30), respectively. Transferring 100 kcal of fat intake at night to earlier periods was associated with a lower LDL cholesterol level, especially transferring to noontime (significantly lower by 5.21 mg/dL, 95% CI: [7.42-2.99]) and evening (significantly lower by 3.19 mg/dL, 95% CI: [6.29-0.08]).

CONCLUSIONS

Total cholesterol and LDL cholesterol had the same pattern of association with the timing of energy intake. The study showed that elevated total and LDL cholesterol were positively associated with nighttime energy and fat intake.

Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies

BACKGROUND

Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men.

METHODS

In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes.

RESULTS

Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes.

INTERPRETATION

Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained.

FUNDING

UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).

Antimalarial Activity of Plant Metabolites

Malaria, as a major global health problem, continues to affect a large number of people each year, especially those in developing countries. Effective drug discovery is still one of the main efforts to control malaria. As natural products are still considered as a key source for discovery and development of therapeutic agents, we have evaluated more than 2000 plant extracts against Plasmodium falciparum. As a result, we discovered dozens of plant leads that displayed antimalarial activity. Our phytochemical study of some of these plant extracts led to the identification of several potent antimalarial compounds. The prior comprehensive review article entitled “Antimalarial activity of plant metabolites” by Schwikkard and Van Heerden (2002) reported structures of plant-derived compounds with antiplasmodial activity and covered literature up to the year 2000. As a continuation of this effort, the present review covers the antimalarial compounds isolated from plants, including marine plants, reported in the literature from 2001 to the end of 2017. During the span of the last 17 years, 175 antiplasmodial compounds were discovered from plants. These active compounds are organized in our review article according to their plant families. In addition, we also include ethnobotanical information of the antimalarial plants discussed.

Design, synthesis and evaluation of novel dihydrostilbene derivatives as potential anti-melanogenic skin-protecting agents

The stems of Dendrobium orchids (Orchidaceae), also known as Shi Hu, have been used for medicinal purposes for centuries in oriental countries. In fact, the health benefits of Shi Hu have been evidenced by its modern pharmacological actions on conquering oxidative stress in pathological conditions. From the extracts of two commonly used Dendrobium species, we obtained discernible amounts of stilbenoids, explicitly trans-resveratrol (1) and dihydro-resveratrol (2), which are prototypical antioxidants. When applied to cultured melanocytes, these stilbenoids, dihydro-resveratrol (2) in particular, significantly reduced melanin formation via inhibiting tyrosinase activity and expression of tyrosinase-related proteins. By utilizing dihydro-resveratrol (2) as the basic structural unit, we synthesized 11 novel dihydrostilbene derivatives (3-13) in good yields and purity, with manipulative steps. In addition to their anti-melanogenic activity, some of the novel derivatives are indeed potential antioxidants as they quenched intracellular oxidative radicals in a manner more efficient than Trolox, a water-soluble analogue of vitamin E, and thus premeditated beneficial to skin protection.

Highly effective cell synchronization in plant roots by hydroxyurea and amiprophos-methyl or colchicine

Effective somatic cell synchronization in root-tip meristems and improved chromosome spreading were achieved in white campion, wheat, rye, and barley by application of hydroxyurea and amiprophos-methyl or colchicine, combined with a pretreatment of ice water and modified fixative, as well as enzymatic digestion of the meristems. The protocol provides metaphase indices of approximately 50%. The chromosomes and chromosomal DNA were with minimum distortion, providing useful material for chromosome banding studies, in situ DNA-DNA hybridization, microdissection, and microcloning.

The impact of modifiable risk factors on mortality from prostate cancer in populations of the Asia-Pacific region

Mortality from cancer of the prostate is increasing in the Asia-Pacific, when much of this region is undergoing a transition to a Western lifestyle. The role that lifestyle factors play in prostate cancer appears limited, but existing data mainly are from the West. We conducted an individual participant data analysis of 24 cohort studies involving 320,852 men (83% in Asia). Cox proportional hazard models were used to quantify associations between risk factors and mortality from prostate cancer. There were 308 deaths from prostate cancer (14% in Asia) during 2.1 million person-years of follow-up. The age-adjusted hazard ratio (95% confidence interval; CI) for men with body mass index (BMI) 28 kg/m2 or more, compared with below 25, was 1.55 (1.12 - 2.16); no such significant relationship was found for height or waist circumference. The BMI result was unchanged after adjustment for other variables, was consistent between Asia and Australia/New Zealand (ANZ) and did not differ with age. There was no significant relationship with diabetes, glucose or total cholesterol (p > or = 0.18). Smoking, alone, showed different effects in the two regions, possibly due to the relative immaturity of the smoking epidemic in Asia. In ANZ, the multiple-adjusted hazard ratio for an extra 5 cigarettes per day was 1.12 (95%CI: 1.03 - 1.22), whereas in Asia it was 0.77 (0.56 - 1.05). Body size is an apparently important determinant of prostate cancer in the Asia-Pacific. Evidence of an adverse effect of smoking is conclusive only in the predominantly Caucasian parts of the region.

The role of lifestyle risk factors on mortality from colorectal cancer in populations of the Asia-Pacific region

Although colorectal cancer is one of the leading malignancies worldwide, there are few data on aetiological relationships from the Asia-Pacific region. Therefore, a collaborative study was conducted involving over half a million subjects from 33 cohort studies in the region. Age-adjusted death rates from colorectal cancer, over an average of 6.8 years follow-up, were 12 and 14 per 100,000 person-years among Asian women and men, respectively; corresponding values in Australasia were 31 and 41. Height was strongly associated with death from colorectal cancer: an extra 5 cm of height was associated with 10% (95%confidence interval, 3% - 18% additional risk, after adjustment for other factors. Smoking increased risk by 43% (9% - 88%), although no significant dose-response relationship was discerned (p>0.05). Other significant (p <0.05) risk factors were body mass index and lack of physical activity. There was no significant effect on colorectal cancer mortality for alcohol consumption, waist circumference, fasting blood glucose or diabetes, although the latter conferred a notable 26% additional risk. Height may be a biomarker for some currently unknown genetic, or environmental, risk factors that are related both to skeletal growth and mutanogenesis. Understanding such mechanisms could provide opportunities for novel preventive and therapeutic intervention.

Body mass index and cardiovascular disease in the Asia-Pacific Region: an overview of 33 cohorts involving 310 000 participants

BACKGROUND

Few prospective data from the Asia-Pacific region are available relating body mass index (BMI) to the risks of stroke and ischaemic heart disease (IHD). Our objective was to assess the age-, sex-, and region-specific associations of BMI with cardiovascular disease using individual participant data from prospective studies in the Asia-Pacific region.

METHODS

Studies were identified from literature searches, proceedings of meetings, and personal communication. All studies had at least 5000 person-years of follow-up. Hazard ratios were calculated from Cox models, stratified by sex and cohort, and adjusted for age at risk and smoking. The first 3 years of follow-up were excluded in order to reduce confounding due to disease at baseline.

RESULTS

A total of 33 cohort studies, including 310 283 participants, contributed 2 148 354 person-years of follow-up, during which 3332 stroke and 2073 IHD events were observed. There were continuous positive associations between baseline BMI and the risks of ischaemic stroke, haemorrhagic stroke, and IHD, with each 2 kg/m(2) lower BMI associated a 12% (95% CI: 9, 15%) lower risk of ischaemic stroke, 8% (95% CI: 4, 12%) lower risk in haemorrhagic stroke, and 11% (95% CI: 9, 13%) lower risk of IHD. The strengths of all associations were strongly age dependent, and there was no significant difference between Asian and Australasian cohorts.

CONCLUSIONS

This overview provides the most reliable estimates to date of the associations between BMI and cardiovascular disease in the Asia-Pacific region, and the first direct comparisons within the region. Continuous relationships of approximately equal strength are evident in both Asian and Australasian populations. These results indicate considerable potential for cardiovascular disease reduction with population-wide lowering of BMI.

Dietary fats and asthma in teenagers: analyses of the first Nutrition and Health Survey in Taiwan (NAHSIT)

BACKGROUND

The occurrence of asthma may be associated with dietary factors.

OBJECTIVE

To examine the association between nutrient intake and physician-diagnosed asthma and allergic rhinitis.

METHODS

A stratified, multiple-staged sampling design was used to select study areas, in which household interviews were carried out to gather information on health status and 24-h food recall. Data from 1166 adolescents, 13-17 years of age, were analysed.

RESULTS

In univariate analysis, total calorie and energy-adjusted fat intake were associated with the prevalence of asthma, whereas vitamin A and vitamin C intake showed negative association with asthma. Multivariate logistic regression was used to adjust for sex and levels of urbanization; intake of saturated fats was associated with increased risk (OR = 2.02 for an increase of one SD, 95%CI 1.40-2.90), while monounsaturated fats were inversely related to asthma (OR = 0.65 for an increase of one SD, 95%CI 0.43-0.99). Vitamin C intake in the lowest quartile was associated with elevated risk for asthma with marginal significance (OR = 1.81, 95%CI 0.88-3.71, P = 0.10). None of the nutritional factors was associated with allergic rhinitis.

CONCLUSION

Results from this cross-sectional survey suggest that saturated and monounsaturated fats may have different effects on airway inflammation.

Prevalence, awareness, treatment and control of hypertension in Taiwan: results of Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996

The objective of this paper is to describe hypertension status in Taiwan using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996, which adopted a clustered stratified multistage sampling scheme. A total of 4838 males and 4876 females aged 4 years and above were interviewed and examined corresponding to a response rate of 74%. Almost all of them (97.5%) had blood pressures measured. The results show that the mean blood pressure of adult males was higher than that of adult females below 45 years of age. After that, the pattern was reversed. When defined by JNC IV criteria (SBP/DBP > or = 160/95 mm Hg or taking antihypertensive drugs), the prevalence was 13% in adult males (> or = 19 years) and 12% in adult females. When defined by JNC VI criteria (SBP/DBP > or = 140/90 mm Hg or taking antihypertensive drugs), the prevalence was 26% in adult males and 19% in adult females. The prevalence in the mountainous area, was the highest among the seven survey strata. Under the JNC IV definition, 43% males and 53% females with hypertension knew their disease status, 31% of males and 45% of females took medicine for it, and 15% of males and 22% of females had their blood pressure under control. Percentages of awareness, treatment, and control were much lower with the JNC V definition, which was introduced toward the end of survey period. People in metropolitan areas had the highest rates of awareness, treatment, control, and compliance to medication.

Incidence and predictors of isolated systolic hypertension and isolated diastolic hypertension in Taiwan

BACKGROUND AND PURPOSE

The significance of isolated systolic hypertension (ISH) has been well documented, particularly in the elderly. However, isolated diastolic hypertension (IDH) has not been formally recognized as a unique hypertension entity. This study compared the ages of onset and characteristics of ISH and IDH.

METHODS

The Cardiovascular Disease Risk Factors Two-Township Study (CVDFACTS) is an ongoing longitudinal study of the risk factors for and pathogenesis of cardiovascular disease in two Taiwanese townships, Chu-Dung (a Hakka community) and Pu-Tzu (a Fukienese community); participating patients were included in our study. Among the 3,357 subjects who were aged at least 20 years, free of hypertension, and had complete data at baseline, 2,374 subjects were followed. The average duration of follow-up was 3.23 years and the follow-up rate was 71%. Data regarding smoking, alcohol consumption, health and socioeconomic background, blood pressure, and body mass index were collected. Clinical and hemostatic profiles were assessed.

RESULTS

ISH (systolic blood pressure, SBP > or = 140 mmHg and diastolic blood pressure, DBP < or = 90 mmHg) incidence increased with age in general (men: 0 per 1,000 person-years at age 20-34 yr, 1.9 at age 35-49, 14.3 at age 50-64, 40.9 at age 65-74, and 73.3 at age 75+ yr; women: 0 per 1,000 person-yr at age 20-34 yr, 3.6 at age 35-49, 17.8 at age 50-64, 64.9 9 at age 65-74, and 33.5 at age 75+ yr), but peak incidence of IDH (DBP > or = 90 mmHg and SBP < or = 140 mmHg) occurred between 35 and 49 years (men: 8.9 per 1,000 person-yr at age 20-34 yr, 14.5 at age 35-49, 12.3 at age 50-64, 2.7 at age 65-74, and 0 at age 75+ yr; women: 1.7 per 1,000 person-yr at age 20-34, 4.2 at age 35-49, 3.7 at age 50-64, 0 at age 65-74, and 0 at age 75+ yr). Significant predictors for ISH were older age (men: hazard ratio, HR = 8.25 at 45-64 yr and HR = 22.91 at 65+ yr; women: HR = 34.11 at 45-64 yr and HR = 97.98 at 65+ yr), diabetes (HR = 2.57) and elevated fibrinogen (HR = 1.49) in men, and shorter clotting time in women (HR = 1.23). Significant predictors for IDH were elevated body mass index (men: HR = 4.03; women: HR = 7.4), and higher glucose (HR = 1.46) and uric acid concentrations (HR = 1.94) in men.

CONCLUSIONS

The results of this study indicate that ISH and IDH have different age incidence patterns and predictors, and suggest that the pathogenesis of ISH and IDH may be different.

Using the overdispersed exponential family to estimate the distribution of usual daily intakes of people aged between 18 and 28 in Taiwan

Assessment of usual dietary intake of a population is essential to understand the nutrition status of the population. Methods like 24-hour dietary recall and food records are commonly used for this task. However, within-individual variation exists in the food record data. Methods considering measurement errors have been used to evaluate the association between nutrient intakes and diseases. Few have been devoted to estimating the distribution of usual daily intakes. This paper proposes applying the formulation of the overdispersed exponential family to estimate the distribution of usual nutrient intake and applies the adjustments developed by Liu to reduce the variance of the distribution. The proposed method has the advantages of working on the original scale of data and implementation convenience. The adjustment of the variance is carried out by dividing the variance into within-individual variance and among-individual variance. The adjusted variance, then, is used to estimate the distribution of the usual daily intake. Sampling weights are considered in all the steps, except the estimation of the ratio of within to among variance. The data for this study are from the Nutritional and Health Survey in Taiwan conducted between 1993 and 1996 (NAHSIT, 1993-1996). An independent external set of data for people aged between 18 and 28 years (49 males and 20 females) is used to estimate the ratio of within to among individual variance. Due to the availability of data in estimating the ratio of within to among individual variance, 430 males and 422 females in the NAHSIT sample are used to estimate the distribution of usual daily intakes for people aged between 18 and 28 in Taiwan. The distribution also allows us to estimate the proportion of people who do not meet the recommended daily nutrient allowance (RDNA). The results show that the intakes of calcium and vitamin E of this group of people fall far below RDNA.

Hyperuricemia and gout in Taiwan: results from the Nutritional and Health Survey in Taiwan (1993-96)

OBJECTIVE

To evaluate the prevalence of hyperuricemia in Taiwan.

METHODS

A multi-stage stratified sampling scheme was used in Nutrition and Health Survey, which was conducted in Taiwan between 1993 and 96. Complete biochemical and questionnaire data for 2754 males and 2953 females aged 4 years and older were included in the analysis. The colorimetric enzymatic method was used to measure plasma uric acid in fasting blood samples. Information on self-reported, physician-diagnosed gout was also obtained.

RESULTS

The uric acid values of males were found to reach a peak between the ages of 13 and 18 and decrease slightly after 18. The uric acid values of females were stable before the age of 18, decreasing slightly between 19 and 44 years, and increasing in the mid to older age groups (> or = 45 years). Twenty-six percent of adult males (> or = 19 years) and 22% of older males (> or = 45 years) either had hyperuricemia (serum uric acid > 458.0 microM or 7.7 mg/dl) or were taking medication for it. Seventeen percent of adult females and 23% of older females either had hyperuricemia (serum uric acid > 392.57 microM or 6.6 mg/dl) or were taking medication for it. Both adult males and females in mountainous areas, who were primarily aboriginal, had the highest prevalence of hyperuricemia (> 50%) among the 7 survey areas. Mean body mass index (BMI), alcohol consumption, and prevalence of gout were among the highest in mountainous people compared to all included in the study. Multivariate analysis showed that mountainous area, age and BMI are important factors associated with hyperuricemia in males, whereas mountainous area, Class II townships, and BMI are the factors associated with hyperuricemia in females.

CONCLUSIONS

We found a high prevalence of hyperuricemia in Han Chinese in Taiwan despite a lack both of obesity and high alcohol consumption. Mountainous people (mainly aborigines) in Taiwan have an even higher prevalence of hyperuricemia, which cannot be completely explained by obesity and alcohol consumption. Genetic components and other environmental factors may have contributed to this pattern of hyperuricemia.

Comparison of official coders versus physician panel in assignment of underlying cause of death

BACKGROUND AND PURPOSE

In outcome analyses of clinical trials and mortality follow-up studies, the underlying cause of death (UCOD) is commonly assigned either by official coders or by a panel of physicians. We evaluated the validity of UCOD assigned by official coders by comparison with the assignments of a panel of physicians who reviewed the available medical records of the deceased.

METHODS

The comparisons focused on deaths occurring from October 1995 through June 1998 in a series of residents in a veterans home. Because of limited resources, only the first 104 deaths that occurred during the study period were included. Agreement rate, sensitivity, specificity, and kappa statistics were calculated to assess the consistency of coder versus physician panel assignment of UCOD by selected main causes of death. For 32 of the 104 deaths, the panel concluded that the information obtained from medical records was insufficient to determine the UCOD, and the following analyses were confined to the other 72 deaths.

RESULTS

For the 72 deaths considered by the panel to have sufficient information to determine UCOD, all four physicians agreed on a single UCOD in 50 (69%) cases, while three or four agreed in 66 (92%) cases. A consensus was reached in cases with disagreement. The two procedures completely agreed in 40 (56%) of the deaths. For general category UCOD, the kappa value was high for cancer (0.83) and cardiovascular disease (CVD, 0.73) but only moderate for pulmonary disease (PD, 0.60). When the UCOD assigned by the panel was used as the gold standard, official coders showed relatively low sensitivity for correct determination of UCOD in cases of CVD (0.76) compared with cancer (0.86) and PD (0.80).

CONCLUSIONS

Given the high inter-physician consistency and the relatively low sensitivity of official coders in assigning CVD as the UCOD, we conclude that the use of clinical review panels would provide more accurate UCOD assignments for use in outcome analyses in mortality follow-up studies and clinical trials in Taiwan.

A selection system for identifying accessible sites in target RNAs

Although ribozymes offer tremendous potential for posttranscriptionally controlling expression of targeted genes, their utility is often limited by the accessibility of the targeted regions within the RNA transcripts. Here we describe a method that identifies RNA regions that are accessible to oligonucleotides. Based on this selection protocol, we show that construction of hammerhead ribozymes targeted to the identified regions results in catalytic activities that are consistently and substantially greater than those of ribozymes designed on the basis of computer modeling. Identification of accessible sites should also be widely applicable to design of antisense oligonucleotides and DNAzymes.

Undiagnosed diabetes mellitus in Taiwanese subjects with impaired fasting glycemia: impact of female sex, central obesity, and short stature

AIMS

To study the extent and determinants of undiagnosed diabetes mellitus (DM) in Taiwanese subjects with impaired fasting glycemia (IFG) defined by the newly proposed WHO criteria.

METHODS

Oral glucose tolerance tests were carried out for 306 IFG subjects identified from 6632 adult participants of two large scale community-based studies: Nutrition and Health Survey in Taiwan (1993-1996) and the Cardiovascular Disease Two-township Study (1994-1997). Similar protocols were used in these two studies to collect data on glycemic status, anthropometric measurements, and other data used in the present study.

RESULTS

Subjects with IFG had a non-trivial undiagnosed diabetes mellitus rate (30% in men and 42% in women) and a high rate of glucose intolerance and undiagnosed DM combined (75% in men and 86% in women). Women with IFG had a 1.6 fold higher risk (p = 0.04) for undiagnosed DM and a 2.1 fold higher risk (p = 0.01) for glucose intolerance and DM when compared to men. There were more women than men with an elevated body mass index in undiagnosed DM patients. Among IFG subjects, undiagnosed DM patients were significantly (p < 0.05) older, more centrally obese and shorter than their normal IFG counterparts, irrespective of gender. In men, height was independent of age and waist circumference in predicting undiagnosed DM (p = 0.037).

CONCLUSIONS

A high proportion of impaired glucose tolerance and undiagnosed DM was found in subjects with IFG. Its public health impact should not be overlooked. Central obesity, female sex, and short stature were associated with undiagnosed DM status in IFG subjects.

Determination of free-form of cocaine in rat brain by liquid chromatography-electrospray mass spectrometry with in vivo microdialysis

A rapid liquid chromatography-electrospray mass spectrometry (LC-ES-MS) method with in vivo microdialysis for the determination of free-form of cocaine (COC) in rat brain has been developed. A C18 column and a gradient elution were employed for the separation. The [M+H]+ (m/z=304) and a fragmented ion (m/z=182) were detected using positive ion mode detection. Selective ion monitoring was utilized for quantitative measurement. The linearity of this assay was good ranging from 0.01 to 1.0 microM (r2=0.999). The inter- and intra-day precisions showed relative standard deviations ranging from 1.0% to 3.3% and 1.0% to 3.6%, respectively. In addition, the detection of one COC metabolite, benzoylecgonine (BE), by this assay was also investigated. The linearity, precision, and detection limit associated with this method for BE were determined. The application of this newly developed method was demonstrated by examining the pharmacokinetics of COC in rat brain.

Dietary factors associated with physician-diagnosed asthma and allergic rhinitis in teenagers: analyses of the first Nutrition and Health Survey in Taiwan

The occurrence of asthma and allergy are related to lifestyle factors, and dietary pattern may be one of the contributing factors. To examine the possible association between dietary intake and the prevalence of asthma and allergic rhinitis in teenagers. In a population-based cross-sectional survey, the relationship was sought between food frequency and physician-diagnosed asthma and allergic rhinitis in 1166 adolescents aged 13-17. The prevalence was 4.0% for asthma and 12.4% for rhinitis. Living in an urbanized area was a significant predictor of asthma and rhinitis. In univariate analysis, higher frequencies of oily fish, butcher's meat, liver and deep-fried foods were associated with asthma. Relevant food frequency variables were dichotomized at the 75th percentile for multivariate logistic regression analysis, which included adjustment for two levels of urbanization. Asthma was associated with intakes of liver (OR = 2.32, 95%CI 1.11-4.80), deep-fried foods (OR = 2.13, 95%CI 1.06-4.30) and butcher's meat (OR 1.84, 95%CI 0.89-3.80). In a similar analysis, allergic rhinitis was associated with liver (OR = 1.67, 95%CI 1.06-2.63). No protective effect was demonstrated for any of the food items examined. Protein-rich and fat-rich foods of animal origin were associated with a higher prevalence of asthma in teenagers.

Cardiac beriberi among illegal mainland Chinese immigrants

The most common symptoms of chronic beriberi due to thiamine deficiency include dyspnoea, fatigue, leg oedema, lower extremity weakness and numbness. When collapsed peripheral circulation, metabolic acidosis, or shock are present, the disease has advanced from chronic beriberi to pernicious or fulminating beriberi heart failure (Shoshin beriberi). We report two patients with fulminating beriberi; both of whom had been incarcerated at a detention centre for 5 months before hospitalization. A prolonged monotonous diet, low in thiamine, was a major risk factor in both patients. Thiamine deficiency should be considered for any patient with symptoms and signs compatible with beriberi.

Predictors of survival among elders suffering strokes in Taiwan: observation from a nationally representative sample

BACKGROUND AND PURPOSE

Cerebrovascular disease was the leading cause of death in Taiwan from 1963 to 1982. Deaths due to stroke now rank second only to cancer, with more deaths resulting from strokes than from any other single pathology. It is important to understand stroke prognosis among elderly stroke survivors, with respect to survival and attendant predictive factors, because aged population in Taiwan is growing rapidly. The aim of the present study was to discern factors affecting survival in stroke patients from a nationally representative elderly sample.

METHODS

A total of 99 stroke survivors, from a representative national sample of elders aged >/=65 years on December 31, 1988, whose strokes occurred in the period 1989-1993, were followed for mortality until July 1, 1995. Personal data were gathered through home interviews conducted by well-trained community nurses, and mortality data were obtained from the national census office by using identification card numbers. Cox proportional hazards regression analysis and the stepwise technique were used to search for important prognostic factors of survival.

RESULTS

Women experienced a higher mortality rate (139.8 per 1000 person-years) than men (126.4 per 1000 person-years), as age-adjusted for World Health Organization world-population figures. Stroke patients who received continuous treatment for diabetes experienced mortality risks similar to those of patients without diabetes and much lower risks than those with discontinuous diabetes treatment. Cognitive impairment was also an independent predictor of survival (relative risk 2.69, P<0.05). In addition, patients with both cognitive and mobility impairments had a 2- to 3-fold greater risk of mortality than those with only a single abnormality.

CONCLUSIONS

This first report on the various prognostic factors related to survival of elderly stroke patients in Taiwan's Chinese population emphasized the benefit of continuous diabetes treatment in improving survival chances. These stroke patients should also be monitored for cognitive and mobility impairments and undergo rehabilitation.

Linkage analysis with candidate genes: the Taiwan young-onset hypertension genetic study

A genetic linkage study of young-onset hypertension was performed on data from 59 nucleus families of Han Chinese residing in Taiwan. Thirty seven microsatellite markers near 18 hypertension candidate genes were genotyped. In a nonparametric identity-by-descent sibpair analysis, a positive linkage signal (defined as P<0.05) was found for four microsatellite markers, viz., D1S1612 (P=0.0162), D1S547 (P=0.0263), D8S 1145 (P= 0.0284), and D17S2193 (P=0.0256), which were located near genes for atrial natriuretic peptide (NPPA)/glucose transporter 5 (SLC2A5), angiotensinogen (AGT), lipoprotein lipase (LPL), and angiotensin-conveting enzyme (DCP1), respectively. Marker D5S1480 located near beta-2-adrenergic receptor (ADRB2) had a borderline P value (P=0.0785) for the positive signal. Comprehensive genotyping with further markers in these regions is underway to confirm whether these genes are linked to young-onset hypertension.

Regulatory effects of D2 receptors in the ventral tegmental area on the mesocorticolimbic dopaminergic pathway

To investigate the regulatory effects of somatodendritic D2 receptors on the terminal's extracellular dopamine (DA) concentration, a D2 antagonist (eticlopride) was infused directly into the ventral tegmental area via a microdialysis probe in chloral hydrate-anesthetized rats. Extracellular DA changes in both the nucleus accumbens (N ACC) and the medial prefrontal cortex (mPFC) were monitored. Infusion of 10.0 fM eticlopride had no effect on DA in the mPFC (110.2 +/- 10.0% of baseline) but significantly increased DA in the N ACC (150.1 +/- 11.7%). Infusion of a higher dose of eticlopride (100.0 or 1,000.0 fM) significantly augmented the DA in the mPFC (121.1 +/- 7.6 and 180.7 +/- 25.8%, respectively) but surprisingly had no effect on DA in the N ACC (111.5 +/- 7.3 and 104.1 +/- 8.7%, respectively). To further investigate whether the bluntness of DA increase in the N ACC was due to DA receptor activation in the mPFC, eticlopride or SCH23390 was infused into the mPFC prior to and during intrategmental eticlopride infusion, and the change of DA in the N ACC was simultaneously monitored. During intra-mPFC 1.0 nM eticlopride infusion but not during 10.0 nM SCH23390 administration (95.5 +/- 6.1%), intrategmental 1,000.0 fM eticlopride infusion could further elevate DA in the N ACC (130.0 +/- 4.6%). Our results indicated that (1) the mesolimbic and the mesocortical pathways were under tonic inhibition by somatodendritic D2 receptors; (2) the DA concentration in the N ACC first increased and then returned to baseline while the intrategmental infusion dose of eticlopride increased; and (3) the bluntness of DA increase in the N ACC resulted from the D2 receptor activation in the mPFC.

Dietary exposure to nitrite and nitrosamines and risk of nasopharyngeal carcinoma in Taiwan

Previous studies of nasopharyngeal carcinoma (NPC) have found elevated risks with higher consumption of salted fish and preserved foods, particularly during childhood. These foods can contain high levels of nitrosamines; however, most studies have not estimated exposure to nitrosamines directly. We conducted a case-control study in Taiwan to evaluate dietary intakes and NPC risk. A total of 375 cases (99% response rate) and 327 controls (88% response rate) were interviewed about their diet as an adult and at age 10 using a food-frequency questionnaire. We interviewed mothers of participants about their child's diet at age 10, age 3 and during weaning and the mother's diet while she was breast-feeding. Mothers of 96 cases and 120 controls were interviewed. Nitrosamine and nitrite levels were assigned to 66 foods based on published values. Intake of nitrosamines and nitrite as an adult was not associated with risk of NPC. High intakes of nitrosamines and nitrite during childhood and weaning were associated with increased risks of NPC for foods other than soy products. Adjusted odds ratios for the highest quartile were 2.2 [95% confidence interval (CI) 0.8-5.6] for age 10, 2.6 (95% CI 1.0-7.0) for age 3 and 3.9 (95% CI 1.4-10.4) for weaning diet. Intakes of nitrite and nitrosamines from soybean products during childhood and weaning were inversely associated with risk. Soybeans contain known inhibitors of nitrosation, and thus may explain the inverse association we observed. Our results suggest that nitrosamine and nitrite intake during childhood may play a role in the development of NPC.

Effects of ascorbate in microdialysis perfusion medium on the extracellular basal concentration of glutamate in rat's striatum

There are many evidences suggest that ascorbate in the extracellular space can affect glutamate concentration in the rat's brain. In this report, we studied how ascorbate in microdialysis perfusion medium affected glutamate level at the striatum in freely-moving rats. Three perfusion mediums were used: 0, 250, and 400 microM of ascorbate in perfusion medium. The extracellular basal concentrations of glutamate were determined to be 1.29+/-0.52 microM for the no ascorbate group, 0.86+/-0.35 microM for the low ascorbate group and 4.76+/-1.48 microM for the high ascorbate group. By using 400 microM of ascorbate in a perfusion medium, we found that the extracellular basal concentration of glutamate significantly increased and its in vivo recovery significantly decreased. This indicated that ascorbate concentration in a perfusion medium was important and must be carefully considered while using microdialysis technique to monitor glutamate concentration in vivo.

Coronary heart disease mortality trends in men in the post World War II birth cohorts aged 35-44 in Japan, South Korea and Taiwan compared with the United States

BACKGROUND

Since World War II, people in Japan, South Korea, and Taiwan have been exposed to a westernized lifestyle. It is most likely that the post World War II cohorts (1950+) have been more exposed. We hypothesize that there would be an increase in mortality from coronary heart disease (CHD) in men aged 35-44 in these countries.

METHODS AND RESULTS

Mortality from CHD in men aged 35-44 in South Korea and Taiwan has recently increased, and in Japan it has decreased. Mortality from CHD in men aged 35-44 is lower in Japan than in either South Korea or Taiwan, and much lower than in the US. National sample data and several epidemiological studies have shown that risk factors for CHD including hypercholesterolaemia and hypertension in the past decade were not much different between young adult men in Japan and the US. Based upon these risk factors, CHD death rates among post World War II cohorts should be similar in Japan and the US. However, the rates are five times higher in the US for men aged 35-44. The majority of deaths in the category of diseases of the heart were from heart failure in men in this age group in Japan; the mortality from heart failure was about three times higher than the mortality from CHD. Heart failure was rarely used in men aged 35-44 in the US.

CONCLUSIONS

The continued low mortality rates from CHD in young men in Japan may be an artifact. It is possible that CHD death rates in post World War II birth cohort in Japan are similar to US rates.

Relationship between hemostatic factors and known cardiovascular disease correlates in two suburban populations in Taiwan

The Cardiovascular Disease (CVD) Risk Factor Two-Township Study is a longitudinal cardiovascular epidemiologic study of two suburban towns in Taiwan. Analyzing baseline data from 1,080 men and 1,510 women aged 18 and above, this paper focuses on the relationship of several hemostatic factors to CVD correlates: blood lipids, apolipoproteins, glucose, and uric acid, and blood pressure. Information on these relationships can shed light on whether hemostatic factors contribute to the pathogenesis of CVD independently or through known mechanisms. Pearson correlation and multiple regression analysis were used to analyze the data. In the population studied, cholesterol, and apolipoprotein B had the strongest correlations with all hemostatic factors tested. Triglyceride was also strongly associated with factor VIIc. Factor VIIIc, factor VIIc, and fibrinogen, ordered by the strength of the correlation, were positively and significantly correlated with glucose, uric acid, and blood pressure levels. The associations of apolipoprotein B and cholesterol with fibrinogen (p = 0.14-0.20) were not as strong as those with factors VIIc (p = 0.28-0.37) and VIIIc (p = 0.15-0.30). Factors VIIc and VIIIc were independently associated with most clinical variables studied, including the levels of cholesterol components, triglyceride, glucose, uric acid, and diastolic blood pressure. These finding indicate that states of coagulating factors correlated, to varied degrees, with levels of blood lipid parameters, uric acid, and blood pressure in the population studied.

Community-based molecular epidemiology of HTLV type I in Taiwan and Kinmen: implication of the origin of the cosmopolitan subtype in northeast Asia

To understand the possible origin and dissemination of HTLV-I infection in northeast Asia, community-based molecular epidemiological studies were conducted on the Kinmen Islands (off the coast of Fukien Province, China) and in Taiwan. A total of 3831 Taiwanese from 3 townships (Pu-Li, Chu-Dung, and Pu-Tze) and 993 aborigines from 4 tribes in Taiwan participated in this study. The prevalence rates of HTLV-I infection in adult residents from Pu-Li, Chu-Dung, and Pu-Tze were 0.82, 1.72, and 1.63%, respectively. None of the aborigines had HTLV-I infection. Previously, 0.73% of the adult population of Kin-Hu, Kinmen were found to have HTLV-I infection. Peripheral blood mononuclear cells were collected from HTLV-I carriers identified both in Taiwan and Kinmen and the HTLV-I LTR sequences were PCR amplified, subcloned, and sequenced for phylogenetic tree analysis. The results showed that all 6 HTLV-I isolates from Kinmen and 13 of 18 (72.2%) isolates from Taiwan were group a (transcontinental) of Cosmopolitan subtype, while 5 of 18 (27.8%) isolates from Taiwan were group b (Japanese) of Cosmopolitan subtype. Since all of the HTLV-I-infected persons were descendants of immigrants from mainland China, the origin of the Cosmopolitan subtype in Taiwan and Kinmen may not have been Japan, as previously theorized, but China, possibly the result of the migration of an infected population in the past several centuries.

Striatal glutamate release is important for development of ischemic damage to striatal neurons during rat heatstroke

This study attempted to ascertain whether heatstroke-induced ischemia is associated with augmented striatal glutamate release and can be attenuated by NMDA receptor antagonists. Mean arterial pressure (MAP), striatal cerebral blood flow (CBF), striatal glutamate release and striatal neuronal damage score were assessed in saline-treated rats and in rats treated with NMDA receptor antagonists. Heatstroke was induced by exposing the animals to a high ambient temperature; the moment at which MAP and CBF began to decrease from their peak levels was taken as the onset of heatstroke. During onset of heatstroke, rats displayed higher values of colonic temperature, striatal glutamate release and striatal neuronal damage score, and lower values of MAP and striatal blood flow compared with normothermic control rats. The decreased MAP, the diminished striatal blood flow, the augmented striatal glutamate release and the increased striatal neuronal damage score during onset of heatstroke were significantly attenuated by pretreatment with an NMDA receptor antagonist such as MK-801 or ketamine. In addition, the survival time (interval between onset of heatstroke and death) of the rats was extended by pretreatment with one of these two NMDA receptor antagonists. These results suggest that marked accumulation of glutamate in the striatum is important for the development of ischemic damage to striatal neurons during the onset of heatstroke.

Incidence of NIDDM and the effects of gender, obesity and hyperinsulinaemia in Taiwan

Our aim is to determine non-insulin-dependent diabetes mellitus (NIDDM) incidence in Taiwan and examine its relation to obesity and hyperinsulinaemia in Chinese men and women. A total of 995 men and 1195 women aged 35-74 years free from diabetes in two townships in Taiwan were followed up with a second examination. At baseline general and metabolic data were recorded, and detailed anthropometric parameters and plasma glucose and insulin were assessed. World Health Organisation (WHO) criteria of fasting glucose 7.8 mmol/l or greater was utilized for defining diabetes. The age-standardized incidence rate based on the United States population in 1970 was 9.3/1000 (CI 5.8-12.8) in men and 9.3/1000 (CI 6.2-12.4) in women and the based on the WHO population in 1976 was 8.9/1000 (CI .5-12.3) in men and 8.9/1000 (CI 5.9-11.9) in women for the Chinese who had a mean BMI slightly greater than 24 (kg/m2). The predictability of the plasma glucose level was greater than that of the insulin level and the obesity indices. NIDDM incidence increased approximately threefold with each 0.67 mmol/l increase in plasma glucose level in men and women. The present study demonstrated the essential relationship of not only BMI but also central obesity indices (such as subscapular and waist circumference) to the incidence of NIDDM among men and women and a stronger relationship between NIDDM incidence and obesity in women than in men. The predictive effects of obesity indices and fasting plasma insulin values on NIDDM risk were independent of each other in men. Obesity and hyperinsulinaemia each without the presence of the other can lead to an increased risk of NIDDM. In women the NIDDM incidence increased more than additively in those with both obesity and hyperinsulinaemia compared to those with single obesity or hyperinsulinaemia. A slightly higher incidence of NIDDM in Taiwan than in western countries was found. The importance of obesity is indicated for predicting NIDDM in the community. Hyperinsulinaemia was found to play a significant role in predicting NIDDM incidence independent of obesity in men and synergistically with obesity in women.

Reference spirometric values in healthy Chinese neversmokers in two townships of Taiwan

The present community-based study was performed to provide predictive equations and lower boundaries of normal values for forced expiratory volume in one second (FEVI), forced vital capacity (FVC), and their percent ratio (FEV1%) in non-smoking, healthy adult men and women residing in communities, using ATS-recommended techniques and equipment. Use was made of data collected cross-sectionally from Nov. 1990 to Dec. 1993 in an ongoing longitudinal study on evolution of cardiovascular disease risk factors in Chinese. The spirometric values in our population reached their peak at around age 20. After age 20, a downward age trend was observed for FVC, FEV1, and FEV1%. Linear and negative relations were found in adults for each of the three spirometric values with age. Linear and positive relations were found between height and FVC or FEV1, but not between height and FEV1%. The age trends of FVC and FEV1 in Chinese adults were similar to those in Caucasians. Mean FVC and FEV1 levels of Chinese in Taiwan were systematically lower than those of Caucasians for a given height and a given age. Age and height specific percentile values of FVC and FEV1 and the age-specific percentile value of FEV1% are provided for adult men and women in this community study.

Effects of different perfusion medium on the extracellular basal concentration of dopamine in striatum and medial prefrontal cortex: a zero-net flux microdialysis study

The zero-net flux microdialysis method was used to determine (1) the basal concentration of dopamine (DA) in the extracellular space, and (2) the in vivo recovery of Da in the striatum and the medial prefrontal cortex by using three different kinds of perfusion medium. They were, (a) commercial Ringer's solution, (b) low Ca2+ Ringer's solution, and (c) artificial cerebrospinal fluid (aCSF). Our results not only support previous findings that the high Ca2+ concentration in the perfusion medium could increase the baseline concentration of DA in the dialysate, which was collected from extracellular space through dialysis probe; but also provides evidence that this baseline increase was primarily due to an increase of basal DA concentration, and not from the increase of the in vivo recovery. Additionally, there was no significant difference in the basal DA concentration by using either commercial Ringer's solution or aCSF. This indicates that both commercial Ringer's solution and aCSF are suitable as good perfusion medium to determine the basal DA in the rat's brain.

Associations between carotid atherosclerosis and high factor VIII activity, dyslipidemia, and hypertension

BACKGROUND AND PURPOSE

A subsample of 147 Chinese subjects from a population-based study of cardiovascular diseases (Cardiovascular Disease Risk Factor Two-Township Study) participated in an ancillary study on extracranial carotid color duplex ultrasonography that aimed to assess the relations of coagulation factors to stroke and carotid atherosclerosis.

METHODS

Logistic models were used to study the associations between cardiovascular disease risk factors and stroke/carotid atherosclerosis, controlling for the effects of age and sex.

RESULTS

Stroke was significantly associated with hypertension and high values of plasma glucose but not with fibrinogen, factor VIIc, or factor VIIIc. Carotid plaques identified in this study were mostly mild and moderate. The presence of these mild and moderate carotid plaques was significantly associated with high values of factor VIII activity, hypercholesterolemia, hypertriglyceridemia, and hypertension. The highest tertile of factor VIIIc (> 1.53) was associated with an odds ratio of 3.35 for carotid atherosclerosis when compared with the lowest tertile (< 1.20). A multiple logistic regression including all significant risk factors showed that the degree of association between factor VIIIc and atherosclerosis was attenuated to an odds ratio of 2.65 (P = .061).

CONCLUSIONS

In the present study, the roles of hypertension, hypercholesterolemia, and hypertriglyceridemia have been implicated in the pathogenesis of carotid atherosclerosis, and roles for hypertension and hyperglycemia in stroke were indicated. A positive association between factor VIIIc and carotid atherosclerosis in this Chinese population was found. Whether this association is independent of the effect of other cardiovascular risk factors awaits further study.

Intrategmental infusion of cocaine decreases dopamine release and enhances norepinephrine release in the medial prefrontal cortex

We evaluated the effects of local cocaine infusion into the A10 (ventral tegmental area), the cell body of the mesocorticolimbic dopaminergic pathway, on the extracellular concentrations of dopamine and norepinephrine in the medial prefrontal cortex, one of its terminal fields. A 1-ml Hamilton syringe was used to infuse a cocaine solution, either 20 or 200 microM, into the ventral tegmental area of anesthetized rats for 120 min through a microdialysis probe. The pure artificial cerebrospinal fluid (0 microM cocaine) infusion served as a control and a lidocaine (100 microM) infusion was administered to prevent the local anesthetic effect of cocaine. After intrategmental cocaine infusion (either 20 or 200 microM), extracellular dopamine and norepinephrine in the ventral tegmental area both increased significantly to a steady state level (208 +/- 42 and 148 +/- 23% for low dose and 220 +/- 24 and 150 +/- 15% for high dose). Simultaneously, the 200-microM cocaine infusion caused a significant decrease in extracellular dopamine (77 +/- 5%) but an increase in norepinephrine (140 +/- 6%) in the medial prefrontal cortex. The local anesthetic, lidocaine, produced no effects on the dopamine or norepinephrine output (neither in the ventral tegmental area nor in the medial prefrontal cortex). This study not only supports recent findings of an increase in extracellular dopamine and norepinephrine in the ventral tegmental area on intrategmental cocaine infusion, but also demonstrates that cocaine infused locally in the ventral tegmental area can decrease dopamine and increase norepinephrine at a remote terminal area (medial prefrontal cortex). Finally, the introduction rate of cocaine into the ventral tegmental area by retrograde microdialysis was found to be 0.83 ng/min for the low dose and 8.14 ng/min for the high dose.

Sexual differences in bone markers and bone mineral density of normal Chinese

We measured bone mineral density (BMD) at lumbar (L2-L4) vertebrae and proximal femurs of 385 healthy Chinese women aged 40-70 years and 156 healthy Chinese men aged 20-85, and four markers-bone alkaline phosphatase isozyme (BAP), procollagen-I C terminal propeptide (PICP), osteocalcin (BGP) in serum, and a bone resorption marker, urinary cross-linked N-telopeptide of type I collagen (NTX), of these subjects. The results indicate that in postmenopausal women, levels of all the markers increased with age. In men, serum BAP, PICP, and urinary NTX decreased significantly, and serum BGP decreased with borderline significance (P = 0.08). With increasing age, bone density decreased at both sites in postmenopausal women and at the proximal femur in men. The lumbar bone density showed no significant age-related changes in men. In premenopausal women, BMD at either site showed no significant change with increasing age. Despite the different trends between men and women of age-related changes in BMD and bone markers, bone density of both proximal femur and spine in both sexes correlated inversely with levels of the bone markers in a manner independent of age or body weight. The meaning of opposite age effects on bone markers in men and women needs further investigation. In addition, higher bone marker levels, implying faster bone turnover rate, are associated with lower BMD in both sexes.

A new video path analyzer to monitor travel distance, rearing, and stereotypic movement of rats

A new video path analyzer, described herein, monitors travel distance, rearing, stereotypic movement, rotation, and speed of rats simultaneously. The video path analyzer was equipped with a cage (black background, 50 cm long x 50 cm wide x 50 cm high), camera, television screen, computer, and printer. A detailed description of this equipment is included. While studying the known activating effects of d-amphetamine on rats' behavior, we also evaluated the equipment for its maximum and accurate contribution to this study. Results indicate that this equipment compared to photocell equipment produced reliable data and offered the advantages of lower cost. It is expected to gain more popularity in the near future.

Bone mineral density and bone markers in relation to vitamin D receptor gene polymorphisms in Chinese men and women

Whether vitamin D receptor gene (VDRG) polymorphism can be used as a predictor for bone turnover rate or bone mass remains controversial. Its role within various ethnic populations are also unsettled. We examined VDRG polymorphism using restrictive enzymes Bsm-I, Apa-I, and Taq-I in 155 men aged 22-88 and 113 premenopausal women aged 40-53. The bone mineral density (BMD) of the vertebrae (L2-4), proximal femur, and total body bone mineral content (tb-BMC) (women only), as well as urinary N-terminal crosslinked fragment of type I collagen (NTX), serum osteocalcin, bone isozyme of alkaline phosphatase, and caboxyterminal propeptide of type I procollagen levels were measured. Chinese men and women exhibited a low prevalence for B (absence of Bsm-I restriction site) phenotypes than white and Japanese. Within the tested samples there were 0.4% BB homozygotes, 6.7% Bb heterozygotes, and 93% bb homozygotes. The distributions of Apa-I polymorphism (9.0% AA, 42.5% Aa, and 48.5% aa) also differed from those reported for the white populations. Most of the Chinese men and women were TT homozygous (96.6%). A comparison of actual values and values adjusted for age and weight of tb-BMC and BMD at the lumbar spine, Trochanter, Ward's triangle, and femoral neck showed no significant difference among three subgroups in each of the three sets of polymorphism. Furthermore, the actual values and adjusted values (adjusted for age) of the four bone markers, respectively, showed no significant differences. We conclude that given the very low prevalence of the suspected high risk genotypes (B, A, and t), and the lack of difference among the polymorphic subgroups, VDRG polymorphism may not be an important determinant of the bone turnover rate and bone mass of Chinese men and women.

Beneficial effects of pravastatin on fasting hyperinsulinemia in elderly hypertensive hypercholesterolemic subjects

We undertook this prospective double-blind, placebo-controlled study to evaluate the efficacy and safety of low-dose (15 mg) pravastatin in elderly hypercholesterolemic hypertensive subjects with concurrent antihypertensive treatment and to determine whether fasting hyperinsulinemia could also be improved. At three hypertension and lipid clinics of two medical centers, 96 elderly (49 women, 47 men) ambulatory subjects were randomized to active treatment or placebo for 12 months after a 3-month single-blind lead-in period. Hypertensive subjects with plasma total cholesterol levels of at least 6.47 mmol/L (250 mg/dL) and triglyceride levels less than 3.39 mmol/L (300 mg/dL) were treated with 15 mg pravastatin for 12 months after receiving 3 months of the American Heart Association step I diet. Lipid, glucose, and fasting insulin levels were measured; clinical laboratory tests included liver function and creatine kinase determinations. After 12 months of pravastatin therapy, plasma total cholesterol concentration decreased by 25.1% (from a mean of 7.29 to 5.47 mmol/L, P < .05), low-density lipoprotein cholesterol decreased by 30.2% (from 5.27 to 3.68 mmol/L, P < .05), and triglycerides decreased by 10.7% (from 1.68 to 1.50 mmol/L, P < .05). High-density lipoprotein cholesterol increased by 9.2% (from 1.20 to 1.31 mmol/L, P < .05). Fasting insulin levels decreased from 89.0 to 61.5 pmol/L (P < .05). All of these changes were greater (P < .05) than any tendency toward change in the placebo group. Adverse events and clinical laboratory abnormalities were generally mild and transient in both placebo and pravastatin groups. Study drugs were withdrawn from one subject in each group with asymptomatic creatine kinase elevations. We conclude that low-dose pravastatin was effective and safe in the treatment of hypercholesterolemic hypertensive subjects on concurrent antihypertensive therapy. It also improved fasting hyperinsulinemia despite the use of beta-blockers and diuretics in these hypertensive subjects.

Thrombophilia in patients with hypercholesterolemia

To investigate a possible interrelationship between hypercholesterolemia and the coagulation and fibrinolytic system, the Cardiovascular Disease Risk Factor Two-Township Study in Taiwan was undertaken as a longitudinal prospective study focusing on the evolution of cardiovascular disease risk factors, with an emphasis on hemostatic factors. Hemostatic parameters measured in this study included prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, factor VIIc, factor VIIIc, antithrombin III, and plasminogen. Subjects of both sexes with hypercholesterolemia (> 6.2 mmol/L) also had significant elevations of diastolic blood pressure, plasma glucose, triglycerides, fibrinogen, and factor VIIc and reduced PT and APTT compared with subjects with lower cholesterol. The hypercholesterolemic women additionally had significant elevations of systolic blood pressure and factor VIIc. Levels of the anticoagulant factors, antithrombin III and plasminogen, were also higher in both hypercholesterolemic men and women. In men, only factor VIIIc had no statistically significant elevation. In women, only PT showed no statistical difference. Established coronary risk factors such as fibrinogen and factor VIIc showed remarkable elevations in patients of both sexes. Using Pearson correlation and multiple regression, the most significant parameter related to cholesterol level was factor VIIc. The present results show that hemostatic abnormalities do exist in patients with hypercholesterolemia, and this thrombophilic phenomenon sheds further light on the study of higher cardiovascular mortality in these subjects.

Locally application of amphetamine into the ventral tegmental area enhances dopamine release in the nucleus accumbens and the medial prefrontal cortex through noradrenergic neurotransmission

The effects and mechanisms of locally applied d-amphetamine (AMPH) into the ventral tegmental area (VTA) on extracellular dopamine (DA) concentrations in both the nucleus accumbens (N ACC) and the medial prefrontal cortex (mPFC) were investigated. A solution containing either, 0, 100, 500 or 1000 microM AMPH was infused, using a 1-ml Hamilton syringe, into the VTA of chloral hydrate-anesthetized rats for 100 min through a microdialysis probe. Infusion of AMPH into the VTA dose-dependently increased extracellular DA in the N ACC and in the mPFC. The introductory rate of AMPH application through the dialysis probe into the VTA was estimated simultaneously. Local infusion of either a selective alpha adrenoceptor antagonist (phentolamine, 1 and 10 microM) or a selective beta adrenoceptor antagonist (alprenolol, 1 and 10 nM) dose-dependently blunted the intra-VTA AMPH-induced extracellular DA increase in the N ACC. Further, local infusion of phentolamine (0.1 and 1 microM) and alprenolol (1 and 10 nM) appreciably and dose-dependently reduced the effects of AMPH on the DA increase in the mPFC. These results suggest that intra-VTA AMPH can enhance DA release in the N ACC and in the mPFC by activating noradrenergic neurotransmission in the VTA.