Benign prostatic enlargement is not associated with diabetes: a population-based study

The association between diabetes and benign prostatic hyperplasia remains inconclusive. In this case-control study, we examined the association of diabetes with benign prostatic enlargement (BPE) using the Longitudinal Health Insurance Database 2000 in Taiwan. In total, 20 152 patients with BPE as cases and 20 152 age-matched patients without BPE were included as controls. Conditional logistic regression analyses were performed to calculate the odds ratio (OR) and corresponding 95% CI for having been previously diagnosed with diabetes between cases and controls. We found that of the 40 304 sampled patients, 9492 (23.6%) had a history of diabetes before the index date. This mean age for the sampled patients was 65.9 with a standard deviation of 12.0 years. A Chi-squared test revealed that there was a significant difference in the prevalence of prior diabetes between cases and controls (25.3% vs. 21.8%, p < 0.001). The conditional logistic regression found that the OR of prior diabetes for cases was 1.21 (95% CI = 1.15-1.27) compared with controls. However, after adjusting for geographic region, monthly income, urbanization level, hypertension, coronary heart disease (CHD), hyperlipidemia, tobacco use disorder, and obesity, the association between prior diabetes and BPE did not reach a statistically significant level (OR = 1.03, 95% CI = 0.98-1.08). In addition, it was noteworthy that hypertension (OR = 1.25, 95% CI = 1.20-1.31), CHD (OR = 1.40, 95% CI = 1.32-1.48), and hyperlipidemia (OR = 1.30, 95% CI = 1.24-1.36) were all significantly associated with BPE. We found that men with a diagnosis of diabetes were not significantly associated with BPE after adjusting for patient's sociodemographic characteristics and comorbidities.

Effects of a needs-based education programme for family carers with a relative in an intensive care unit: a quasi-experimental study

Critical illness and subsequent hospitalisation of a relative to an intensive care unit (ICU) can result in many physiological and psychosocial problems for patients and their family members. Caring for the anxiety and frustration of these families is an integral part of critical care nursing. The purpose of this study was to examine the effect of a needs-based education programme provided within the first 3 days of patients’ hospitalisation, on the anxiety levels and satisfaction of psychosocial needs of their families. This was a quasi-experimental study with pre- and post-test design. A convenience sample was recruited over a period of three months, consisting of one primary family carer of each critically ill patient who had been admitted to an ICU in Hong Kong. Conducted by an ICU nurse specially assigned for the purpose, family carers in the experimental group (n=34) received an individual education programme based on the results of a literature review and an individual family needs assessment carried out at the time of patient admission, using the Critical Care Family Needs Inventory. The subjects in the control group (n=32) received the usual orientation and explanation given by the ICU nurses. Anxiety and need satisfaction were measured in the two groups at pre- and post-test and their mean scores were compared. Of the ten most important statements identified by the family carers in the two groups, the statements regarding the needs for information and assurance were found to predominate. After the needs-based intervention, the experimental group reported significantly lower levels of anxiety and higher levels of satisfaction of family needs than the control group at the post-test. The findings support the effectiveness of providing families of newly admitted critically ill patients, with a needs-based educational intervention to allay anxiety and satisfy immediate psychosocial needs. The formulation of a family education programme should be based on the results of a needs assessment, in order to meet family carers’ individual needs.

Agreement between hearing thresholds measured in non-soundproof work environments and a soundproof booth

AIMS

To study the agreement between audiometric test results measured in non-soundproof environments at the worksite, and in a soundproof booth.

METHODS

In a cross sectional prevalence study on noise induced hearing loss, 885 transport workers whose hearing thresholds were measured by a standard audiometric test method in non-soundproof environments at the worksite were identified to have some hearing loss (>25 dB), and were retested in a soundproof booth.

RESULTS

At 4-8 KHz, the mean of the absolute differences in hearing threshold obtained by these two methods was 2 dB or less. When the proportions of hearing loss (> or =30 dB for any frequencies at 3-8 KHz, or > or =90 dB for three low frequencies at 0.5-2 KHz, or > or =90 dB for three high frequencies at 3-6 KHz) were compared, considerable differences existed. A much better agreement was obtained when the criteria for hearing loss as measured in the field test under non-soundproof conditions were relaxed by 5 dB. At 4 KHz, the difference between the proportion of subjects with hearing loss as measured in the field and that as measured in the booth was the smallest. The kappa statistic was highest at 3 and 4 KHz.

CONCLUSIONS

Audiometric test results conducted in non-soundproof environments in the field are comparable to those obtained in a soundproof environment among transport workers with a hearing loss of >25 dB. The hearing threshold at 4 KHz appears suitable for the estimation of the prevalence of hearing loss when appropriate adjustments are made in the diagnostic criteria.

A comparison of simplified lansoprazole suspension administered nasogastrically and pantoprazole administered intravenously: effects on 24-h intragastric pH

AIM

To compare the 24-h intragastric pH effects of simplified lansoprazole suspension, 30 mg, administered nasogastrically, with pantoprazole, 40 mg, administered intravenously.

METHODS

Thirty-six healthy adults were enrolled and given simplified lansoprazole suspension, 30 mg (nasogastrically), or pantoprazole, 40 mg (intravenously), once daily for five consecutive days in a cross-over fashion. Intragastric pH was monitored at baseline and on Days 1 and 5 of each treatment period. The pharmacokinetic parameters of lansoprazole and pantoprazole were also determined on Days 1 and 5.

RESULTS

No statistically significant changes in pharmacokinetic parameters occurred between Days 1 and 5 with either regimen, except for pantoprazole Cmax. On Days 1 and 5, significantly higher mean 24-h intragastric pH values were observed with 30 mg simplified lansoprazole suspension compared with 40 mg intravenous pantoprazole (Day 1, 3.13 vs. 2.67; Day 5, 3.95 vs. 3.61, respectively; P < 0.05). Additionally, 30 mg simplified lansoprazole suspension produced significantly (P < 0.05) higher percentages of time intragastric pH was above 3, 4, 5 or 6 as compared with 40 mg intravenous pantoprazole throughout Days 1 and 5.

CONCLUSIONS

A 30 mg dose of simplified lansoprazole suspension administered nasogastrically was consistently more effective at controlling intragastric pH than pantoprazole, 40 mg, administered intravenously.

Colorectal cancer among Chinese restaurant waiters

To investigate whether Chinese restaurant waiters in Hong Kong had an increased risk of dying from colorectal cancer, we linked the records of deceased union members to the mortality information for the general population between 1986 and 1995. A case-control analysis among the deceased was performed with 346 deceased waiters and 306 deceased male kitchen workers. Waiters were found to have a significantly higher mortality odds ratio [(MOR) 2.29; 95% confidence interval (CI) = 1.47-3.56] of colorectal cancer when compared with the general population. The MOR (1.45; 95% CI = 0.71-2.93) was increased, but not significantly, when compared with the kitchen workers. The study suggested that waiters in Hong Kong Chinese restaurants are at a higher risk of dying from colorectal cancer. An unhealthy diet associated with their job is a possible explanation, and interventions should be initiated.

Effects on 24-hour intragastric pH: a comparison of lansoprazole administered nasogastrically in apple juice and pantoprazole administered intravenously

OBJECTIVE

To compare the 24-h intragastric pH effects of lansoprazole, 30 mg administered nasogastrically, with pantoprazole, 40 mg administered i.v.

METHODS

Healthy adults were enrolled in an open label, two-way crossover, single-center study. Thirty milligrams of lansoprazole (administered nasogastrically in apple juice) or pantoprazole (i.v.) were administered once daily at 8:00 AM for 5 consecutive days with at least a 2-wk washout period between the regimens. Ambulatory 24-h intragastric pH was monitored at baseline and on days 1 and 5 of each treatment period. Blood specimens were collected on days I and 5 for pharmacokinetic parameter determinations.

RESULTS

Thirty-three adults completed both crossover periods, with the exception of one patient with a zero lansoprazole plasma concentration on day 1 of period 2. Lansoprazole, 30 mg per nasogastric tube, produced significantly higher mean 24-h intragastric pH values relative to pantoprazole, 40 mg i.v., on both day 1 (3.05 vs 2.76, p < 0.002) and day 5 (3.65 vs 3.45, p = 0.024). Lansoprazole sustained the intragastric pH above 3 (days 1 and 5), 4, and 5 (day 1) significantly longer relative to pantoprazole. Lansoprazole's time to the maximum observed concentration and area under the plasma concentration-time curve over the 24-h time interval increased significantly from day I to day 5 (1.7 h vs 2.0 h and 1865 ng x h/ml vs 2091 ng x h/ml, respectively), and a significant increase in half-life relative to day 1 (0.96 h) was observed on day 5 (1.03 h) during pantoprazole treatment.

CONCLUSION

Lansoprazole, 30 mg administered nasogastrically, effectively controls intragastric pH and is an alternative to i.v. pantoprazole in patients who are unable to swallow solid dosage formulations.

HIV-1 Tat protein interacts with mammalian capping enzyme and stimulates capping of TAR RNA

HIV gene expression is subject to a transcriptional checkpoint, whereby negative transcription elongation factors induce an elongation block that is overcome by HIV Tat protein in conjunction with P-TEFb. P-TEFb is a cyclin-dependent kinase that catalyzes Tat-dependent phosphorylation of Ser-5 of the Pol II C-terminal domain (CTD). Ser-5 phosphorylation confers on the CTD the ability to recruit the mammalian mRNA capping enzyme (Mce1) and stimulate its guanylyltransferase activity. Here we show that Tat spearheads a second and novel pathway of capping enzyme recruitment and activation via a direct physical interaction between the C-terminal domain of Tat and Mce1. Tat stimulates the guanylyltransferase and triphosphatase activities of Mce1 and thereby enhances the otherwise low efficiency of cap formation on a TAR stem-loop RNA. Our findings suggest that multiple mechanisms exist for coupling transcription elongation and mRNA processing.

Delineation of CTG repeats and clinical features in a Taiwanese myotonic dystrophy family

Myotonic dystrophy (DM) is an inherited, autosomal dominant muscular disease which is primarily caused by a CTG trinucleotide expansion mutation on chromosome 19q13.3. The size of this trinucleotide repeat is related both to the age of onset and to the severity of the clinical manifestation. This disease is very rare in Taiwan, and clinical and genetic study on DM has not yet been documented in this area. Here, we present both clinical features and degrees of CTG expansion for a Taiwanese DM family. All of the DM patients examined in this family showed obvious clinical manifestations by age 30, which included facial and limb muscle weakness with atrophy, myotonia, and ptosis. In addition, individual DM members also exhibited variable phenotypes, which may reflect the complexity of the pathogenic mechanism. Because the collection of blood specimens was considered to be an invasive procedure, a genetic study on this DM family was performed using buccal cells. Our results confirmed that four members showing classic symptoms of DM had CTG repeat expansion in the DMI locus, and that one member with ptosis and minor muscle weakness in the right foot was a normal homozygote for CTG repeat. These data demonstrate that buccal cells can provide clear and reliable results, and thus, are suitable for a family study of DM.

Natural and experimental infection of white spot syndrome virus (WSSV) in benthic larvae of mud crab Scylla serrata

White spot syndrome virus (WSSV), the causative agent of white spot syndrome in shrimp, has a wide host range which extends to crabs, copepods and other arthropods. In this study, benthic larvae of the mud crab Scylla serrata were captured from Taiwan's coastal waters and screened for the presence of WSSV by polymerase chain reaction (PCR) and in situ hybridization. WSSV was detected in around 60% of the larvae, and this prevalence rate remained fairly constant when the captured larvae were subsequently maintained in an aerated system in the laboratory. WSSV-free larvae obtained from a hatchery were challenged by immersion in a WSSV inoculum. Fifteen days after challenge, cumulative mortality in the experimental group reached 43% compared to 20% in the control group. PCR detection of WSSV in both moribund and surviving specimens clearly implicated the virus as the cause of death in most cases. Histological and in situ hybridization data confirmed that WSSV tissue tropism in Scylla serrata crab larvae is similar to that found in shrimp.

Detection of Borna disease virus RNA from peripheral blood cells in schizophrenic patients and mental health workers

Accumulating evidence suggests that Borna disease virus (BDV), a neurotropic, negative-stranded RNA virus, might be associated with certain human mental disorders. Several research groups reported that psychiatric patients had a significantly higher prevalence of BDV serum antibodies than normal controls. In addition, a significantly higher presence of BDV RNA from peripheral blood cells was identified in mental patients than in controls. In our previous study, we first identified the presence of BDV serum antibodies in a cohort of Chinese schizophrenic patients from Taiwan, and we also demonstrated a significantly higher seroprevalence of BDV antibodies among schizophrenic patients than in non-psychiatric controls. Prompted by the positive seroepidemiological result, we set out to investigate the detection of BDV RNA from the peripheral blood cells of our schizophrenic patients. By using the reverse transcription-polymerase chain reaction (RT-PCR) method, 10 out of 74 Chinese schizophrenic patients from Taiwan were found to have BDV RNA in their blood cells, whereas only one out of 69 controls was positive. The BDV RNA detection rate among schizophrenic patients was significantly higher than that in controls (14% vs 1.4%, P < 0.01). Furthermore, we studied the BDV RNA detection rate among mental health workers, and seven out of 45 mental health workers were found to have positive results. The prevalence rate was significantly higher than that in normal controls (15% vs 1.4%, P < 0.001), which lends further support to our previous finding that mental health workers have a significantly higher presence of BDV serum antibodies. In summary, our data support the finding that BDV infection might be a contributory factor to the pathogenesis of schizophrenia in the Chinese population.

High seroprevalence of Borna virus infection in schizophrenic patients, family members and mental health workers in Taiwan

Borna disease virus (BDV), a negative-strand RNA virus, has been reported to be associated with severe psychiatric disorders. The association is mainly based on the findings that patients with schizophrenia and depression have a higher seroprevalence rate of BDV-specific antibodies than controls. In addition, psychiatric patients were also found to have a higher detection rate of BDV transcripts in their blood than controls. By using an improved Western blot analysis, we first demonstrated that Chinese schizophrenic patients from Taiwan also have a higher seroprevalence of BDV-specific antibodies than controls (12.1% vs 2.9%, P< 0.001), providing support to the positive association between BDV and psychiatric disorders in our population. Because of the contagious nature of viral infection, we further examined patients' family members and mental health workers, who have close contact with patients. We found that both groups also have a higher seroprevalence of BDV-specific antibodies, 12.1% and 9.8%, respectively, than controls. This finding provides some evidence for a possible human-to-human transmission of Borna disease virus. Our finding needs further independent verification from other research groups and the clinical relevance of this preliminary observation deserves further study.

Curve patterns and etiologies of scoliosis: analysis in a university hospital clinic in Taiwan

BACKGROUND

The curvature characteristics and etiologies of scoliosis have been well documented in many countries and among different races but have seldom been reported for Asians. We aimed to determine the etiology frequency and curvature characteristics of scoliotics in Taiwan.

MATERIALS AND METHODS

From July 1994 through December 1997, 648 new patients with scoliosis were examined. A whole spine standing radiographic study was taken for each patient. The data were collected prospectively for analysis.

RESULTS

Idiopathic scoliosis was the leading type in our series (86%), followed by congenital (6%) and neuromuscular scoliosis (5%). Single thoracic curve was the most common curve pattern (37%), followed by single lumbar (30%), double major (13%), single thoracolumbar (13%), and double thoracic curve (6.6%). The most frequent types of curve were right thoracic (28%) and left lumbar curve (22%), and these were defined as typical curves. The average curve magnitude was smaller in patients with atypical curves (left thoracic or right lumbar) and large curves were not commonly seen. The average curve magnitude increased in patients from the ages of 8 to 12 years and it exceeded Cobb's angle of 20 degrees at the age of 11.

CONCLUSION

Idiopathic scoliosis is the most frequent etiology of scoliosis in Taiwan. In our series, idiopathic scoliosis was female predominant (4.3:1), but there were no gender ratio differences in non-idiopathic patients (p < 0.001). Left thoracic curve occurred more often in juvenile idiopathic scoliotics (p = 0.006). Atypical curves were more resistant to curve progression and seldom induced large curves. School scoliosis screening beginning at age 11 is adequate and effective in Taiwan.

Increased risk of malignancy in patients with systemic lupus erythematosus

BACKGROUND

Systemic lupus erythematosus is a chronic, multisystem, autoimmune disorder that primarily affects women. Morbidity and mortality have improved for lupus patients during the last 15 years. An increased risk of malignancy in patients with lupus has been shown in some, but not all studies. The purpose of this study was to ascertain cancer risk in lupus patients by linking two disease registries.

METHODS

Participants in the Chicago Lupus Cohort included 616 women with lupus who were residents of Cook County, Illinois. They were seen during 1985-1995 at 4 University, inner city, and suburban inpatient and outpatient clinics in Chicago. Malignancies occurring in these subjects during the study interval, 1985-1995, were identified from the Illinois State Cancer Registry by matching name, birthdate, and social security number. Standardized incidence ratios (SIRs) were estimated for all malignancies in this cohort of lupus patients using age, gender, and all race or race-stratified specific cancer incidence data from Cook County, Illinois.

RESULTS

The registry linkage study with the Illinois State Cancer Registry documented that 30 women with lupus had a malignancy. The expected number of malignancies for women in the lupus cohort was 15.0. There were 8 cases of breast cancer and 4 each of lung and cervical cancer. In the remaining 14 women, 12 different types of cancers were noted. The SIR and 95% confidence interval (CI) for malignancy for all women with lupus in the study were 2.0 (1.4, 2.9) and lung cancer was the only individual cancer increased in all women--SIR and 95% CI were 3.1 (1.3, 7.9). In the analysis stratified by race, the risk of malignancy (SIR and 95% CI) was increased in Caucasian women, 2.3 (1.4, 3.9). Breast cancer was the only individual cancer increased in Caucasian women with lupus with an SIR and 95% CI of 2.9 (1.4, 6.4).

CONCLUSIONS

Lupus patients have an increased risk of malignancy. Breast, lung, and gynecological malignancies were the most common malignancies observed in the cohort and breast cancer was significantly increased in Caucasian women.

Platelet adhesion onto the wall of a flow chamber with an obstacle

In the present study, the data of the initial adhesion of platelets onto the wall of a flow chamber with an obstacle in steady human blood flows were obtained. The flowfields and the distribution of stress-related factors were simulated numerically by a finite volume method and the fluid dynamic effect on the platelet adhesion is discussed. In addition to the wall shear effect, the normal stress effect was also taken into account. A parameter Vn/[Vt] was devised to assess the combined effect of both shear and normal forces in platelet adhesion. It was found that the peak adhesion occurred next to, but not on, the impingement point on the obstacle where the value of Vn/[Vt] was negative. In these regions, direct impact played a major role in platelet adhesion. On the other hand, near the separation point before the obstacle where Vn/[Vt] was insignificant, the mechanism was believed to be different from that in the direct impact region. Denser adhesion there might be caused by the accumulation and frequent collision of particles due to flow retardation and/or detour of the flow path. Interestingly, relatively low adhesion was found inside the recirculation regions. These results show that the normal stress effect (impingement) should be considered in platelet adhesion in addition to the shear effect.

Velocity transients and viscoelastic resistance to active shortening in cat papillary muscle

When isotonic force steps were applied to activated papillary muscles, the velocity was almost never constant. Early rapid shortening associated with the step persisted for 2-7 ms after the step ends. The early rapid shortening is attributed to lightly damped series elastic recoil and velocity transients of the contractile elements. In most steps, the subsequent velocity declines progressively with shortening, and most of the decline in velocity can be accounted for by compression of a viscoelastic element in parallel with the contractile elements. To demonstrate this, the time course of isotonic velocity was compared with a model in which the force-velocity characteristics of the contractile element were assumed to be constant, and the decline in velocity was due to increasing compression of the viscoelastic element. This model predicted the observed results except that the predicted velocities rose progressively above the measured values for steps to light loads applied late in the twitch, and fell below the velocity trace for heavy loads applied early in the twitch. These deviations would occur if rapid shortening caused deactivation late in the twitch, and if activation were rising early in the twitch. A conditioning step applied to the muscle during the rise of force depressed both isometric force and maximum velocity measured at the peak of force; isometric force was more depressed with later conditioning steps than with earlier steps, while maximum velocity was depressed by about the same extent with both early and late steps. This difference between the effects on isometric force and maximum velocity are explained by a combination of deactivation and viscoelastic load.

Internal viscoelastic loading in cat papillary muscle

The passive mechanical properties of myocardium were defined by measuring force responses to rapid length ramps applied to unstimulated cat papillary muscles. The immediate force changes following these ramps recovered partially to their initial value, suggesting a series combination of viscous element and spring. Because the stretched muscle can bear force at rest, the viscous element must be in parallel with an additional spring. The instantaneous extension-force curves measured at different lengths were nonlinear, and could be made to superimpose by a simple horizontal shift. This finding suggests that the same spring was being measured at each length, and that this spring was in series with both the viscous element and its parallel spring (Voigt configuration), so that the parallel spring is held nearly rigid by the viscous element during rapid steps. The series spring in the passive muscle could account for most of the series elastic recoil in the active muscle, suggesting that the same spring is in series with both the contractile elements and the viscous element. It is postulated that the viscous element might be coupled to the contractile elements by a compliance, so that the load imposed on the contractile elements by the passive structures is viscoelastic rather than purely viscous. Such a viscoelastic load would give the muscle a length-independent, early diastolic restoring force. The possibility is discussed that the length-independent restoring force would allow some of the energy liberated during active shortening to be stored and released during relaxation.

A sensitive photoelectric force transducer with a resonant frequency of 6 kHz

A displacement-type photoelectric force transducer with a projection arm and a resonant frequency of 6 kHz is described. A vane on a moving element partially interrupts a light beam shining on a pair of phototransistors. Movement of the vane causes changes in the phototransistor currents, which are amplified to give an overall sensitivity of 10 mV/mg. Most of the half of each phototransistor not under the vane is covered by a mask, the edge of which is parallel to the edge of the vane. This increases the sensitivity of the transducer so that stiffer moving elements can be used. Compliance of the transducer at the tip of the projection arm is about 10 micrometers/g. The inertia of the lightweight moving element is minimized by having it rotate about a twisting strip hinge. The equivalent mass of the moving element at the tip, 6 mm from the pivot, is about 0.9 mg. The principal advantages of the transducer over other types is that it is nearly impervious to moisture.

A piezoelectric force transducer for single muscle cells

A cantilevered piezoelectric force transducer is described. The cantilevered element has a 6-mm glass extension that can be projected into a horizontal muscle bath from above. By adjusting the length of the piezoelectric bar from 1 to 4 mm, the sensitivity of the device can be varied between 25 and 100 mV/mN (0.25--1.0 mV/mg) with its resonant frequency varying inversely between 8 and 15 kHz. Although moderately fragile, the sensing elements are inexpensive and easily made. The output of the sensing element is amplified by a small, unity-gain, high-input-resistance amplifier mounted on a support block with the element. Although the arrangement does not provide a DC output, its time constant of over 500 s is sufficiently long for measuring tension during muscle contractions lasting 1--2 s.