Effects of metallothionein-1 genetic polymorphism and cigarette smoking on the development of hepatocellular carcinoma.

BACKGROUND: A low expression of metallothionein (MT) has been observed in liver cancer. Such a phenomenon might be influenced by oxidative stress, thus resulting in the cells being more susceptible to DNA damage and apoptotic death. In particular, oxidative stress induced by cigarette smoking might affect MT-1 expression. We designed a hospital-based case-control study to evaluate the effects of MT-1 genotypes and smoking on hepatocellular carcinoma (HCC) occurrence. METHODS: A total of 102 HCC patients and 191 matched healthy control subjects were recruited, and epidemiological information was collected. Six genotypes of MT-1 were determined with TaqMan single-nucleotide polymorphism genotyping assays. RESULTS: Individuals possessing MT-1 rs8052394 A, rs964372 G, and rs8052334 T alleles as well as engaging in cigarette smoking had increased risks of HCC; these alleles also had higher linkage disequilibrium. Carriers with MT-1 rs8052394, rs964372, and rs8052334 A-G-T haplotype had a 2.25-fold (95 % confidence interval [CI] 1.46-3.26) risk for HCC development than the control group (A-C-T, the most common haplotype). Compared to nonsmokers with other haplotypes (A-C-T, G-G-C, A-G-C, G-G-T, G-C-T, and G-C-C), nonsmokers with A-G-T haplotype had a 1.93-fold (95 % CI 1.01-3.71) increased risk, and smokers with other haplotypes had a 3.66-fold (95 % CI 1.78-7.54) increased risk, whereas smokers carrying the A-G-T haplotype had the highest risk (matched relative risk 6.72; 95 % CI 2.86-15.79) of developing HCC. CONCLUSIONS: The MT-1 A-G-T haplotypes are associated with increased risk of HCC, especially in those who smoke.

Neonatal jaundice is a risk factor for childhood asthma: a retrospective cohort study.

BACKGROUND: The association between neonatal jaundice and childhood asthma is a new finding of two reports. The purpose of the study was to verify their results. METHODS: Data from 11,321 children were collected from the National Health Insurance Research Database. Their claims data were evaluated from birth to 10 yr old. Children were analyzed as case (those with neonatal jaundice) and controls (those without neonatal jaundice). The diagnostic criteria for asthma were as follows: at least four asthma diagnoses at outpatient services and emergency department (ED), or one asthma diagnosis during an admission. In children fitting the asthma criteria, those with no asthma diagnosis after 1 yr of age were excluded. Mantel-Haenszel's odds ratios were calculated after adjustment for the following confounders: preterm/low birth weight, neonatal infection, other respiratory conditions, other birth conditions, and gender. Asthma rate, onset time, the use of drugs, upper respiratory infection and lower respiratory infection (LRI) rates, hospital admission/ED visit rates, and the effect of phototherapy were evaluated. RESULTS: After adjustment for the confounding factors, the rate of asthma was higher in icteric children (OR: 1.64, 95% CI 1.36-1.98, p < 0.001), and the influence in females was stronger. There still was an association between neonatal jaundice and late onset asthma (asthma onset after 3 yr of age). In asthmatic children, those with neonatal jaundice have increased asthma onset rate before age 6, increased use of inhalant steroids, LRI rates, and ED visits for respiratory disease. CONCLUSIONS: Neonatal jaundice increased the rate and severity of childhood asthma in subjects aged up to 10 yr and may be a risk factor for childhood asthma.

Elevated risk of hypertension induced by arsenic exposure in Taiwanese rural residents: possible effects of manganese superoxide dismutase (MnSOD) and 8-oxoguanine DNA glycosylase (OGG1) genes.

Heavy metals, including arsenic and lead, may lead to cellular oxidative damage that is linked to hypertension. Manganese superoxide dismutase (MnSOD) is a scavenger of reactive oxygen species, and 8-oxoguanine DNA glycosylase (OGG1) is the major glycosylase that repairs DNA lesions. Interestingly, whether there is an elevated risk of hypertension with arsenic or lead exposure in individuals with genetic variations in MnSOD or OGG1 has not yet been investigated. Questionnaires were administered to 240 Taiwanese rural residents. Blood pressure and biochemical indicators were assessed in each subject. Urinary levels of arsenic and lead were measured with atomic absorption spectrometry; and MnSOD and OGG1 genotypes were identified via polymerase chain reaction. There was a dose-response relationship between urinary arsenic levels and risk of hypertension (P = 0.021, test for trend). However, there was no association between urinary lead levels and hypertension risk. Individuals with high urinary arsenic levels and the MnSOD Val-Ala/Ala-Ala genotypes had a greater risk of hypertension than those with low urinary arsenic levels and the MnSOD Val-Val genotype (odds ratio [OR] = 4.2, 95% confidence interval [CI] = 1.7-10.3). Subjects with a high urinary arsenic level and the OGG1 Cys-Cys genotype also had a greater risk of hypertension than those with a low urinary arsenic level and the OGG1 Ser-Ser/Ser-Cys genotypes (OR = 3.4, 95% CI = 1.1-10.7). Thus, both MnSOD and OGG1 genotypes may be prone to an increased risk of hypertension associated with arsenic exposure.

Osteoprotegerin genetic polymorphisms and age of symptom onset in ankylosing spondylitis.

OBJECTIVES: Osteoporosis is one of the recognized features of AS. It is known that RANK ligand (RANKL), which binds to RANK, can cause the activation of bone resorption. Osteoprotegerin (OPG) also competes with RANK by binding to RANKL and inhibiting bone absorption. Therefore, we designed a case-control study to evaluate the association between occurrence and clinical features of AS and RANK, RANKL and OPG genetic polymorphisms. METHODS: A total of 330 AS patients and 330 age- and gender-matched controls were recruited. PCR-restriction fragment length polymorphism was applied to identify RANK C575T, RANKL C-290T and OPG G1181C genotypes. RESULTS: OPG GG genotype carriers had an elevated risk of AS compared with those with the GC and CC genotypes (matched odds ratio 1.74; 95% CI 1.26, 2.40). Age of symptom onset and frequency of peripheral arthritis significantly differed among AS patients by OPG G1181C genotypes. HLA-B27(+) patients with the OPG C allele had the earliest age of symptom onset [mean (s.d.) 26.6 (9.6) years], followed by HLA-B27(+) patients with the OPG G allele [32.6 (12.2) years], HLA-B27(-) patients with the OPG G allele [38.1 (13.6) years] and HLA-B27(-) patients with the OPG C allele [38.6 (9.8) years]. CONCLUSION. OPG G1181C polymorphism may be associated with AS development and clinical manifestations.

Effects of genetic polymorphisms of programmed cell death 1 and its ligands on the development of ankylosing spondylitis.

OBJECTIVES: There is a known association of imbalanced peripheral tolerance and autoimmune diseases. The binding of programmed cell death 1 (PD-1) with its ligands 1 and 2 (PD-L1 and PD-L2) inhibits T-cell proliferation through a negative signal via recruitment of src homology 2-domain-containing tyrosine phosphatase 2. Therefore we evaluated the effect of the PD-1, PD-L1 and PD-L2 genotypes on the occurrence of AS in a population of Taiwanese patients. METHODS: Genetic polymorphisms of PD-1 G-536A, PD-L1 A8923C and PD-L2 C47103T were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for 330 AS patients and 330 healthy controls who were matched by age and gender. RESULTS: Subjects with the PD-1 GG genotype [matched relative risk (RR(m)) 1.78; 95% CI 1.13, 2.81] and the GA genotype (RR(m) 1.59; 95% CI 1.09, 2.31) had significantly greater risk for AS than those with the AA genotype. Subjects with the PD-L2 CT genotype had lower risk for AS than those with the CC genotype (RR(m) 0.01; 95% CI 0.001, 0.06). Interestingly, the combined genotypes of PD-1 G-536A, PD-L1 A8923C and PD-L2 C47103T also appear to be associated with AS development. CONCLUSIONS: Our results suggest that PD-1 G-536A, PD-L1 A8923C and PD-L2 C47103T polymorphisms are associated with the presence of AS.

Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery.

Fungal rhinosinusitis is an important clinical problem with diverse manifestations. Although many literatures had found low recurrence rate after surgical treatment of fungus ball rhinosinusitis, patient satisfaction and treatment outcomes (symptom-free and symptom improvement rate, etc.) for fungus ball sinusitis are not yet well established. The purpose of this study is to estimate the patient satisfaction and treatment outcome in patients with fungus ball rhinosinusitis undergoing functional endoscopic sinus surgery (FESS). Medical records of consecutive patients with diagnosed fungus ball rhinosinusitis treated by FESS between 1995 and 2005 were reviewed retrospectively. The post-operative improvement in individual symptom was assessed by chart review and telephone visiting. Ninety consecutive patients (21 men and 69 women) were eligible for the study. Six patients (7%) presented bilateral fungus ball rhinosinusitis. Multiple paranasal sinus fungus ball involvements were found in 48 patients (53%). Complete resolution of complaints with respect to nasal discharge, postnasal drip, cough with sputum, nasal bleeding, fetid odor of nose, olfactory dysfunction, nasal obstruction, headache, and facial pain or pressure were described in 74 patients (82%). The overall patient satisfaction rate was 96%. The estimated recurrence rate of fungus ball rhinosinusitis treated with FESS was 3%, with a mean follow-up of 81 months. Treatment protocol of fungus ball rhinosinusitis with FESS and without postoperative antifungal drugs is efficient because of very low recurrence rate, high patient satisfaction, and very high symptom-free rate. Furthermore, the obvious difference of symptom-free rate between fungus ball rhinosinusitis and chronic rhinosinusitis highlights the need of further studies to discover the pathophysiology of fungal sinusitis.

Treatment and toxicity evaluation of methylene blue using electrochemical oxidation, fly ash adsorption and combined electrochemical oxidation-fly ash adsorption.

Treatment of a basic dye, methylene blue, by electrochemical oxidation, fly ash adsorption, and combined electrochemical oxidation-fly ash adsorption was compared. Methylene blue at 100 mgL(-1) was used in this study. The toxicity was also monitored by the Vibrio fischeri light inhibition test. When electrochemical oxidation was used, 99% color and 84% COD were removed from the methylene blue solution in 20 min at a current density of 428 Am(-2), NaCl of 1000 mgL(-1), and pH(0) of 7. However, the decolorized solution showed high toxicity (100% light inhibition). For fly ash adsorption, a high dose of fly ash (>20,000 mgL(-1)) was needed to remove methylene blue, and the Freundlich isotherm described the adsorption behavior well. In the combined electrochemical oxidation-fly ash adsorption treatment, the addition of 4000 mgL(-1) fly ash effectively reduced intermediate toxicity and decreased the COD of the electrochemical oxidation-treated methylene blue solution. The results indicated that the combined process effectively removed color, COD, and intermediate toxicity of the methylene blue solution.

Hylan G-F 20 has better pain relief and cost-effectiveness than sodium hyaluronate in treating early osteoarthritic knees in Taiwan.

BACKGROUND/PURPOSE: Intra-articular injection of hyaluronan (hyaluronic acid; HA) products is available to treat early osteoarthritis (OA) of the knee in Taiwan. We tested whether HA products with different molecular weights have significantly different effects on clinical efficacy and cost-effectiveness. METHODS: Thirty-seven patients with mild to moderate OA of both knees underwent five weekly intra-articular injections of sodium hyaluronate (Artz) in one knee and three weekly intra-articular injections of chemically cross-linked Hylan G-F 20 (Synvisc) in the other. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne's index, and Hospital for Special Surgery (HSS) knee scores were compared initially and at the last injection, and at 8, 12, 16, 20, and 26 weeks after the first injection. RESULTS: VAS, WOMAC, WOMAC-A1 (pain when walking on a flat surface) scores before week 16, HSS scores before week 12, and Lequesne's index scores except at week 26 all showed that HA significantly improved the scores time-dependently. In VAS scores, Synvisc showed better improvement before week 20, while this effect appeared at week 12 for the WOMAC-A1 scores. The incremental cost-effectiveness ratio of the Taiwan National Health Insurance Program, of the patient, and both of these was lower for Synvisc, which also reduced the number of additional hospital visits for injections by two. CONCLUSION: Synvisc possesses better symptom-modifying ability and cost-utility in treating early OA of the knee in Taiwan.

Polymorphisms in metabolic GSTP1 and DNA-repair XRCC1 genes with an increased risk of DNA damage in pesticide-exposed fruit growers.

Pesticide exposure is associated with various neoplastic diseases and congenital malformations. Previous studies have indicated that pesticides may be metabolized by cytochrome P450 3A5 or glutathione S-transferases. DNA-repair genes, including X-ray repair cross-complementing group 1 (XRCC1) and xeroderma pigmentosum group D (XPD), may also be implicated in the process of pesticide-related carcinogenesis. Thus, we investigated whether various metabolic and DNA-repair genotypes increase the risk of DNA damage in pesticide-exposed fruit growers. Using the comet assay, the extent of DNA damage was evaluated in the peripheral blood of 135 pesticide-exposed fruit growers and 106 unexposed controls. The metabolic genotypes CYP3A5 (A(-44)G) and GSTP1 (Ile105Val) and DNA-repair genotypes XRCC1 (Arg399Gln, Arg194Trp, T(-77)C) and XPD (Asp312Asn, Lys751Gln) were identified by polymerase chain reaction. Our multiple regression model for DNA tail moment showed that age, high pesticide exposure, low pesticide exposure, GSTP1 Ile-Ile, and XRCC1 399 Arg-Arg genotype were associated with increased DNA tail moment (DNA damage). Further analysis of interaction between GSTP1 and XRCC1 genes that increase susceptibility revealed a significant difference in DNA tail moment for high pesticide-exposed subjects carrying both GSTP1 Ile-Ile with XRCC1 399 Arg-Arg genotypes (2.49+/-0.09 microm/cell; P=0.004), compared to those carrying GSTP1 Ile-Val/Val-Val with XRCC1 399 Arg-Gln/Gln-Gln genotypes (1.98+/-0.15 microm/cell). These results suggest that individuals with susceptible metabolic GSTP1 and DNA-repair XRCC1 genotypes may be at increased risk of DNA damage due to pesticide exposure.

Phytoextraction of cadmium by Ipomoea aquatica (water spinach) in hydroponic solution: effects of cadmium speciation.

Phytoextraction is a promising technique to remediate heavy metals from contaminated wastewater. However, the interactions of multi-contaminants are not fully clear. This study employed cadmium, Triton X-100 (TX-100), and EDTA to investigate their interactions on phytotoxicity and Cd phytoextraction of Ipomoea aquatica (water spinach) in simulated wastewater. The Cd speciation was estimated by a chemical equilibrium model and MINEQL+. Statistic regression was applied to evaluate Cd speciation on Cd uptake in shoots and stems of I. aquatica. Results indicated that the root length was a more sensitive parameter than root weight and shoot weight. Root elongation was affected by Cd in the Cd-EDTA solution and TX-100 in the Cd-TX-100 solution. Both the root length and the root biomass were negatively correlated with the total soluble Cd ions. In contrast, Cd phytoextraction of I. aquatic was correlated with the aqueous Cd ions in the free and complex forms rather than in the chelating form. Additionally, the high Cd bioconcentration factors of I. aquatica (375-2227 l kg(-1) for roots, 45-144 l kg(-1) for shoots) imply that I. aquatica is a potential aquatic plant to remediate Cd-contaminated wastewater.

Evaluation of internal consistency and re-test reliability of Bath ankylosing spondylitis indices in a large cohort of adult and juvenile spondylitis patients in Taiwan.

The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Score (BAS-G) have been recommended for evaluating function and disability in patients with ankylosing spondylitis (AS). The aim of this study was to develop a Chinese version of the BASDAI, BASFI, and BAS-G and assess their reliability and validity. The Chinese version was obtained after a translation and back-translation process. A total of 447 patients with adult and juvenile AS were assessed using these three instruments. Reliability was tested by internal consistency and test-retest reliability. Internal consistency of the instrument was given as Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation coefficient. To assess the sensitivity to change, 153 patients were included in an 8-week follow-up study. In our analysis, the reliability of these three instruments-the BASDAI, BASFI, and BAS-G-for a 24-h test-retest showed acceptable intraclass correlation coefficients (0.92-0.94). Our Chinese versions of the BASDAI, BASFI, and BAS-G also showed 0.87, 0.94, and 0.90, respectively, with Cronbach's alpha coefficient, indicating good reliability. For sensitivity to change in 8-week follow-up, all three instruments showed 5.0 to 5.4% changes. Our Chinese versions of the BASDAI, BASFI, and BAS-G showed adequate reliability, validity, and responsiveness to clinical change. Thus, disease activity and functional status in Chinese-speaking patients with AS may be adequately evaluated with these versions of the original instruments.

Emission of polycyclic aromatic hydrocarbons and lead during Chinese mid-autumn festival.

The emission factors of total particulate polycyclic aromatic hydrocarbons (PAHs), Benzo(a)pyrene (BaP), BaP-equivalent doses (BaP(eq)) and Pb for burning three kinds of charcoal were investigated in this study: fast-lighting charcoal, Taiwanese, and Indonesian charcoal (the latter two of which are not fast-lighting). Compared to the burning of Taiwanese and Indonesian charcoal, the burning of fast-lighting charcoal can emit much larger amounts of total PAHs, BaP(eq) and Pb into the atmosphere. The emission factors of total PAHs, BaP and BaP(eq) for broiling meat were noticeably higher than those for broiling vegetables and non-fish seafood. When using Indonesian charcoal to broil meat, the total emission factors of particulate PAHs and BaP were about 15.7 and 0.39 mg/kg, respectively. The total amounts of particulate PAHs and Pb emitted from cookouts during Mid-Autumn Festival were 2881 and 120 g, respectively. Total PAHs and BaP(eq) in PM(10) aerosols on Mid-Autumn Festival nights increased about 1.6 and 1.5 times, respectively, higher than those on non-festival nights. The mean concentration of Pb on the nights of Mid-Autumn Festival increases to about 2.8 times that of non-festival nights.

Factors contributing to patient dumping in Taiwan.

OBJECTIVE: Little research has been carried out to explore the issues surrounding patient dumping outside of the US. This study, therefore, uses a national research survey to examine the factors contributing to patient dumping within Taiwan. METHODS: A self-administered postal survey was undertaken to assess the prevalence of patient dumping in Taiwan, with the study subjects being superintendents of general hospitals. Data from the Bureau of Medical Affairs at the Department of Health in Taiwan were used in conjunction with the Taiwan National Health Insurance Research Database (NHIRD) to obtain estimates of factors potentially contributing to patient dumping. A multiple logistic regression analysis was performed to determine the relationships between the perceived extent of patient dumping occurring within the respondents' healthcare networks, as well as other factors, including the total number of hospitals, total number of hospital beds, the percentages of beds in public, for-profit and teaching hospitals (vis-à-vis all hospital beds), discharges, discharges covered under the case payment system, transferred inpatients, and the perceived degree of competition within each healthcare market. RESULTS: A total of 485 survey questionnaires were distributed, of which 251 were returned, giving a response rate of 51.75%. The responses from 29.9% of the sample group indicated that the perceived extent of patient dumping occurring in their service area was 'serious' or 'very serious'. The regression analysis showed that after controlling for other factors, the superintendents' perceived extent of the patient dumping occurring within their healthcare networks was positively related to the total number of patients covered under the case payment system, the total number of discharged patients, the extent of healthcare market competition and the number of respondent's hospital beds. CONCLUSIONS: We conclude from our findings that, under the National Health Insurance system, patient dumping is a widespread problem within Taiwan's healthcare industry.

Is unenhanced 18F-FDG-PET/CT better than enhanced CT in the detection of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma?

Positron-emission tomography/computed tomography (PET/CT) has been proposed as a means to enhance the pretreatment evaluation of cervical lymph node status in patients with nasopharyngeal carcinoma (NPC). We conducted a prospective study to compare PET/CT and enhanced CT for the detection of retropharyngeal lymph node (RLN) metastasis in NPC, and to ascertain the factors that affect its diagnostic performance. Our study population was made up of 33 patients-24 men and 9 women, aged 30 to 81 years (mean: 52)-with newly diagnosed NPC who had been treated over a 2-year period. All patients underwent enhanced CT first, followed by unenhanced 18F-fluorodeoxyglucose (FDG) PET/CT. The detection rate of RLN metastasis on PET/CT was significantly lower than that on enhanced CT (36.4 vs. 75.8%; p < 0.001). A total of 25 of 26 nodes with a discordant finding were negative on PET/CT; they included 13 metastatic lymph nodes with low FDG uptake, 9 that were located close to the primary tumor, 2 that were confluent RLNs, and 1 that was adjacent to the physiologic FDG-avid prevertebral muscle. The maximum standardized uptake value (SUVmax) of RLNs was positively correlated with the minimum axial diameter (r = 0.803, p < 0.001). The PET/CT detection rate was 0% for lymph nodes smaller than 5 mm, 9% for those 5 to 10 mm, and 73% for those 1 cm or larger. The detection rate of PET/CT at level C1 was significantly lower than that at C2 (22 vs. 67%; p = 0.035). We conclude that unenhanced PET/CT is markedly inferior to enhanced CT for detecting RLN metastasis in NPC, especially in lymph nodes with a minimum axial diameter of less than 1 cm and those in proximity to the primary tumor. Using enhanced CT in PET/CT is justified to improve the recognition of RLN metastasis in patients with NPC.

The effect of anterior vaginal wall prolapse on urethral pressure profile.

OBJECTIVE: To evaluate whether anterior vaginal wall prolapse will cause a decrease in urethral pressure. METHODS: Two hundred ninety-four patients with uterovaginal prolapse served as study cases. In addition, 127 patients without uterovaginal prolapse were included as controls. The urethral pressure profile measurement was performed using a microtransducer and the fluid-bridge method with the patient in the lithotomy position. The parameters of the urethral pressure profile and its associated variables were compared between the control and study groups. RESULTS: The proximal portion of urethral pressure and the resting and stress urethral closure pressures in women with anterior vaginal wall prolapse were significantly lower than those of the control group. An indentation segment (or a plateau pressure zone) in the proximal portion of the urethral pressure profile curve was noted in patients with anterior vaginal wall prolapse, especially for stage I (64.2%) and stage II (73.0%). Anterior vaginal wall prolapse and genuine stress incontinence had a statistically significant odds ratio for predicting the presence of an indentation segment (or a plateau pressure zone) in the proximal portion of the urethral pressure profile curve (1.58 and 3.19, respectively). CONCLUSIONS: An indentation segment (or a plateau pressure zone) of the proximal portion of the urethral pressure profile curve was observed in most of our patients with anterior vaginal wall prolapse. Defects in the anterior vaginal wall supports may attenuate the proximal urethral support, and these defects will contribute to a reduction in the proximal urethral pressure.

The variation of percent free prostate-specific antigen determined by two different assays.

BACKGROUND: We evaluated the difference in values of the percent free Prostate-specific antigen (PSA) as measured by the Hybritech Tandem R assay (USA) and the Cis bio international assay (France). MATERIALS AND METHODS: A total of 99 patients scheduled for transrectal ultrasonography (TRUS) of the prostate and sextant biopsy were subjected to measurements of total and free PSA using the Hybritech Tandem R assay and the Cis bio international assay with the same serum sample. RESULTS: Thirty patients were confirmed to have prostate cancer and 69 patients to have benign prostate hyperplasia (BPH). The Pearson coefficients of correlation of the Cis bio international assay versus the Tandem R assay were 0.979 for total PSA, 0.987 for free PSA and 0.937 for percent free PSA. The mean total PSA measured by Tandem R was 8.65 +/- 5.36 ng/ml, which was significantly higher than those determined by Cis bio international assay, 7.60 +/- 4.46 ng/ml (p < 0.0001). The mean free PSA determined by Tandem R assay was 1.47 +/- 1.01 ng/ml, which was significantly less than that measured by Cis bio international assay, 1.75 +/- 1.18 ng/ml (p < 0.0001). Thus the percent free PSA calculated by the Cis bio international assay also had significantly higher mean values compared to the Tandem R assay (24.08 +/- 10.09 vs. 18.22 +/- 8.17, p < 0.0001). CONCLUSION: The optimal cut-off value of percent free PSA for biopsy reference was demonstrated to be higher when determined by Cis bio international assay than Tandem R assay.

Serial-measured versus estimated creatinine clearance in patients with non-small cell lung cancer receiving cisplatin-based chemotherapy.

BACKGROUND AND PURPOSE: Cisplatin-based chemotherapy is the main therapy for patients with advanced stage non-small cell lung cancer (NSCLC). The dose of cisplatin is adjusted according to the patient's renal function. Calculation of creatinine clearance (CCr) by 24-hour urine collection is the most common method for estimating the glomerular filtration rate but is time-consuming and inconvenient. Estimation of CCr using the Cockcroft-Gault formula has been suggested to be accurate, reproducible, and less costly. This study compared CCr values obtained by measured and estimated methods during cisplatin-based chemotherapy in NSCLC patients in Taiwan. METHODS: A total of 92 patients (58 men, 34 women) with advanced NSCLC who completed 6 cycles of chemotherapy participated in the study. The dose of cisplatin per cycle was 80 mg/m(2) every 28 days, reduced to 50 mg/m(2) if CCr was 30 to 60 mL/min by the measured method. When urine collection was finished, serum and urine creatinine levels were measured simultaneously. Estimated values were calculated before each cycle of chemotherapy. RESULTS: The mean measured CCr was 85.2 mL/min, 25.7 mL/min higher than the mean estimated value. CCr values obtained by both methods were significantly reduced during the 6 cycles of chemotherapy. There was no significant difference in CCr values between patients aged < 65 years or >/= 65 years (-19.9 vs -15.1 mL/min, p = 0.15). Using a cut-off of measured CCr >/= 60 or < 60 mL/min, agreement on the dosage for both methods was 51% for all patients, 77.7% for patients < 65 years, and 26.7% for patients >/= 65 years. CONCLUSIONS: The Cockcroft-Gault formula underestimated measured CCr by about 25 mL/min in this study. Cisplatin-based chemotherapy reduced CCr, with no significant difference between older and younger patients. Use of the estimated method would result in significant under-dosing, especially for patients >/= 65 years old.

Prognostic factors for outcome in pediatric probable lesional frontal lobe epilepsy with an unknown cause (cryptogenic).

The outcomes of children with cryptogenic seizures most probably arising from the frontal lobe are difficult to predict. We retrospectively collected data on 865 pediatric patients with epilepsy. In 78 patients with cryptogenic frontal lobe epilepsy, the age at first seizure was inversely correlated with the outcome, including the degree of intellectual disability/developmental delay (P = .002) and seizure frequency (P = .02) after adequate treatment. Intellectual disability was more prevalent in children with a first seizure at 0 to 3 years old (P = .002), and seizures were more frequent in those with a first seizure at 0 to 6 years old than at 7 to 16 years old (P = .026). For pediatric cryptogenic frontal lobe epilepsy, the age at first seizure is important and inversely correlated with outcome, including seizure frequency and intellectual disability.

High-resolution computed tomography in assessment of patients with emphysema.

OBJECTIVE: To assess whether high-resolution computed tomography (HRCT) variables are as good as other known clinical variables in grading emphysema patients. METHODS: A detailed clinical history was taken and physical examination performed. We performed serum study, lung function testing, and HRCT scanning to assess emphysema. Mean lung density, the attenuation value separating the least 15% of pixels (PERC15), the percentage of the relative area of the lungs with attenuation values < -950 Hounsfield units (HU) (RA950), and histogram analysis were calculated from computerized data. RESULTS: The final analysis was based on data from 92 subjects, and they were moderately emphysematous (mean lung density was -877 ± 23 HU, PERC15 was -953 ± 21 HU, and RA950 was 16 ± 5%). There was a significant difference regarding subjective emphysema severity in the St George's Respiratory Questionnaire, smoking history, FEV1, C-reactive protein, age, and body mass index (P < .001). There was a significant correlation between the 3 objective image variables and the 6 objective clinical variables (St George's Respiratory Questionnaire, smoking history, FEV1, C-reactive protein, age, and body mass index) (P < .001). CONCLUSIONS: This study shows the possible important role of HRCT in the diagnosis and quantification of pulmonary emphysema.

Differences in health complaints among Taiwanese workers in different occupational categories.

OBJECTIVES: The objectives of this study were to determine the prevalence of and differences in certain health complaints, including physical symptoms and psychological distress, among workers in different occupational categories and to explore the associations between occupational category and each complaint. METHODS: A cross-sectional study was conducted using a self-administered questionnaire. A total of 1,628 workers representing seven occupational categories from ten companies in different industries submitted completed questionnaires. The self-administered questionnaire contained three parts: personal data, physical symptoms and psychological distress. Physical symptoms were measured using nine questions developed by a panel of ten general practitioners; the questions included nine common physical symptoms across main organ systems. Psychological distress was measured using the Chinese Health Questionnaire. RESULTS: Muscle pain (44.7%) and dizziness (30.1%) were the most common symptoms reported by participants, and 16.6% of participants suffered from psychological distress. Significant differences in physical symptoms and psychological distress were found among workers in different occupational categories (Χ(2)=53.59, p<0.001). Compared with service workers, office workers and managers had higher prevalence rates of physical symptoms; office workers also showed a higher prevalence of psychological distress. CONCLUSIONS: The study merits attention in terms of prevention of health problems in the workplace by focusing on a set of physical symptoms and psychological distress (not merely morbidity). Occupational category should be taken into consideration when planning workplace health promotion. Our findings highlight the need for health promotion programs that specifically target office workers and managers.