Magnesium exposure increases hip fracture risks in patients with chronic kidney disease: a population-based nested case-control study.

This population-based study demonstrates a strong link between Mg-containing antacid exposure and hip fracture risk in nondialysis CKD and dialysis patients. As an Mg-containing antacid, MgO is also commonly used as a stool softener, which can be effortlessly replaced by other laxatives in CKD patients to maintain bone health. PURPOSE: Bone fracture is a severe complication in chronic kidney disease (CKD) patients, leading to disability and reduced survival. In CKD patients, blood magnesium (Mg) concentrations are usually above the normal range due to reduced kidney excretion of Mg. The present study examines the association between Mg-containing antacid exposure and the risk of hip fracture of CKD patients. METHODS: In this nationwide nested case-control study, we enrolled 44,062 CKD patients with hip fracture and 44,062 CKD matched controls, among which the mean age was 77.1 years old, and 87.9% was nondialysis CKD. RESULTS: As compared to non-users, Mg-containing antacid users were significantly more likely to experience hip fracture (adjusted odds ratio (OR) 1.36, 95% CI, 1.32 to 1.41; p < 0.001). Subgroup analysis showed that such risk exists in both nondialysis CKD patients and long-term dialysis patients. In contrast, aluminum or calcium-containing-antacid use did not reveal such association. Next, we examined the influence of Mg-containing antacid dosage on hip fracture risk, the adjusted ORs in the first quartile (Q1), Q2, Q3, and Q4 were 1.20 (95% CI, 1.15 to 1.25; p < 0.001), 1.35 (95% CI, 1.30 to 1.41; p < 0.001), 1.49 (95% CI, 1.43 to 1.56; p < 0.001), and 1.54 (95% CI, 1.47 to 1.61; p < 0.001), respectively, showing that such risk exists regardless of the antacid dosage. A receiver operating characteristic curve analysis demonstrated that the best cutoff value of the exposed Mg dose to discriminate the hip fracture is 532 mEq during the follow-up period. CONCLUSION: This population-based study demonstrates a strong link between Mg-containing antacid exposure and the hip fracture risk in both nondialysis CKD and dialysis patients.

Increased risk of bone fracture among patients with urinary calculi: a nationwide longitudinal population-based study.

UNLABELLED: Urinary calculi were associated with higher risk of vertebral and upper limb fracture. Therefore, patients with urinary calculi should be evaluated carefully because they may have a higher risk of subsequent fracture later in life. INTRODUCTION: The contribution of urinary calculi to reduced bone mineral density has been recognized. However, the association of urinary calculi with the risk of fracture remains inconclusive. The aim of the study was to determine the risk of overall fracture and fractures at different anatomic sites in patients with urinary calculi. METHODS: The records of inpatients and outpatients with urinary calculi were retrieved from the Taiwan National Health Insurance Database from 2000 to 2010. Among patients with urinary calculi at the cohort entry, controls were matched using propensity scores on a 1:1 ratio. All subjects were followed up from the date of enrollment until fracture occurrence, death, or December 31, 2010. There were 46,243 Medicare beneficiaries with a diagnosis of urinary calculi and 46,243 controls without calculi enrolled. RESULTS: Among these patients, 6005 patients with a diagnosis of urinary calculi and 5339 controls developed fractures during a median follow-up period of 5.3 years. Patients with urinary calculi had a higher incidence of fracture compared with controls (23.9 versus 22.1 per 1000 person-years) and a greater risk of overall fractures (adjusted hazard ratio [aHR] 1.08, 95 % confidence interval [CI], 1.04-1.12), mainly located at the vertebrae (aHR 1.15, 95 % CI, 1.06-1.25) and upper limb (aHR 1.07, 95 % CI, 1.01-1.14), but the risk for hip fracture was not increased (aHR 1.09, 95 % CI, 0.96-1.22). CONCLUSIONS: Urinary calculus is independently associated with higher risk of subsequent fracture. Patients with urinary calculi should pay attention to the future vertebral and upper limb fractures.

Carcinogenesis of Male Oral Submucous Fibrosis Alters Salivary Microbiomes.

Most oral squamous cell carcinoma (OSCC) tumors arise from oral premalignant lesions. Oral submucous fibrosis (OSF), usually occurring in male chewers of betel quid, is a premalignant stromal disease characterized by a high malignant transformation rate and high prevalence. Although a relationship between the inhabited microbiome and carcinogenesis has been proposed, no detailed information regarding the oral microbiome of patients with OSF exists; the changes of the salivary microbiome during cancer formation remain unclear. This study compared the salivary microbiomes of male patients with OSCC and a predisposing OSF background (OSCC-OSF group) and those with OSF only (OSF group). The results of high-throughput sequencing of the bacterial 16S rRNA gene indicated that OSF-related carcinogenesis and smoking status significantly contributed to phylogenetic composition variations in the salivary microbiome, leading to considerable reductions in species richness and phylogenetic diversity. The microbiome profile of OSF-related malignancy was associated with increased microbial stochastic fluctuation, which dominated the salivary microbiome assembly and caused species co-occurrence network collapse. Artificial intelligence selection algorithms consistently identified 5 key species in the OSCC-OSF group: Porphyromonas catoniae, Prevotella multisaccharivorax, Prevotella sp. HMT-300, Mitsuokella sp. HMT-131, and Treponema sp. HMT-927. Robust accuracy in predicting oral carcinogenesis was obtained with our exploratory and validation data sets. In functional analysis, the microbiome of the OSCC-OSF group had greater potential for S-adenosyl-l-methionine and norspermidine synthesis but lower potential for l-ornithine and pyrimidine deoxyribonucleotide synthesis and formaldehyde metabolism. These findings indicated that the salivary microbiome plays important roles in modulating microbial metabolites during oral carcinogenesis. In conclusion, our results provided new insights into salivary microbiome alterations during the malignant transformation of OSF.

Heavy metal removal from wastewater using zero-valent iron nanoparticles.

Because of having a high reduction potential, the zero-valent iron (ZVI) is often applied for the remediation of wastewater or groundwater with heavy metals. The purpose of this study was aimed to investigate the reaction behavior of heavy metals with ZVI nanoparticles in the wastewater. The affecting factors, such as initial pH, dosage of nanoscale ZVI and initial concentration of heavy metal, on the removal efficiency of heavy metals by ZVI in the wastewater were examined by the batch experiments in this study. It was found that the removal of heavy metals was affected by initial pH. The rate and efficiency of metal removal increased with decreasing initial pH. Greater than 90% of the heavy metals were removed when the initial pH was controlled at 2. In addition, the rate and efficiency of metal removal increased as the dosage of nanoscale ZVI increased. The removal efficiency of heavy metal was higher than 80% when 2.0 g/L of ZVI was added in the wastewater. On the other hand, the slow rate and low efficiency of metal removal from the wastewater treated by nanoscale ZVI was found in the wastewater with high concentration of heavy metal.

Tachycardia, hypertension and decreased reflex bradycardia produced by striatal lesions induced by kainic acid.

The effects of intra-striatal injection of kainic acid on cardiovascular function were assessed in urethane-anesthetized rats. Intra-striatal administration of 2 micrograms of kainic acid (in a volume of 0.5 microliter) produced both tachycardia and hypertension. The tachycardia induced by intra-striatal injection of kainic acid was antagonized by either prior bilateral vagotomy or spinal transection of the animals (at C7). On the other hand, the hypertension induced by intra-striatal administration of kainic acid was antagonized by prior bilateral vagotomy, but not spinal transection. In addition, reflex bradycardia was produced by intravenous infusion of adrenaline in rats. Over the dose range (1.25-5.0 micrograms/kg, i.v.) of adrenaline used, a dose-dependent bradycardia was obtained. It was found that pretreatment of animals with intra-striatal injection of kainic acid, although causing no change in the adrenaline-induced pressor effect, did reduce the adrenaline-induced bradycardia. Intravenous administration of same dose of kainic acid had no effect on these cardiovascular responses. Thus, the data indicate that striatal neurones are involved in the central control of cardiovascular function.

Primary osteogenic sarcoma of the skull: case report.

A case of primary osteogenic sarcoma of the skull with metastases to the lungs, left diaphragm, 2nd lumbar and 1st sacral vertebral bodies, and both femoral heads was presented. A young man with a lump over his right parieto-occipital region since the age of 14 had noticed rapid growth of the mass after having experienced definite head trauma. The tumor was surgically removed and the bony defect was repaired with a stainless stell plate. The recurrence of the tumor mass was suppressed by 60Co irradiation, but a necrotic lesion developed over the right temporal scalp. Twenty-two months after the surgical removal of the tumor, the patient died of respiratory failure and septicemia.

Traumatic intracavernous carotid aneurysm with massive epistaxis.

Five cases of traumatic intracavernous carotid aneurysm are presented. All of the patients were young men with a history of severe head injury. The clinical manifestations were massive epistaxis and an ipsilateral cavernous sinus syndrome. The diagnosis was made correctly by carotid angiography. All of the patients developed another episode of massive epistaxis after admission. Emergency trapping of the internal carotid artery was performed. An urgent rescue method was used in one of our patients to prevent exsanguination before definitive surgical treatment. One patient died of exsanguination in spite of emergency ligation of the internal carotid artery. In the other four patients, no epistaxis was experienced after the operation.

Retrograde localization of the innervation of the middle cerebral artery with horseradish peroxidase in cats.

The innervation of the middle cerebral artery (MCA) of the cat was studied by applying horseradish peroxidase (HRP) to the wall of the right MCA. After a survival period of 48 to 72 hours, the bilateral superior cervical ganglia, middle cervical ganglia, stellate ganglia, T-4 sympathetic paravertebral ganglia, geniculate ganglia, semilunar ganglia, nodose ganglia, and brain stem including midbrain, pons, and medulla oblongata were removed to be processed with tetramethyl benzidine. HRP-labeled neurons were found in the ipsilateral superior cervical ganglion, semilunar ganglion, and dorsal raphe nucleus. The other areas did not have HRP activity. The results suggest that the adrenergic nerves innervating the MCA originate in the ipsilateral superior cervical ganglion, the sensory nerves originate in the ipsilateral semilunar ganglion, and the serotonergic nerves originate in the ipsilateral dorsal raphe nucleus. Cerebral arterial constriction may relate to the intrinsic (intracerebral) neurogenic pathway involving the trigeminal nerve and the dorsal raphe nucleus.

Effects of cholinomimetic drugs on sudomotor, metabolic, respiratory, vasomotor, and temperature response in palmar hyperhidrosis.

The effects of cholinomimetic drugs such as mecholyl (methacholine) and pilocarpine on autonomic functions (including sudomotor, metabolic, respiratory, vasomotor, and temperature responses) were assessed at room temperature (24 degrees C) in three groups of individuals, including normal, hyperhidrotic, and denervated subjects. The normal group had no palmar hyperhidrosis, with intact T2-3 ganglia, the hyperhidrotic group had palmar hyperhidrosis with intact T2-3 ganglia, and the denervated group had palmar hyperhidrosis treated with T2-3 ganglionectomy. Subcutaneous administration of mecholyl and pilocarpine each produced a fall in oral temperature in the normal group. The hypothermia was brought about by a decrease in metabolic rate, an increase in local sweating rate (mainly of the upper limb and trunk), and an increase in cutaneous circulation (estimated by an increase in the upper limb and trunk skin temperatures). The autonomic functions induced by these cholinomimetic drugs were antagonized by pretreatment with atropine sulfate (an antagonist of cholinergic receptors). Moreover, the hypothermia induced by mecholyl or pilocarpine was greatly reduced in the hyperhidrotic group. The reduction in the cholinomimetic-induced hypothermia in the hyperhidrotic group was due to the reduced sudomotor and metabolic responses after the injections of these cholinomimetic drugs, as compared to those of the normal group. However, neither the excessive sweating of the palms nor the reduced cholinergic responses in the hyperhidrotic group was observed after T2-3 ganglionectomy. The data indicate that the T2-3 ganglia play a role in the elaboration or modulation of the sudomotor and metabolic responses induced by activation of certain cholinergic receptors in humans.

Thermoregulatory sweating in palmar hyperhidrosis before and after upper thoracic sympathectomy.

To assess thermoregulatory sweating in palmar hyperhidrosis, the authors determined the responses of three groups of normal, hyperhidrotic, and denervated subjects to a variety of ambient temperatures (TA's), 22 degrees, 28 degrees, and 41 degrees C. The normal group had no hyperhidrosis, with intact T2-3 ganglia, the hyperhidrotic group had palm hyperhidrosis with intact T2-3 ganglia, and the denervated group had hyperhydrosis treated with T2-3 ganglionectomy. Both groups of hyperhidrotic and denervated subjects maintained oral and mean skin temperatures within normal limits displayed by the normal group over a wide range of TA's tested. The local sweating rate (LSR) of both the palms and the soles of the feet in the hyperhidrotic group was decreased to a minimal level by either the T2-3 ganglionectomy or the subcutaneous administration of atropine sulfate. Furthermore, the denervated group had a significantly lower LSR of both the forehead and the upper chest regions, but showed a higher LSR or both the ventral thigh and the lateral lumbar regions at a TA of 41 degrees C when compared to the LSR of either the normal or the unoperated hyperhidrotic group. The data demonstrate that the surgical removal of both the T-2 and the T-3 ganglia, although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating in man.

Experimental study on the pathogenesis of heat stroke.

A heat-balance study was carried out on conscious rabbits exposed to ambient temperatures (Ta) from 8 degrees to 40 degrees C. At Ta = 40 degrees C, heat gain exceeded heat loss and led to hyperthermia and heat stroke, and the latency for the onset of heat stroke was found to be around 87 minutes. At the onset of heat stroke, the comatose animals showed higher levels of rectal temperature, ear skin blood flow, respiratory evaporative heat loss, metabolic rate, intracranial pressure (ICP), and cerebral water content as compared to those of control animals (kept at an ambient temperature of 24 degrees C). Before the start of heat stress, the animals had an average mean arterial blood pressure (MABP) of 94 mm Hg and cerebral perfusion pressure (CPP) of 80 mm Hg. However, at the onset of heat stroke, the average MABP and CPP decreased to 67 and 19 mm Hg, respectively. The reduction in CPP at the onset of heat stroke was due to both a decrease in MABP and an increase in ICP. In addition, the comatose animals which received an intravenous infusion of 10% glycerol (3 ml/min) had a survival time (interval between onset of heat stroke and death) longer than that of the comatose animals which received the control-vehicle solution. The prolongation of survival time in the glycerol-treated animals may be due to lower rectal temperature, lower cerebral water content, or lower ICP during the development of heat stroke. The present data indicate that not only hyperthermia but also cerebral edema, intracranial hypertension, decreased MABP, and decreased CPP are the main causes of heat stroke. The therapeutic values of glycerol on heat stroke may be related to the depressant action on cerebral edema, intracranial hypertension, and body temperature.

Recovery of vasomotor response in human spinal cord transection.

Vasomotor responses of the skin of the thumb and the big toe were measured in normal subjects and patients with spinal transection at a neutral ambient temperature of 22.0 +/- 0.5 degrees C, and in a cool (12.0 +/- 0.5 degrees C) and warm (32.0 +/- 0.5 degrees C) environment. The vasomotor response of the hand and foot to the cooling and warming of part of the opposite upper or lower extremity was also recorded. Spinal transection at T5-11 abolishes acutely all vasomotor responses in the paraplegic lower extremities, but does not alter the responses in the upper extremities. By 4 months, the vasomotor tone in the lower extremities at a neutral ambient temperature returned to normal values as did the response to a cool and warm environment. The crossed vasomotor reflex to cooling and warming one lower extremity recovers more slowly, requiring a period of 18 months for complete recovery. The slower recovery of the vasomotor reflex in spinally transected man than in similarly treated dogs is though to be due to the greater spinal shock in the former. The recovery of vasomotor responses in the paraplegic limbs to cooling and warming after thoracic transections suggests that these responses are primitive and powerful thermoregulatory mechanisms.

Acute and chronic phase platelet aggregability studies in Chinese patients after implantation of a permanent transvenous pacemaker.

It has been suggested that the incidence of thromboembolic events always increases in patients after insertion of a transvenous pacemaker. Blood samples from twenty consecutive patients (fifteen males and five females) before and after pacemaker implantation was retained for platelet aggregability studies which were analyzed separately with ADP, collagen, epinephrine and arachidonic acid. The maximal amplitude of platelet aggregatory curve was detected by an aggregometer. The samples collected the day before pacemaker implantation (day 0) were used as self-control. Day 1 and day 3 after pacemaker implantation were defined as the acute phase, while day 30 was defined as the chronic phase. The maximal amplitude of platelet aggregatory curve was observed to be lowest on day 1 and then return to normal on day 3 and day 30. The results of platelet aggregability, however, showed no significant difference (P>0.05) between self-control and post-implantation samples. In conclusion, there was no significant change in platelet aggregability for either acute or chronic phases after pacemaker implantation. Antiplatelet medications may not be necessary for the prevention of thromboembolic events after the implantation of a pacemaker.

Efficient phase field simulation of a binary dendritic growth in a forced flow.

Efficient quantitative phase field simulation using an adaptive finite volume method with an antisolutal trapping scheme is presented for a binary dendritic growth in a forced flow. For the case of no convection, the calculated results with different interface thickness are examined. It is found that with a proper antisolutal trapping flux, a thick interface, but smaller than the diffusion boundary layer, could be used and the solution could approach to the sharp-interface Gibbs-Thompson equation limit in almost all aspects quantitatively. Based on the concentration driving force obtained from the sharp-interface limit of the Wheeler-Boettinger-McFadden (WBM) model, the calculated results are in good agreement with the classic Oseen-Ivantsov solution for the concentration-driven growth in a forced flow. And the selection scaling factor also increases with the external flow as the theoretical prediction.

Epidemiological study of moyamoya disease in Taiwan.

From January 1978 to December 1995, 92 cases of Moyamoya disease were collected from seven major medical centers in Taiwan. The data gave an annual incidence rate of 0.048 per 100,000 population. There were 40 males and 52 females and the ages ranged from 2 to 62 years with the peak incidence in the 31-40 year age group (23 cases). Cerebral infarction occurred in 20 out of 24 juvenile patients (83%), and in 24 out of 68 adult patients (35%). The difference was statistically significant. Haemorrhagic stroke was more frequent in adult patients. Computed tomographic scans following stroke showed cerebral infarction in 44 cases, ventricular haemorrhage in 26 cases, intracerebral haemorrhage in 14 cases and pure subarachnoid haemorrhage in eight. The most frequent initial symptom was motor disturbance (59%), followed by headache (49%) and impaired consciousness (35%). This survey showed an incidence rate much lower than that in Japan, but comparable with those in other Oriental countries and higher than those in Western countries. The male-to-female ratio once differed considerably from that of the Japanese series, but from the present study is now quite similar.

Thoracic sympathectomy for palmar hyperhidrosis: report of 457 cases.

A thoracic sympathetic ganglionectomy was performed on 457 patients with palmar hyperhidrosis, resulting in a complete cessation of the excessive palmar sweating but not a total abolition of the sweating of the upper extremity, forehead, face, neck, upper chest and upper back. This procedure does not produce a Horner's syndrome. The present data provide evidence that sympathetic pathways for controlling sweating of the above-mentioned skin areas come mainly through the second thoracic ganglion, and therefore from the spinal cord segment below T1 in man.

Intracerebral hematoma simulating a new growth.

Three cases of organized intracerebral hematomas presented slowly progressive neurological deficits and hence mimicked brain tumors. Computed tomography scanning revealed ring enhancement of intracerebral mass lesions with midline shift. Angiographic studies showed avascular mass lesions. Soft, well-encapsulated, organized, large intracerebral hematomas with feeding arteries on their capsules were removed surgically. The lesions contained fresh and old hemorrhages. It is presumed that the feeding artery caused slowly continuous bleeding, thus causing these intracerebral hematomas to grow in a manner that made their clinical picture simulate that of intracerebral neoplasms. Their pathogenesis is discussed.

Epidemiology of head injury in rural Taiwan -a four year survey.

An epidemiological study of head injury in Hualien County, Taiwan, was undertaken from January 1, 1988 to December31, 1991. The age-adjusted incidence rate of head injury was 382/100 000, 499/100 000 for males and 244/100 000 for females. The highest incidence rate was observed in the elderly group 70 years or older. It is notable that 79% of head injuries were associated with traffic accidents, 75% of which directly involved motocycle use. The age-adjusted mortality rate was 89/100 000 per year, 125/100 000 for males and 47/100 000 for females. As to the severity of head injury, the elderly group presented the highest percentage of moderate to severe degrees of injury as well as mortality. The victims of motorcycle accidents and pedestrians had the highest percentage of relatively severe head injury. Hospitalised patients showed an outcome worse than that ever reported in the literature.

[Intracranial arteriovenous malformations in Taiwan].

This paper analyzes the available literature on intracranial arteriovenous malformations (AVM) in Taiwan. The incidence and symptoms of the disease are studied with a view to assisting practitioners in its recognition. The incidence of intracranial AVM in patients who have suffered hemorrhagic stroke in Taiwan is 2.5% to 4.8%, with the male to female ratio being 1.5:1. The peak age at which bleeding from intracranial AVM occurred ranged from 10 to 40 years; bleeding showed no seasonal variation. Sudden headaches, vomiting, and disturbance of consciousness were the commonest presenting symptoms of AVM, similar to the rupture of intracranial aneurysms. However, the possibility of focal neurological deficit among patients with intracranial AVM was higher than in patients with intracranial aneurysms. Risk factors, such as hypertension, diabetes mellitus, heart disease, smoking and alcohol intake showed no close relationship to bleeding in intracranial AVM. Pregnancy is not a risk factor in female patients with intracranial AVM with no history of hemorrhage. Small intracranial AVM are more likely to bleed. Since 1961 the majority of Taiwan's intracranial AVM patients have been treated surgically, while before that date general medicine was the treatment of choice. In recent years, several developments such as operation microscope, microsurgical instruments and microsurgical techniques have enhanced the efficacy of surgical intervention in the treatment of AVM. When the mortality and morbidity rates resulting from the two forms of treatment are compared, surgical treatment shows a better prognosis for the treatment of intracranial AVM.

Neurobehavioral manifestations following closed head injury.

This study was designed to examine neurobehavioral sequelae following closed head injuries. It adapted the Neurobehavioral Rating Scale (NRS) which was designed by Harvey S. Levin in 1987. The scale has been proven to be valid and reliable in previous Western studies and was translated by the authors into Mandarin with the consent of its designer. A total of 335 cases of closed head injury in eight major hospitals in Taipei were studied. The main findings obtained from this preliminary study were: 1) the correlation coefficients between raters ranged from 0.749 to 0.956, manifesting satisfactory reliability; 2) seven factors were obtained through factorial analysis of NRS, explaining 65.5% of the variance; and 3) significant differences in neurobehavioral change were found in patients with various degrees of severity and various types of head injuries. The results demonstrate that NRS is applicable to Chinese patients. Possible modification as well as elaboration of this scale is suggested.