Complex relation among Health Belief Model components in TB prevention and care.

OBJECTIVES: This study aims to explore the relationships among components of the Health Belief Model, tuberculosis (TB) preventive behavior, and intention of seeking TB care. STUDY DESIGN: Cross section study. METHODS: Using convenience sampling, 1154 rural-to-urban migrant workers were selected between the ages of 18-50 years in six urban areas of three provinces in China. The survey was conducted by individual, face-to-face interviews with a standardized questionnaire. Lisrel 8.7 was used to conduct path analysis. RESULTS: The knowledge and benefits components of the Health Belief Model predicted preventive behaviors: cover nose/mouth when coughing or sneezing (ß = 0.24, 0.33 respectively), evade others' coughs (ß = 0.13, 0.25) and also predicted seeking TB care (ß = 0.27, 0.19). Susceptibility and severity also predicted seeking TB care (ß = 0.12, 0.16). There were also important relationships among model components. Knowledge of TB predicted both susceptibility (ß = 0.32-0.60) and severity (ß = 0.41-0.45). Further, each of susceptibility (ß = 0.30) and severity (ß = 0.41) predicted perceived benefits of preventive care. CONCLUSION: Thus, a path from knowledge, through severity and susceptibility, and then through benefits predicted prevention and TB care seeking behaviors.

Improvement of tissue-adhesive obliteration of bleeding gastric varices using adjuvant hypertonic glucose injection: a prospective randomized trial.

BACKGROUND AND STUDY AIMS: Rebleeding can occur after endoscopic injection of gastric varices with tissue adhesive. The aim of this study was to evaluate whether adjuvant hypertonic glucose solution injections enhance the effects of Histoacryl after successful initial variceal obliteration. PATIENTS AND METHODS: A total of 67 patients (37 men, 30 women; mean age +/- standard deviation [SD] 60 +/- 17 years) with initially successful Histoacryl obliteration of bleeding gastric varices were included in the study and randomly divided into two groups: a "combined" group of patients who had adjuvant injection of hypertonic glucose solutions in cases of residual gastric varices (F1 or less) and a "control" group of patients who did not receive such therapy. End points were either variceal recurrence/progression (F2 or more) requiring Histoacryl reinjection or rebleeding. RESULTS: Residual small varices were found in 56% of patients in the combined group and in 60% of patients in the control group. Adjuvant therapy was only performed in the combined group. During the follow-up period (mean duration +/- SD 37.9 +/- 18.5 months, range 19-56 months), two patients in the combined group showed gastric variceal progression, compared with nine patients showing progression in the control group, with two cases of rebleeding, both occurring in the control group. Two years after the first Histoacryl injection, the cumulative proportion of patients who did not have gastric variceal progression was significantly higher in the combined group than it was in the control group (92.8% vs. 71.4%, P = 0.029). There was no significant difference between the two groups with respect to their survival curves (P = 0.12). No marked immediate or delayed symptoms or complications were observed in the patients given hypertonic glucose injections. CONCLUSIONS: Adjuvant treatment with hypertonic glucose solution for residual small gastric varices is a safe and simple method. It helps reduce the recurrence or progression of gastric varices after tissue adhesive injections and can therefore reduce the risk of rebleeding.

Anatomic and clinical analysis of 96 Beall prostheses explanted over a 13-year period.

Over 13 years, 96 Beall prostheses (80 Teflon, 16 Pyrolite) explanted at surgery were examined for durability, material wear, and clinical symptoms leading to surgical indication for excision were evaluated. The Teflon valves showed progressive disc wear and notching and two cases of disc escape from the cage; the Pyrolite discs were intact in all prostheses. The Dacron-Velour covering common to both types showed dehiscence at the inlet, significantly more severe after the third implant year in the Teflon (p less than 0.005) than in the Pyrolite prostheses. Sixty-nine (85 percent) cases with Teflon valves showed clinical manifestations of congestive heart failure due to prosthetic dysfunction; in 50 there was significant hemolytic anemia. Seven (44 percent) of the 16 Pyrolite disc valves were excised primarily because of dysfunction. The degree of hemolysis with the Pyrolite valves was usually mild. These data clearly suggested the advisability of early excision of the Beall Teflon prostheses in symptomatic patients and a close follow-up in patients with the Pyrolite models.

Microbiologically induced corrosion of aluminum alloys in fuel-oil/aqueous system.

To investigate the microbiologically induced corrosion of aluminum alloys in fuel-oil/aqueous system, aluminum alloys A356, AA 5052, AA 5083 and AA 6061 were chosen as the test alloys and Cladosporium and several fuel-oil contaminated microbes isolated in Taiwan were used as test organisms. Aluminum alloy AA 5083 in fuel-oil/aqueous system was the most susceptible material for microbial corrosion, then followed by aluminum alloys AA 5052 and A356, and AA 6061 was more resistant to microbial aggression. Mixed culture had high capability of corrosion, then followed by Penicillium sp. AM-F5, Fusarium sp. AM-F1, Pseudomonas aeruginosa AM-B5, Ps. fluorescens AM-B9, C. resinae ATCC 22712, Penicillium sp. AM-F2, Candida sp. AM-Y1 and Ps. aeruginosa AM-B11. From energy dispersive spectrometer analysis, aluminum and magnesium contents decreased in the corrosion area, while chlorine and sulfur contents increased. The major organic acid produced in fuel-oil/aqueous system was acetic acid, and the total organic acids content had a positive correlation with the degree of microbial corrosion.

IL-10 promoter gene polymorphisms and sustained response to combination therapy in Taiwanese chronic hepatitis C patients.

BACKGROUND AND AIMS: Host genetic factors may affect clinical outcomes of hepatitis C virus (HCV) infection; however, the possible mechanisms remain largely unknown. The role of immunopathogenesis in chronic hepatitis C leads to extensive exploration of host immunity including inflammatory cytokines. METHODS: We examined interleukin 10 (IL-10) promoter gene polymorphisms at positions -1082, -819, and -592 relative to transcription start site and studied their association with response to 24 weeks of pegylated interferon plus ribavirin treatment in 143 chronic hepatitis C patients, of whom 97 (67.8%) achieved a sustained virologic response (SVR). In addition, 134 healthy adults were used as controls. RESULTS: Of chronic hepatitis C patients, 111 (77.6%) were genotype 1 infection, 32 (22.4%) were genotype 2 infection. Patients with sustained virologic response were younger and had higher pretreatment ALT levels than those without. No statistical difference was found between chronic hepatitis C patients who achieved SVR or not in terms of gender, HCV genotype, pretreatment HCV RNA levels, and severity of liver disease. The serum IL-10 levels were comparable between healthy controls and chronic hepatitis C patients as well as between HCV patients with and without SVR. The distribution of IL-10 promoter gene polymorphisms at positions -1082, -819, and -592 relative to transcription start site was comparable between HCV patients and healthy controls as well as HCV patients with and without SVR. A high frequency of ATA haplotype of common IL-10 promoter gene SNPs was found in both chronic hepatitis C patients (70.3%) and healthy controls (69.8%). However, ATA haplotype was not associated with SVR in chronic hepatitis C patients. CONCLUSIONS: Our data fail to demonstrate the influence of IL-10 promoter gene polymorphisms on the response to combination therapy in Taiwanese chronic hepatitis C patients. The impact of genetic variations in IL-10 haplotype on the response to anti-HCV treatment among different ethnic populations deserves further examination.

Oxytetracycline production in solid state and submerged fermentation by protoplast fusants of Streptomyces rimosus.

Streptomyces rimosus TM-55 was treated with 3% EMS, and 29 auxotrophic mutants (AM-1 - AM-29) were isolated from 5457 colonies at a survival rate between 6.6-66.7%. Three sets of the auxotrophic mutants, AM-3 and AM-27, AM-7 and AM-28, and AM-3 and AM-21, were chosen for protoplast fusion with 50% PEG 1000 for 30 minutes at 25 degrees C, and 25 fusants were isolated (f-1 - f-25). In solid substrate, oxytetracycline production of 20% fusants was higher than that of the wild strain, while in submerged fermentation, it was 44%. Oxytetracycline productions of fusants f-1, f-6, f-11, f-12, f-20 and f-21 were lower than that of the wild strain in solid substrate, but this was reversed in submerged fermentation. On the other hand, OTC production of fusant f-8 was higher than that of the wild strain in solid substrate, and this was reversed in submerged fermentation.

Effect of vapor phase corrosion inhibitor on microbial corrosion of aluminum alloys.

Vapor phase corrosion inhibitors were used to investigate the antimicrobial activities and anticorrosion of aluminum alloy. Aspergillus flavus, A. niger, A. versicolor, Chaetomium globosum and Penicillium funiculosum had moderate to abundant growth on the aluminum alloy AA 1100 at Aw 0.901, while there was less growth at Aw 0.842. High humidity stimulated microbial growth and induced microbial corrosion. Dicyclohexylammonium carbonate had a high inhibitory effect on the growth of test fungi and the microbial corrosion of aluminum alloy, dicyclohexylammonium caprate and dicyclohexylammonium stearate were the next. Aluminum alloy coating with vapor phase corrosion inhibitor could prevent microbial growth and retard microbial corrosion.

Microbial corrosion of aluminum alloy.

Several microbes were isolated from the contaminated fuel-oil in Taiwan and the microbial corrosion of aluminum alloy A356-T6 was tested by MIL-STD-810E test method. Penicillium sp. AM-F5 and Cladosporium resinac ATCC 22712 had significant adsorption and pitting on the surface of aluminum alloy, Pseudomonas acruginosa AM-B5 had weak adsorption and some precipitation in the bottom, and Candida sp. AM-Y1 had the less adsorption and few cavities formation on the surface. pH of the aqueous phase decreased 0.3 to 0.7 unit for 4 months of incubation. The corrosion of aluminum alloy was very significant in the cultures of Penicillium sp. AM-F2, Penicillium sp. AM-F5 and C. resinac ATCC 22712. The major metabolites in the aqueous phase with the inoculation of C. resinac were citric acid and oxalic acid, while succinic acid and fumaric acid were the minors.

Aluminum utensils contribute to aluminum accumulation in patients with renal disease.

Presently, aluminum utensils are widely used in the world, especially in the developing countries. However, whether aluminum leaching from such utensils contributes to aluminum accumulation or causes any damage in patients with renal disease remains unknown. We designed a prospective study to evaluate this problem. After excluding patients who were not examined at follow-up or who poorly complied during the study period, the opened randomized study consisted of 42 patients with chronic renal insufficiency (creatinine clearance <60 mL/min and >10 mL/min). All patients had not taken any aluminum-containing agents for 3 months, but used aluminum kitchen utensils for more than 1 year. Twelve patients comprised the control group; the other 30 patients comprised the study group. The aluminum kitchen utensils used by the study group patients were replaced with stainless steel utensils for 3 months, but those used by the control group were not. After 3 months, the decrements of serum aluminum (5.5 +/- 4.6 microg/L v 2.1 +/- 3.5 microg/L; P = 0.012) and daily urine aluminum excretion (14.3 +/- 15.2 microg/d v 2.1 +/- 5.6 microg/d; P = 0.005) in the study group patients were greater than those in the control group patients. The increments of transferrin saturation of the study group patients (1.8% +/- 9.5% v -3.7% +/- 9.5%; P = 0.052) were greater than those of the control group patients. In addition, the increments of iron (r = 0.368, P = 0.035) and transferrin saturation (r = 0.345, P = 0.049) positively correlated with the decrements of daily aluminum excretion in all patients. The study group patients with greater decrements of serum aluminum (>5.5 microg/L) had greater serum iron levels (90.2 +/- 27.7 microg/dL v 71.9 +/- 27.8 microg/dL; P = 0.047) and transferrin saturation (30.5% +/- 11.0% v 23.0% +/- 9.5%; P = 0.046) than those with less decrements of serum aluminum (<5.5 microg/L) after the study. Our study demonstrates that aluminum kitchen utensils may be the important aluminum exposure source for patients with chronic renal insufficiency who are not taking aluminum-containing agents, and hints that the long-term exposure of aluminum leaching from aluminum utensils probably affects iron levels in patients with chronic renal insufficiency. Further studies are clearly needed to confirm this observation.

Ten-year pathological study of Beall mitral valve prostheses.

Detailed pathological studies are reported on 20 cloth-covered Beall mitral valve prostheses, which had to be removed for valve failure nine months to 10 years after implantation. Results in all patients except one indicated that there was a progressive and persistent granulomatous reaction that continued up to at least 10 years. Although the rate of tissue ingrowth into the valve decreased with time, the total volume of tissue formation increased. Cloth wear and disruption and deformity of the teflon discs was frequently seen. In these 20 valves the desired result--namely, the complete and smooth endothelialisation of the prosthesis--was certainly not achieved.

Endoscopic treatment of bleeding gastric varices by N-butyl-2-cyanoacrylate (Histoacryl) injection: long-term efficacy and safety.

BACKGROUND: The long-term efficacy and safety of the endoscopic injection of N-butyl-2-cyanoacrylate (Histoacryl) were evaluated to define its role as the initial treatment for bleeding gastric varices. METHODS: Ninety patients with bleeding gastric varices underwent endoscopic injections of Histoacryl for hemostasis within a 6-year period. Histoacryl was injected intravariceally as a 1:1 mixture with Lipiodol. Among the 90 patients, 5 had active bleeding and 85 had recent bleeding. Most of the varices were large (F2 or F3, 85 cases). The most common locations were the fundus and the posterior wall of the proximal body (94.4%). After Histoacryl injection, patients were followed endoscopically with retreatment as necessary. RESULTS: The rate of hemostasis at 1 week was 94.4%. Recurrent bleeding occurred in 23.3% of the patients from 3 days to 16 months after the initial injection. Recurrent bleeding was stopped with reinjections of Histoacryl in 16.7% of the patients. The rate of definitive hemostasis was 93.3% (84 of 90). The treatment failure-related mortality rate was 2.2% (2 of 90). To date, 35 patients have died, mostly as a result of malignancy or liver failure, and 55 are still alive. The determining factor for long-term survival was the underlying disease leading to portal hypertension. There were few long-term complications except for Histoacryl cast extrusion-related mucosal defects. CONCLUSIONS: Endoscopic injection of Histoacryl is highly effective for the treatment of bleeding gastric varices, with rare complications both acutely and long term. This treatment modality is appropriate as the first choice for bleeding gastric varices.