Associations between body composition and vertebral fracture risk in postmenopausal women.

INTRODUCTION: Osteoporosis is a metabolic bone disease with low bone mineral density (BMD) and high incidence of vertebral fractures (VFs). Postmenopausal women with osteoporosis have decreased total fat and lean mass. This study aimed to investigate the associations between body composition and VF risk and explore the potential predictor of VF risk in postmenopausal women. METHODS: Enrolled 731 postmenopausal women were referred by various departments and outpatient clinics to assess vertebral status between October 2016 and November 2017. The main measures were total body lean mass, fat mass, and BMD. Patients were divided into osteopenia, osteoporosis, and normal groups based on T-scores. Logistic regression analyses were performed to evaluate associations between body composition parameters and VF. RESULTS: VF was significantly associated with increased age, lower height, and lighter weight in all participants, and higher BMI was observed in VF participants. Participants in the osteoporosis group were older and had lower height, weight, and BMD than those in normal and osteopenia groups. Femoral and total hip T-scores as well as T-scores for lumbar spine were significantly lower in participants with VF than in non-VF participants. Percentage of bone mass was also significantly lower in VF participants compared to that of non-VF participants. Women with increased BMD and lower bone mass had reduced odds for VF occurrence. Bone mass was significantly able to identify VF occurrence. CONCLUSIONS: Body composition analysis discerns differences in the bone status of postmenopausal women with and without VF. The cutoff value of the bone mass might be used effectively as an indicator of risk for VF occurrence.

Characterization and expression analysis of somatic embryogenesis receptor-like kinase genes from Phalaenopsis.

Somatic embryogenesis receptor-like kinase (SERK) genes have been found to be involved in the somatic embryogenesis of several plant species. We identified and characterized 5 PhSERK genes in the Phalaenopsis orchid. The amino acid sequences of PhSERKs and other SERK proteins are highly conserved, with the highest homology observed in the leucine-rich repeat-receptor-like kinase domain. All 5 PhSERKs were expressed in all Phalaenopsis organs examined (root, leaf, shoot apical meristem, and flower), with the strongest expression, particularly for PhSERK1 and 3, in the shoot apical meristem of mature plants. Expression of all PhSERKs was downregulated during early floral bud development and was upregulated gradually until the semi-open flower stage was reached. All 5 PhSERKs were expressed during both seed germination and protocorm-like-body (PLB) development. In germinated seeds, quantitative real-time PCR revealed upregulation of all PhSERKs except PhSERK4 at 1 week and downregulation after 4 weeks. The 5 PhSERKs were differentially expressed in the early stage of PLB development and maintained substantial levels during PLB formation, with PhSERK1 and 5 upregulated 1 week after culture and PhSERK2, 3, and 4 downregulated over this period. Because physical wounding of PLB stimulates secondary PLB formation, the PhSERK5 expression peak at week 3 coincided with visible and fully developed secondary PLBs. PhSERK5 may be important in PLB induction and subsequent development. Our PhSERK expression analysis revealed that these genes have a broad role during orchid plant development.

Physical wounding and ethylene stimulated embryogenic stem cell proliferation and plantlet regeneration in protocorm-like bodies of Phalaenopsis orchids.

Phalaenopsis orchids have been regenerated by inducing protocorm-like bodies (PLBs) from etiolated leaf sections. However, the physiological and molecular mechanisms of secondary PLB development and subsequent proliferation have not been explored. Bisectionally cutting primary PLBs resulted in more secondary PLBs at 5 weeks, suggesting an embryogenic stem cell property imposed by wounding of primary PLB tissues. The ethylene precursors ethephon and 1-aminocyclopropanecarboxylic acid and the ethylene perception inhibitor silver nitrate increased PLB formation, while aminoethoxyvinylglycine decreased PLB formation. Ethylene content in wounded PLB explants increased over culture time in media containing ethylene precursors or inhibitors. mRNA levels of PhACS2, PhACS3, and PhACO were increased by ethephon and decreased by ethylene inhibitors. Expression of genes in the ethylene signaling pathway was enhanced following ethylene-precursor treatment and was mitigated by ethylene inhibitors during PLB proliferation. Transcription of PhETR and PhEIN3, as well as PhERS, PhCTR, and PhGTP, was significantly increased 12 h after ethylene treatment. Ethylene and physical wounding stimulated secondary PLB formation in Phalaenopsis, probably through ethylene biosynthesis and signal transduction.

Impact of non-tuberculous mycobacteria on pulmonary function decline in chronic obstructive pulmonary disease.

OBJECTIVE: Although chronic obstructive pulmonary disease (COPD) is a common form of structural lung disease associated with pulmonary non-tuberculous mycobacteria (NTM) infection, no longitudinal studies have investigated the role of NTM in COPD disease progression. DESIGN: From 2000 to 2008, spirometry-confirmed COPD patients with sputum specimens sent for mycobacterial cultures were included. Analysis of clinical, microbiological and pulmonary function data was performed. RESULTS: The 251 patients were divided into three groups according to the number of NTM isolates: multiple (n = 47), single (n = 63), and no (n = 141) isolates. Mycobacterium avium complex was the most common species in multiple isolates (36.2%) and single isolate (28.6%) groups. Overall, 24.7% of COPD patients had been admitted for exacerbations at least once a year, and patients with multiple and single NTM isolates were more than twice as likely as those with no isolate to experience such exacerbations (38.3% vs. 31.7% vs. 17.0%). After controlling for confounders, patients with multiple NTM isolates had a greater decline in forced expiratory volume in one second than those with single or no isolates (-79.4 ± 32.8 ml vs. -61.6 ± 31.9 ml and -56.2 ± 31.5 ml). CONCLUSION: This study suggests that NTM may play a role in disease progression and deterioration of pulmonary function in COPD patients.

Biomechanics during exercise with a novel stairclimber.

The current study aimed to investigate the stair-climbing biomechanics related to the lower extremities when subjects used the novel designed stair-climber, which could provide opportunity for both sagittal and frontal movements. 12 volunteers were required to step while either keeping the trunk static (STATIC) or allowing the trunk to shift with weight bearing (SHIFT). A motion analysis system and the 6-axis force and torque sensor embedded in the pedal were used to collect data. Foot contact forces and joint moments were calculated to represent loading characteristics. The joint angle and corresponding moments at the terminal point of the stance phase were computed to serve as the indicator of safety. Significant differences were found in peak foot contact forces, knee extensor moment, and hip abductor moment. At the end of the stance phase, various directions of moment between conditions were found in the knee and the ankle. The knee valgus angle, hip abductor moment, and knee extensor moment were significantly greater in SHIFT than in STATIC. The various stepping strategies caused differences in joint loading characteristics; therefore, these findings need to be given greater consideration in the design of training protocols.

Intratympanic injection with dexamethasone for sudden sensorineural hearing loss.

OBJECTIVE: To investigate the efficacy of intratympanic steroid therapy in adults with sudden sensorineural hearing loss, and to analyse the factors associated with treatment outcome. DESIGN: Retrospective study of patients undergoing intratympanic steroid injection for sudden sensorineural hearing loss between 1 January 2006 and 30 June 2007 at a teaching hospital in Taipei, Taiwan. RESULTS: Patients who received intratympanic steroid therapy within seven days of disease onset achieved a significantly better response rate (76.1 per cent), compared with the delayed treatment group (50 per cent). The total response rate, after four steroid injections, was 68.9 per cent. Patients with low and mid-frequency hearing loss were more responsive to steroid treatment. Vertigo was a negative prognostic factor for recovery. There were no long-term sequelae of intratympanic steroid treatment. CONCLUSION: Intratympanic steroid injection may be a simple and effective treatment for patients with sudden sensorineural hearing loss.

Cryptococcosis and tuberculosis co-infection at a university hospital in Taiwan, 1993-2006.

BACKGROUND: The human immunodeficiency virus (HIV) epidemic and increasing use of immunosuppressive agents have increased the prevalence of both cryptococcosis and tuberculosis (TB). However, the status of co-infection with both pathogens remains unknown. METHODS: This study retrospectively reviewed patient records of cryptococcosis and TB co-infection from 1993 to 2006. The temporal sequence of co-infection was defined as either concurrent or sequential. Data collected included patient demographics, HIV status, co-morbidities, clinical manifestations, treatment strategies, and outcome at 1-year follow-up. RESULTS: There were 23 patients with cryptococcosis and TB co-infection, representing 5.4% of cryptococcosis or 0.6% of TB cases. Eleven (48%) patients were HIV-infected, and no underlying disease or immunocompromised state could be identified in six (26%) patients. Twelve (52%) patients presented with concurrent infection, but diagnosis of co-infection could be achieved simultaneously in only three (13%). Constitutional symptoms, particularly fever and weight loss, were the most common presenting symptoms, developing in more than two-thirds of the patients. The majority (83%) of the patients made a good recovery following dual antifungal and anti-TB therapy. There were three mortalities at the 1-year follow-up, which might be attributable to a delay in diagnosis and treatment of co-infection. The outcomes of HIV-infected and non-HIV-infected patients were not significantly different. CONCLUSIONS: Cryptococcosis and TB co-infection, although rare, develops in both immunocompromised and healthy individuals. Early diagnosis and treatment may improve patient prognosis. There should be a high index of suspicion in order to achieve a timely diagnosis in a TB endemic area.

Transplantation of cultivated oral mucosal epithelial cells for severe corneal burn.

PURPOSE: To access the feasibility of using cultivated oral mucosal epithelial cell transplantation (COMET) for the management of severe corneal burn. METHODS: COMET was performed to promote re-epithelialization in two eyes with acute alkaline burn and one eye with chronic alkaline burn, and to reconstruct the ocular surface in two eyes with chronic thermal burn. Autologous oral mucosal epithelial cells obtained from biopsy were cultivated on amniotic membrane. Immunoconfocal microscopy for keratins and progenitor cell markers was performed to characterize the cultivated epithelial sheet. Following transplantation, the clinical outcome and possible complications were documented. The patients were followed for an averaged 29.6+/-3.6 (range: 26-34) months. RESULTS: Cultivated oral mucosal epithelial sheet expressed keratin 3, 13, and progenitor cell markers p63, p75, and ABCG2. After COMET, all the corneas became less inflamed, and the corneal surface was completely re-epithelialized in 6.0+/-3.2 (range: 3-10) days in all but one patients. Microperforation occurred in one patient, and a small persistent epithelial defect developed in another. Both were solved uneventfully. In all patients, superficial corneal blood vessels invariably developed, and to further improve vision, conjunctivo-limbal autografting (N=3) and/or penetrating keratoplasty (N=3) were performed subsequently. The vision of all patients showed substantial improvement after additional surgeries. CONCLUSIONS: This study showed the potential of COMET to promote re-epithelialization and reduce inflammation in acute corneal burn, and to reconstruct the corneal surface in chronic burn. COMET may, therefore, be considered an alternative treatment for severe corneal burn.

One-stage correction for blepharophimosis syndrome.

PURPOSE: To classify the severity of blepharophimosis, describe associated features and their effects on the incidence of amblyopia and to recommend guidelines for surgical treatment and management of surgical complications. METHODS: The case records of 23 patients with blepharophimosis syndrome were examined retrospectively. Patients' photographs and measurements were reviewed to analyse the severity of blepharophimosis, surgical techniques undertaken, surgical outcomes, and complications. Statistical analyses were performed using paired-sample t-tests to evaluate the surgical outcome and Spearman correlation to examine the influence of blepharophimosis on the interpalpebral fissure height (PFH). RESULTS: Eighteen out of 23 (78%) patients underwent one-stage surgery before the age of 5 years. About 31% of these patients had amblyopia. Only two patients had a blepharophimosis ratio greater than 1.5 as poor result. Two out of 18 (11%) patients with PFHs more than 2 mm needed a repeat operation, but all five (100%) patients with s less than 2 mm (very severe ptosis) needed repeat operations. CONCLUSIONS: The one-stage corrective procedure provided acceptable results both in function and cosmesis. However, patients with very severe ptosis required multiple stages of reconstruction for ptosis correction at an earlier age, after which correction of telecanthus and small horizontal palpebral fissure length followed at an older age.

Pharmacogenomics: the future of drug therapy.

Pharmacogenomics aims to optimize patient management by customizing and synthesizing drugs based on genetic variations in drug response. Polymorphisms affecting metabolism, receptors, and absorption can influence drug sensitivity, toxicity, and dosing. The Human Genome Project, DNA chips, and bioinformatics advance the practice of this field by, respectively, identifying polymorphisms related to drug response, determining an individual's profile of polymorphisms, and integrating data to facilitate clinical decision making. Potential benefits of pharmacogenomics include increasing efficacy and preventing adverse drug reactions, thus improving patient care and decreasing costs. These factors imply that a thorough understanding of the principles and applications of pharmacogenomics will be an indispensable part of the future of drug therapy in clinical medicine.

In vivo hatching phenomenon of mouse blastocysts during implantation.

PURPOSE: To determine whether the blastocyst zona shedding process within the murine uterine cornus in vivo is due to a global lytic process caused by uterine proteolytic enzyme, or is triggered by the blastocyst hatching process as observed in vitro. METHODS: Fifty-one female ICR mice aged 5-8 weeks were used for this study. From 8:00 p.m. of the 4th day postcoitus to 7:00 p.m. of the 5th day postcoitus, the uterine cornua of 51 mice were isolated at 30-min intervals. Blastocysts within the uterine cornua were flushed out with a balanced solution under the dissecting microscope. The stages of blastocyst development and the proportion of hatching or hatched blastocysts and the discarded zona pellucida (ZP) were inspected and counted. RESULTS: A total of 672 blastocysts were recovered from the uterine horns of the 51 mice. They were divided into six groups according to the blastocyst developmental stages (before or after ZP escape; before or after the initiation of implantation). Group I represents the earliest embryonic stage and Group VI represents the most advanced blastocyst developmental stage during the peri-implantation period. The empty ZP recovery rates (number of discarded ZP/all hatched blastocysts) were 52.3%, 21.5%, 17.2%, 6.6%, 1.6%, and 0% in Groups I-VI, respectively. Five hatching blastocysts out of 199 embryos in Group I were found and a 100% of ZP recovery rate was obtained from 6 of 19 mice in Groups I and II. CONCLUSIONS: The present study shows that active blastocyst hatching occurs in vivo because both hatching blastocysts and empty ZP can be found within the uterine cornua of ICR mice before implantation. The empty ZP recovery rate declined significantly, along with a progression of embryo development and implantation, implying that intrauterine zona lytic activity occurs during the peri-implantation stage.

Uncoupling of ATP-induced inositol phosphate formation and Ca(2+) mobilization by phorbol ester in canine cultured tracheal epithelial cells.

The regulation of the increase in inositol phosphates (IPs) production and intracellular Ca(2+) concentration ([Ca(2+)](i)) by protein kinase C (PKC) was investigated in canine cultured tracheal epithelial cells (TECs). Pretreatment of TECs with phorbol 12-myristate 13-acetate (PMA, 1 microM) for 30 min attenuated the ATP- and UTP-induced IPs formation and Ca(2+) mobilization. The concentrations of PMA that gave half-maximal (EC(50)) inhibition of ATP- and UTP-induced IPs accumulation and an increase in [Ca(2+)](i) were 5-10 and 4-12 nM, respectively. Prior treatment of TECs with staurosporine (1 microM), a PKC inhibitor, partially inhibited the ability of PMA to attenuate ATP- and UTP-induced responses, suggesting that the inhibitory effect of PMA is mediated through the activation of PKC. Furthermore, analysis of cell extracts by Western blotting with antibodies against different PKC isozymes revealed that TECs expressed PKC-alpha, -betaI, -betaII, -gamma, -delta, -epsilon, -theta, and -zeta. With PMA treatment of the cells for various times, translocation of PKC-alpha, -betaI, -betaII, -gamma, -delta, -epsilon, and -theta from the cytosol to the membrane was seen after 5- and 30-min and 2- and 4-h treatment. However, 6-h treatment caused a partial down-regulation of these PKC isozymes. PKC-zeta was not significantly translocated and down-regulated at any of the times tested. In conclusion, these results suggest that activation of PKC may inhibit the phosphoinositide (PI) hydrolysis and consequently attenuate the [Ca(2+)](i) increase or inhibit independently both responses to ATP and UTP. The translocation of PKC-alpha, -betaI, -betaII, -delta, -epsilon, -gamma, and -theta induced by PMA caused an attenuation of ATP- and UTP-induced IPs accumulation and Ca(2+) mobilization in TECs.

Air sparging tracer test to investigate the flow path.

The paper presents a useful method for investigating the flow path of the injected air, estimating the radius of influence, and assisting the design of well spacing of sparging wells. The method applies both tracer and modeling approach. A field test using helium as a tracer was conducted on an air sparging pilot. A 3-dimensional, 3-phase compositional model was utilized to simulate the air sparging process at the pilot. The model was first calibrated with the tracer concentrations observed in the field test at various locations between the air sparging well and the soil vapor extraction well. The calibrated model was then used to predict the flow path of the injected air and to simulate the water saturation distributions in the aquifer. The steady-state water saturation distributions was found useful for estimating the radius of influence of air sparging and for designing the well spacing of sparging well.

Physical heights of children with prolonged low dose-rate gamma-radiation exposure in radiocontaminated buildings.

PURPOSE: To evaluate low dose-rate radiation effects on the physical heights of children staying in apartments with 60Co-contaminated steel construction. MATERIALS AND METHODS: Children who once resided in radiocontaminated apartments since early 1983 were examined for height and body weight status from age 1 month to 18 years and before they moved out of the apartments. The physical heights and body weights of 21 898 age- and sex-matched non-exposed children from a nationwide school surveillance in 1997-98 were taken as controls. The physical height data were shown as height percentiles (HP) compared with reference children and age-specific relative height differences (RHD). RESULTS: HP and RHD in 48 exposed boys and 37 girls were analysed using generalized estimating equations (GEE), which accounted for multiple measurements and correlation between these measurements in the same individuals during this period. After adjusting for effects from parental heights and body mass index (BMI), clear dose-related decreases in HP and RHD were observed in the exposed boys with a cumulative exposure > 60 mSv. CONCLUSIONS: Prolonged low dose-rate y-radiation exposure was associated with adverse effects on the physical heights of growing boys, but were less apparent in the exposed girls.

Intercellular adhesion molecule-1 suppression in skin by topical delivery of anti-sense oligonucleotides.

We topically applied 20 nucleotide phosphorothioate intercellular adhesion molecule-1 anti-sense oligodeoxynucleotide in a cream formulation. It effectively inhibited tumor necrosis factor-alpha-induced expression of intercellular adhesion molecule-1 in human skin transplanted on severe compromised immunodeficient mice. The effects were concentration dependent, sequence specific, and resulted from reduction of intercellular adhesion molecule-1 mRNA levels in the skin. Intravenous administration of the drug did not show pharmacologic effects, probably due to insufficient drug concentrations in skin. Topical delivery, however, produced a rapid and a significantly higher accumulation of oligodeoxynucleotide in the epidermis and dermis. The results strongly suggest that topically applied anti-sense oligonucleotides can be delivered to target sites in the skin and may be of considerable value in the treatment of psoriasis and other inflammatory skin disorders.

Identification of a novel platelet-derived growth factor-like gene, fallotein, in the human reproductive tract.

We isolated the cDNA of a novel platelet-derived growth factor-like gene from human endometrium. The gene was named fallotein; it was 3007 bases in length, and encoded a protein of 345 amino acids. Antiserum against the fallotein protein can recognize a specific protein in the fallopian tube, with a molecular size in accordance with the anticipated size of fallotein. Fallotein mRNA is expressed in two molecular sizes, 3.8 and 2.9 kb, with the former being more abundant. High expression of the gene was found in the prostate, testis, and uterus. A weaker expression signal was found in the spleen, thymus, and small intestine, but expression of fallotein in the colon and peripheral blood leukocytes was negligible.

P2Y(2) receptor-stimulated phosphoinositide hydrolysis and Ca(2+) mobilization in tracheal epithelial cells.

Extracellular nucleotides have been implicated in the regulation of secretory function through the activation of P2 receptors in the epithelial tissues, including tracheal epithelial cells (TECs). In this study, experiments were conducted to characterize the P2 receptor subtype on canine TECs responsible for stimulating inositol phosphate (InsP(x)) accumulation and Ca(2+) mobilization using a range of nucleotides. The nucleotides ATP and UTP caused a concentration-dependent increase in [(3)H]InsP(x) accumulation and Ca(2+) mobilization with comparable kinetics and similar potency. The selective agonists for P1, P2X, and P2Y(1) receptors, N(6)-cyclopentyladenosine and AMP, alpha,beta-methylene-ATP and beta, gamma-methylene-ATP, and 2-methylthio-ATP, respectively, had little effect on these responses. Stimulation of TECs with maximally effective concentrations of ATP and UTP showed no additive effect on [(3)H]InsP(x) accumulation. The response of a maximally effective concentration of either ATP or UTP was additive to the response evoked by bradykinin. Furthermore, ATP and UTP induced a cross-desensitization in [(3)H]InsP(x) accumulation and Ca(2+) mobilization. These results suggest that ATP and UTP directly stimulate phospholipase C-mediated [(3)H]InsP(x) accumulation and Ca(2+) mobilization in canine TECs. P2Y(2) receptors may be predominantly mediating [(3)H]InsP(x) accumulation, and, subsequently, inositol 1,4,5-trisphosphate-induced Ca(2+) mobilization may function as the transducing mechanism for ATP-modulated secretory function of tracheal epithelium.

Embryonic dormancy phenomenon in obstructed healthy mouse fallopian tubes.

PURPOSE: A mouse model of unilateral oviductal obstruction was designed to study whether healthy oviducts can support embryo development in an advanced stage toward blastocyst hatching and implantation when the embryos in the contralateral side normally move into the uterine cavity. METHODS: The oviducts of 80 female ICR mice (aged 5-8 weeks) were ligated unilaterally 12-40 hr postcoitus. The ligated oviducts were isolated from day 4 to 19.5 postcoitus. Embryos within the ligated oviducts were then flushed out to record the developmental stage and compared with the conceptuses in the contralateral uterine horns with unligated oviducts. Embryos recovered from ligated oviducts were then cultured in vitro to observe their potential for further development. RESULTS: In 33 mice, 53.4% (163/305) and 86.1% (241/280) of the morphologically normal blastocysts had hatched from the zona pellucida within the obstructed tube and contralateral uterine horns, respectively, on the 5th day postcoitus. The data demonstrated that the hatching process could take place within the obstructed fallopian tube, but the timing was delayed. From 5.5 to 19.5 days postcoitus, a total of 362 implanted embryos were obtained in unligated control uterine horns, but none of the 404 embryos in the artificially obstructed oviducts were implanted. The embryos within the ligated tubes were dormant in the hatched blastocyst stage as demonstrated by their ability to continue growing (98.2%) when removed from the oviduct to an in vitro environment. CONCLUSIONS: In this study, we demonstrate that mouse embryos can hatch, although delayed, in obstructed healthy oviducts. Tubal pregnancy is not likely to happen in artificially obstructed healthy mouse fallopian tubes, since all the viable embryos were dormant at the hatched blastocyst stage.

Effectiveness of psoralen photochemotherapy for vitiligo.

To evaluate the response to oral psoralen ultraviolet-A (PUVA) photochemotherapy in patients with vitiligo in Taiwan, we retrospectively reviewed the clinical data of 21 vitiligo patients treated from 1990 to 1998. Diagnosis included generalized vitiligo in 16 patients, focal vitiligo in three, and acrofacial vitiligo in two. All patients were treated two to three times per week over a period of 3 to 19 months with 0.2 to 0.4 mg/kg of trioxsalen 2 hours before exposure to long-wave ultraviolet light irradiation. The results for PUVA therapy showed 10 patients (48%) had an excellent response (75-100% repigmentation), four (19%) had a good response (50-75% repigmentation), one had a moderate response (25-50% repigmentation), and six (29%) had a poor response (0-25% repigmentation). Despite the high rate of satisfactory outcomes, the response to PUVA therapy with respect to specific localization revealed poor response in eight out of 10 patients with vitiligo on the hands and feet. Acute adverse effects of PUVA included pruritus in eight patients xerosis in one patient, and burning with blistering in four patients. Long-term adverse effects such as actinic keratosis and skin cancer were not found within the follow-up period, which ranged from 2 months to 7 years. Our findings indicate that long-term oral PUVA with trioxsalen is an effective treatment for vitiligo in Taiwanese patients.