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Plastic products are wildly used in human life. Di(2-ethylhexyl)phthalate (DEHP) is an essential additive in plastic manufacturing and is used as plasticizer formany products including plastic food packaging.DEHPis a teratogenic compound and can cause potent reproductive toxicity. DEHP can also cause liver damage, peroxisome proliferation, and carcinogenesis. DEHP is also strongly associated with peptic ulcers and gastric cancer; however, the underlying effect and mechanism of DEHP on the gastrointestinal tract are not entirely clear. The oral infection route of H. pylori parallels the major ingestion route of DEHP into the human body. Therefore, we wanted to study the effect of DEHP and H. pylori exposure on the human gastric epithelial cell line, AGS (gastric adenocarcinoma).Theviability of the AGS cell linewas significantly lower in 80 μM-DEHP and H. pylori (MOI = 100 : 1) coexposure than DEHP or H. pylori alone.DEHP and H. pylori coexposure also induced caspase-3 activation, and increased Bax/Bcl-2 ratio and DNA fragmentation in AGS cells. These results indicate that DEHP can enhance H. pylori cytotoxicity and induce gastric epithelial cell apoptosis. Therefore, it is possible that DEHP and H. pylori coexposure might enhance the disruption of the gastric mucosa integrity and potentially promote the pathogenesis of gastric carcinogenesis. [ABSTRACT FROM AUTHOR]

Aims: Iron overload identified by elevated ferritin concentrations has been implicated in risks of altered glucose metabolism and diabetic complications. The relationship between ferritin and insulin resistance in different gender and ethnicities remains uncertain; this study aimed to investigate it using homeostasis model assessment (HOMA-IR), and to explore whether it is gender-specific. Methods: A total of 524 type 2 diabetic patients were selected cross-sectionally from a cohort participating in a diabetic control study in Taiwan. Result: Overall, tertiles of ferritin were significantly and dose-dependently associated with elevated fasting plasma glucose, hemoglobin Alc, high-sensitivity C-reactive protein, HOMA-IR levels as well as Western dietary pattern scores generated by factor analysis (all p trend <0.05). Stratified by gender, a 1-tertile ferritin increase significantly correlated with a 0.241-unit increase in HOMA-IR (beta = 0.241, p = 0.001) in female diabetes, but not in male diabetes (beta = 0.072, p = 0.232), after adjusting for demographic, dietary, clinical and inflammatory factors. Conclusion: Iron overload, which produces elevated levels of ferritin, may augment insulin resistance in female but not in male type 2 diabetes. Longitudinal studies are warranted to establish relationships between iron stores and diabetes development in men and women of different ethnicities. [ABSTRACT FROM AUTHOR]

OBJECTIVE--An association between insulin resistance and microalbuminuria in type 2 diabetes has often been found in cross-sectional studies. We aimed to reassess this relationship in a prospective Taiwanese cohort of type 2 diabetic subjects. RESEARCH DESIGN AND METHODS--We enrolled 738 normoalbuminuric type 2 diabetic subjects, aged 56.6 ± 9.0 years, between 2003 and 2005 and followed them through the end of 2009. Average follow-up time was 5.2 ± 0.8 years. We used urine albumin-to-creatinine ratio to define microalbuminuria and the homeostasis model assessment of insulin resistance (HOMA-IR) to assess insulin resistance. The incidence rate ratio and Cox proportional hazards model were used to evaluate the association between HOMA-IR and development of microalbuminuria. RESULTS--We found incidences of microalbuminuria of 64.8, 83.5, 93.3, and 99.0 per 1,000 person-years for the lowest to highest quartiles of HOMA-IR. Compared with those in the lowest quartile of HOMA-IR, the incidence rate ratios for those in the 2nd, 3rd, and highest quartiles were 1.28 (95% CI 0.88-1.87), 1.44 (0.99-2.08), and 1.52 (1.06-2.20), respectively (trend test: P < 0.001). By comparison with those in the lowest quartile, the adjusted hazard ratios were 1.37 (0.93-2.02), 1.66 (1.12-2.47), and 1.76 (1.20-2.59) for those in the 2nd, 3rd, and highest HOMA-IR quartiles, respectively. CONCLUSIONS--According to the dose-response effects of HOMA-IR shown in this prospective study, we conclude that insulin resistance could significantly predict development of microalbuminuria in type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- In this randomized controlled trial we evaluated the effect of registered dietitian-led management of diabetes on glycemic control and macronutrient intake in type 2 diabetic patients in primary care clinics in Taiwan and studied the association between changes in macronutrient intake and glycemic measures. RESEARCH DESIGN AND METHODS -- We recruited 154 adult patients with type 2 diabetes and randomly assigned them to a routine care control group (n = 79) or a registered dietitian-led intervention group (n = 75) who received on-site diabetic self-management education every 3 months over 12 months. RESULTS -- Over the 1-year period, neither the intervention group (n = 75) nor the control group (n = 79) had significant changes in A1C, whereas the intervention patients with poorly controlled baseline A1C (≥7%) (n = 56) had significantly greater improvements in A1C and fasting plasma glucose than the control subjects (n = 60) (-0.7 vs. -0.2%, P = 0.034; - 13.4 vs. 16.9 mg/dl, P = 0.007) during the same period. We also found significant net intervention-control group differences in overall energy intake (-229.06 ± 309.16 vs. 56.10 ± 309.41 kcal/day) and carbohydrate intake (-31.24 ± 61.53 vs. 7.15 ± 54.09 g/day) (P < 0.001) in patients with poorly controlled A1C. Multivariable adjusted modeling revealed an independent association between changes in carbohydrate intake and A1C in the intervention group (n = 56; β = 0.10, SEM = 0.033, P = 0.004). CONCLUSIONS -- On-site registered dietitian-led management of diabetes can improve glycemic control in patients with poorly managed type 2 diabetes in primary care clinics in Taiwan. A reduction in carbohydrate intake may improve glycemic status. [ABSTRACT FROM AUTHOR]

Taiwanese aborigines have a high prevalence of hyperuricemia and gout. Uric acid levels and urate excretion have correlated with dopamine-induced glomerular filtration response. MAOs represent one of the major renal dopamine metabolic pathways. We aimed to identify the monoamine oxidase A ( MAOA, Xp11.3) gene variants and MAO-A enzyme activity associated with gout risk. This study was to investigate the association between gout and the MAOA single-nucleotide polymorphisms (SNPs) rs5953210, rs2283725, and rs1137070 as well as between gout and the COMT SNPs rs4680 Val158Met for 374 gout cases and 604 controls. MAO-A activity was also measured. All three MAOA SNPs were significantly associated with gout. A synonymous MAOA SNP, rs1137070 Asp470Asp, located in exon 14, was associated with the risk of having gout ( P = 4.0 × 10−5, adjusted odds ratio 1.46, 95% confidence intervals [CI]: 1.11–1.91). We also showed that, when compared to individuals with the MAOA GAT haplotype, carriers of the AGC haplotype had a 1.67-fold (95% CI: 1.28–2.17) higher risk of gout. Moreover, we found that MAOA enzyme activity correlated positively with hyperuricemia and gout ( P for trend = 2.00 × 10−3 vs. normal control). We also found that MAOA enzyme activity by rs1137070 allele was associated with hyperuricemia and gout ( P for trend = 1.53 × 10−6 vs. wild-type allele). Thus, our results show that some MAOA alleles, which have a higher enzyme activity, predispose to the development of gout. [ABSTRACT FROM AUTHOR]

Abstract Background/Purpose  The outcome analysis of obese patients undergoing laparoscopic cholecystectomy (LC) in Asia–Pacific countries is rarely reported. This study examined associations between body mass index (BMI) and clinical outcomes of elective LC in Taiwan. Methods  A total of 627 patients with gallbladder disease due to gallstones undergoing LC were divided into three groups based on BMI: 2 (normal, NO; n = 310), 25.0–29.9 kg/m2 (overweight, OW; n = 252), and >30 kg/m2 (obese, OB; n = 65). Results  Both overweight and obesity were not associated with conversion and complication rates. The conversion rates of the three groups were 5.5 (NO), 6.0 (OW), and 4.6% (OB), and the complication rates were 3.2 (NO), 2.4% (OW), and 4.6% (OB), respectively. However, overweight and obesity were related to a trend toward longer operating time (NO 67.4 ± 31.8; OW 77.8 ± 35.6; OB 79.0 ± 37.9 min) (P trend 2) was due to septic complications. In the multivariable logistic analysis, only acute cholecystitis, but not BMI, was a predictor for conversion and complications. Conclusions  Based on these results, it appears that BMI was not associated with clinical outcomes and that LC is a safe procedure in obese patients with uncomplicated gallstone disease in Taiwan. [ABSTRACT FROM AUTHOR]

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are commonly added to infant formula worldwide; however, dietary concentrations needed to obtain optimal tissue levels have not been established. Hence, we studied tissue responses in piglets fed various doses of DHA and ARA. Doses were 0, 12, and 5 times those used in U.S. infant formulas and DHA/ARA in Diet 0, Diet 1 Diet 2, and Diet 5 were 0, 4.1/8.1, 8.1/16.2, and 20.3/40.6 mg/100 kJ formula, respectively. Supplementation of dietary DHA and ARA increased DHA in brain, retina, liver, adipose tissue, plasma, and erythrocyte by 1.1- to 25.8-fold of Diet 0 (P-trend <0.01). Tissue ARA (1.1- to 6.0-fold of Diet 0) responded to dietary ARA in liver, adipose tissue, plasma, and erythrocytes (P-trend < 0.05); brain and retina ARA was, however, unresponsive to dietary DHA and ARA. Plasma and erythrocyte DHA were positively associated with DHA in neural (brain and retina) and visceral (liver and adipose) tissues (r² = 0.11-0.56; P < 0.001-P = 0.042). Plasma and erythrocyte ARA did not correlate with neural ARA. Only plasma ARA was associated with liver ARA (r² = 0.222; P = 0.02) and adipose ARA (r² = 0.867; P < 0.001) and erythrocyte ARA correlated with adipose ARA (r² = 0.470; P < 0.001). We conclude that dietary DHA supplementation affords an effective strategy for enhancing tissue DHA, ARA in visceral but not neural tissues is sensitive to dietary ARA, and erythrocyte and plasma DHA can be used as proxies for tissue DHA, although blood-borne ARA is not an indicator of neural ARA. [ABSTRACT FROM AUTHOR]

Background and Purpose: The volume-outcome effect has been well documented in both medical treatment and surgery. The relationship of volume-outcome utilization in laparoscopic cholecystectomy has not been studied. The aims of this study were to examine whether the operational volume of individual surgeons is associated with the clinical and economic outcomes of patients with gallbladder diseases undergoing laparoscopic cholecystectomy. Methods: A retrospective study was made of all patients who underwent elective laparoscopic cholecystectomy in the Department of Surgery, Kaohsiung Medical University Hospital between January 1998 and April 2002. In total, 916 patients were operated on by 4 surgeons and the volume for each surgeon was 502, 192, 147, and 75 cases, respectively. Clinical and economic information for each patient was abstracted from medical charts and the financial division. Multiple logistic and linear regression models were used to examine the relationship between three outcome variables, complications, length of stay, total hospital charges, and surgeon volume while controlling for the severity of illness and other selected covariates (morbidity index). Results: Overall, a complication rate of 1.2% was identified. On average, the patient's stay in hospital was 4.7 days, and the average total hospital charge was TWD 49,581 . After adjusting for covariates, three regression models indicated that the surgeon with the highest volume had the lowest complication rate, shortest length of stay, and lowest hospital charges. Conclusions: The operative volume of individual surgeons not only had a positive impact on clinical outcomes, it also had greater effect on conservation of health care resources. The findings validate the theory of practice makes perfect. [ABSTRACT FROM AUTHOR]

Background Addition of highly polyunsaturated fatty acids to infant formulas raises the possibility of increased lipid peroxidation. Aim of the study We determined the effects of increasing levels of dietary docosahexaenoic acid DHA) and arachidonic acid (AA) on lipid peroxidation and peroxidative potential in piglet tissues. Methods Four groups of piglets (n=6) were bottle-fed a formula containing one of four treatments: no long chain fatty acid (Diet 0) and three different levels of DHA/AA at 1-fold (0.3%/0.6% FA; Diet 1) 2-fold (0.6%/1.2% FA; Diet 2) and 5-fold (1.5%/3% FA; Diet 5) concentration used in some human infant formulas, and all with equal amount of vitamin E (5.7 IU/ 100 kcal formula) for four weeks. Results There were no significant differences between the groups in conjugated diene and glutathione (GSH) levels in the liver, and thiobarbituric acid-reactive substance (TBARS) in plasma. TBARS levels of the erythrocyte membranes increased in a dose-dependent manner when in vitro oxidation was induced with 10 mM hydrogen peroxide (H[sub2]O[sub2]) for 30 minutes. The TBARS levels of the liver homogenates of the Diet 5 and Diet 2 groups were significantly different than those of the membranes of the Diet 0 group when the in vitro oxidation was induced with H[sub2]O[sub2]. Conclusion The results show that dietary vitamin E effectively prevented lipid peroxidation at the LCP concentrations investigated and suggest that levels presently in infant formulas are sufficient. [ABSTRACT FROM AUTHOR]

Our study evaluates the usefulness and the limitations of using the medical records of a central referral hospital to develop a child injury surveillance system in northern Malawi. The most prevalent types of injury were falls (29.6%), road traffic injuries (22.0%), burns (21.4%) and poisoning (15.1%). Older children (aged 5-14 years), in the cool-dry season (May to August) and the hot-dry season (September to October), were significant predictors for total injury admissions. Our study indicated that hospital medical records are a valuable component of a child injury surveillance system and can illustrate the trends and patterns of moderate to severe injuries as well as suggest potential prevention strategies for local settings. Combined with a specially designed trauma registry form, it is possible for developing countries at local level to combat the emerging public health issues. [ABSTRACT FROM AUTHOR]

Adiponectin is fat-cell derived hormones, which is thought to be respectively protective and disadvantageous with regard to the development of cardiovascular disease (CVD) and diabetes mellitus type 2. A number of genetic variations have been studied. Among them, single nucleotide polymorphism, SNP276G>T of adiponectin gene showed an association with type 2 diabetes in different ethnic groups. The aim of the study is to examine associations between genetic variations of SNP 276 G > T with glucose tolerance status in 683 Taiwan aborigines from Southern Taiwan. Normoglycemia was classified as fasting glucose levels <110 mg/dl and hyperglycemia was ≧ 126 mg/dl. The T-allele frequencies were significantly associated with hyperglycemic state (p<0.01). After adjusting for confounding factors, waist ≧90 cm (OR=2.54, 95% CI=1.26-5.14) and SNP276 T allele carrier (OR=2.3, 95% CI=1.24-4.34) were independently associated with risks of impaired glucose tolerance status. On the other hand, adiponectin ≧ 10.9 ug/ml (OR=0.41, 95% CI=014-0.98) was negatively correlated. In conclusion, the SNP276 of the adiponectin gene and waist circumference may predict the increasing risk for impaired glucose tolerance state in general population. [ABSTRACT FROM AUTHOR]

The long chain polyunsaturats (LCP), docosahexaenoic acid (DHA), and arachidonic acid (ARA) are associated with perinatal neural development; however, optimal dietary levels are not established. Tissue responses in newborn piglets after a 28-day feeding with supplemental DHA and ARA were examined. Supplemental DHA/ARA (mg/mg) were 0, 1, 2, and 5 times those used in U.S. infant formulas respectively (Control Diet: 0/0 ; Diet 1: 17/34, Diet 2: 34/68, Diet 5: 85/170 per 100 kcal formula). Dietary DHA/ARA resulted in 1.1-25.8 fold increases in DHA in brain, retina, liver, adipose tissue, plasma and erythrocyte than the control (p for trend <0.01). Tissue ARA responded positively (1.1-6.0 fold) to dietary ARA only in liver, adipose tissue, plasma and erythrocyte (p for trend <0.05), ARA in brain and retina was unresponsive to dietary supplementation. Plasma/erythrocyte DHA was linearly associated with DHA in neural (brain and retina) and visceral (liver and adipose) tissues. Plasma/erythrocyte ARA did not correlate to neural ARA. Only plasma ARA was linearly associated with liver ARA (p=0.02) and adipose ARA (p<0.01), and erythrocyte correlated with adipose ARA (p<0.01). In conclusion, dietary DHA supplementation affords an effective strategy for enhancing tissue DHA, ARA in visceral but not neural tissues was sensitive to dietary ARA. This project was partially supported by a grant from Mead-Johnson Nutritionals. [ABSTRACT FROM AUTHOR]