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To study the risk factors for acute pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).From November of 2009 to May of 2014, 522 admitted patients [aged 42-93 years, mean(72±9)] with AECOPD received CT pulmonary angiography(CTPA) in the First Affiliated Hospital of Guangzhou Medical University. The patients were classified as PE positive (positive result on CTPA) or PE negative (negative results on CTPA), and related risk factors for PE were analyzed.The frequency of PE was 10.3% in this series of 522 patients with AECOPD. Single factor analysis showed that the following factors were significantly different (χ(2)=4.32-57.06, mean P0.05)between PE positive and PE negative groups: age≥70 years, immobilization≥3 days, deep vein thrombosis(DVT) and a history of venous thromboembolism(VTE), cor pulmonale caused by COPD, pneumonia, stroke, artery embolization, atrial fibrillation, lower extremity edema, the levels of N-terminal pro-brain natriuretic peptide(NT-proBNP) and D-dimmer. Multiple regression analysis showed that immobilization ≥3 days(OR=25.36, 95%CI: 7.42-86.69, P0.001), lower extremity edema(OR=7.34, 95%CI: 3.43-15.71, P0.001) and D-dimmer≥2 000 μg/L(OR=10.10, 95%CI: 2.25-45.42, P=0.003) were the risk factors. The ratio for purulent sputum was 48.1%(26/54) in the PE positive group, and 42.6% (23/54) of the patients showed concurrent purulent sputum and increase of blood markers of infection. The frequency of purulent sputum between PE positive and PE negative groups was not different.Patients with AECOPD admitted to hospital should be considered for the presence of PE if they had the risk factors of immobilization≥3 days, lower extremity edema and D-dimmer ≥2 000 μg/L.

Objectives: To examine the association between ethnicity, depression, quality of life, and diabetic control in Malaysian adolescents and young adults with type I diabetes mellitus. Methods: Fifty-two outpatients with type I diabetes (mean age 15.5 years) who attended a Diabetes Clinic were included. The level of HbA1c was the measure of diabetes control used (better control defined as HbA1c < 10%). Other variables were measured through questionnaires (e.g., depressive symptoms, quality of life), computerized diagnostic interviews (major depression), and medical records (e.g., demographic, family circumstances, compliance with treatment). Results: Ethnic Chinese youth showed better diabetic control than Malays and Indians (mean HbA1c 9.1%, 10.3%, and 11.0% respectively). Young people with better diabetic control (HbA1c < 10%) were more likely to have better quality of life and less likely to live in problematic families. When the cut-off for diabetic control was stricter (HbA1c ≤ 8%), the young person's compliance was the main predictor of poor control. Family problems were also associated with poor control but to a lesser extent. The initial association between poorer diabetes control and depression became non-significant when quality of life was taken into account. Conclusions: There are ethnic differences in juvenile diabetic control in this Malaysian sample which need to be understood further. Previous findings of an association between quality of life and glycemic control were verified but different definitions of good control showed different associations with individual and environmental variables. Clinicians' awareness and early intervention for psychosocial problems (for example, inadequate family support) could improve diabetes control.

To evaluate a simple optimization technique intended to improve planning target volume (PTV) dose coverage and organ-at-risk (OAR) sparing in intensity-modulated radiotherapy (IMRT) of advanced laryngeal cancer.Generally acceptable initial IMRT plans were generated for 12 patients and were improved individually by the following two techniques: (1) base dose function-based (BDF) technique, in which the treatment plans were reoptimized based on the initial IMRT plans; (2) dose-controlling structure-based (DCS) technique, in which the initial IMRT plans were reoptimized by adding constraints for hot and cold spots. The initial, BDF and DCS IMRT plans and additionally generated volumetric modulated arc therapy (VMAT) plans were compared concerning homogeneity index (HI) and conformity index (CI) of PTVs prescribed at 70 Gy/60 Gy (PTV70/PTV60), OAR sparing, monitor units (MUs) per fraction and total planning time.Compared with the initial IMRT and DCS IMRT plans, the BDF technique provided superior HI/CI, by approximately 19-37%/4-11%, and lower doses to most OARs, by approximately 1-7%, except for the comparable HI of PTV60 to DCS IMRT plans. Compared with VMAT plans, the BDF technique provided comparable HI, CI and most-OAR sparing, except for the superior HI of PTV70, by approximately 13%. The BDF technique produced more MUs and reduced the planning time.The BDF optimization technique for IMRT of advanced laryngeal cancer can improve target dose homogeneity and conformity, spare most OARs and is efficient.A novel optimization technique for improving IMRT was assessed and found to be effective and efficient.

The major purposes of this paper are to explore the phenomena of family structure, illness symptoms, family coping and adaptation for patients with schizophrenia or manic-depression psychosis. This paper tries to provide a good reference instrument for application by nurses in home care, in order to understand and evaluate family needs. Subjects are schizophrenic or manic-depression outpatients from 3 hospitals located in northern Taiwan. Data were collected through home interview with primary caregivers and observations. There were fifty subjects from each of the 3 hospitals, and 151 subjects in total. Descriptive statistics, t-test, one way ANOVA, Pearson correlation and multiple stepwise correlation were used to analyze data. Research indicates that most patients are aged between 31 to 40, with over 10 years elapsed since onset, and are not married. Most primary caregivers are parents over 60 years old. Most family development was at the stage with young adult offspring. The manic-depressive patients have more working opportunities than schizophrenic patients. For schizophrenic patients, paranoia was the most serious in active symptoms; lack of interpersonal interaction was the most serious in negative symptoms; the other major problem was sleep disturbance in emotion-behavior assessment. Patient's disposition was the most concerning issue for families and the worst coping efficiency occurred with lazy behavior and sleep disturbance. For manic-depressive patients, aggressive behavior was the most serious active symptom, lack of energy was the most serious in negative symptom, and sleep disturbance was the most concerning problem in emotion-behavior assessment. The patient's symptom was the most concerning issue for families and the worst coping efficiency was found in drug side effect. The result also indicates that active and negative symptoms are both related to coping efficiency.

To search for unique mutations in the apolipoprotein B (apoB) gene that disrupt the binding of LDL to its receptor and cause hypercholesterolemia, we examined more than 800 patients with high LDL cholesterol levels and/or coronary artery disease (CAD). Analysis of patient DNA by single-strand conformation polymorphism and allele-specific oligonucleotide hybridization of the sequence surrounding the putative receptor- binding domain of apoB (amino acid positions 2965 to 3534) revealed seven variations. LDL from heterozygotes with either Arg 3500 Gln or Arg 3531 Cys bound defectively with the LDL receptor in competitive binding assays. The Arg 3500 Gln substitution was statistically more prevalent in patients with hypercholesterolemia (P = 0.0003). Total cholesterol and LDL-cholesterol were significantly higher (P0.0004) in 34 apoB 3500 Gln carriers than in the controls. The allele encoding the Arg 3531 Cys substitution was more prevalent (0.8%) in the CAD group (P = 0.05) than in the controls. A Ser 3252 Gly variant was statistically more prevalent in the hypercholesterolemic group (P = 0.03), but LDL with this mutation had normal LDL receptor-binding activity. The other four variants identified (Leu 3350 Leu, Gln 3405 Glu, Val 3396 Met, and Ser 3455 Arg) were not associated with defective LDL-receptor binding, hypercholesterolemia, or CAD, nor were the apoB mutations associated with elevated lipid levels in family members. The surprising result that only two mutations of apoB in the receptor-binding domain (Arg 3500 Gln and Arg 3531 Cys) were associated with defective LDL binding, hypercholesterolemia, or CAD is in stark contrast with familial hypercholesterolemia, where nearly 150 mutations of the LDL receptor have been described that disrupt its function. This study strongly suggests that a limited number of mutations of apoB markedly influence LDL binding to its receptor.

An in-house radioimmunoassay (RIA) for the measurement of androstenedione levels in serum was established and validated. Levels of androstenedione were measured by RIA using serum samples from various normal population groups and patients with congenital adrenal hyperplasia (CAH). Analytical recovery and linearity results were95%, while intra- and inter-assay CVs were10% and22% respectively. The assay sensitivity was 0.5 nmol/l or 25 fmol/tube. In normal population groups, the highest androstenedione levels were found in preterm neonates (1.6-12.4 nmol/l), followed by adult females (1.5-10.2 nmol/l), adult males (1.6-8.0 nmol/l) and term neonates (0.8-8.8 nmol/l), while the lowest values were observed in prepubertal children (0.5-3.4 nmol/l). There were no significant differences in diurnal variation and between follicular and luteal phases. The range of androstenedione levels in untreated or poorly controlled CAH patients (7.6-355.0 nmol/l, median 42.5 nmol/l, n = 20) were significantly higher (p0.001) than the upper normal limit of 3.4 nmol/L for prepubertal children. The normal androstenedione reference ranges for paediatric and adult groups have thus been established.

Since conventional radioimmunoassays (RIA) for measurement of 17-hydroxyprogesterone (17-OHP) in serum samples require a laborious solvent extraction step, a direct and rapid in-house RIA was developed for early diagnosis and management of congenital adrenal hyperplasia (CAH). In-house rabbit anti-17-OHP antiserum, tritium labelled 17-OHP and dextran-coated charcoal were used in assay buffer with low pH 5.1 and preheated serum samples. Both inter- and intra-assay CVs were10% and the sensitivity was 1.2 nmol/l or 12 fmol/tube. Results from the direct assay correlated well with values from an extraction assay, r = 0.88 in samples from CAH patients, r = 0.85 in adults and children, 0.69 and 0.40 in term and preterm neonates respectively, 0.66 and 0.63 in luteal phase and third trimester pregnancy; p0.001 in all groups except p0.05 in preterm neonates. However, results from the direct assay were two to three times higher in serum samples from CAH patients, normal adults and children, but were five to seven times higher in pregnancy and term neonates and thirty times higher in preterm neonates. The markedly elevated levels measured by the direct assay are probably due to cross-reactivities with water-soluble steroid metabolites such as 17-hydroxypregnenolone sulphate and dehydroepiandrosterone sulphate (DHEAS). Although the direct assay is only useful as a screening test for preterm babies, it can be used for both diagnosis and monitoring of treatment of CAH in all other age groups.

We examine how cover stories of isomorphic problems affect transfer. Existing models posit that people retain content in problem representations and that similarities and differences between the "undeleted" cover stories might interfere with recognition of structural similarities. We propose that cover stories can affect transfer in another way--by inducing semantic knowledge that modifies problem structures. Two experiments examined how people represent and solve permutation problems dealing with random assignment of elements from one set to elements from another set. Although the problems were structurally isomorphic, cover stories involving different pairs of element sets led subjects to abstract different "interpreted structures." Problems involving objects and people (e.g., prizes and students) led subjects to abstract an asymmetric structure ("get") and problems involving similar sets of people (e.g., doctors and doctors) led subjects to abstract a symmetric structure ("pair"). Transfer was mediated by similarities and differences between the interpreted structures of the learned and the novel problems.

Thyroid function and pubertal development of aborigines (Orang Asli) and Malays at different socioeconomic strata were assessed among 1136 subjects aged 7 years and above. Anthropometric measurements, goitre and pubertal staging were done. Serum thyroxine (T4), triiodothyronine (T3) and growth hormone were measured using radioimmunoassays (RIA) and serum thyroid stimulating hormone (TSH) by immunoradiometric assays (IRMA). It was found that serum T3 in children was significantly higher in Malays from rural areas, girls and children aged less than 13 years. However, in adults, T3 was significantly associated with anthropometric indices. On the contrary, serum T4 levels were higher among children from urban areas. In adults, serum T4 levels were significantly related to nutritional status and they increased according to the levels of social development, being lowest in remote areas and highest in urban areas. However, serum TSH levels were significantly higher in Orang Asli at all ages and among malnourished children. By using multiple regression, apart from age, gender and ethnicity, nutritional status was a significant predictor for T3 levels in children and adults. Presence of goitre was an important factor which determined the T4 levels in children and adults after controlling for other factors. It was also a predictor for TSH levels in children but not in adults. Fasting serum growth hormone (GH) levels were significantly higher among less privileged groups and decreased according to social development. Serum growth hormone was negatively correlated with anthropometric indices and had a significant association with malnutrition.(ABSTRACT TRUNCATED AT 250 WORDS)

Fasting growth hormone (GH) level is an important reference level in dynamic tests of GH secretion. Other studies have demonstrated sex and age variation in the rate of GH secretion. We analysed fasting serum samples from 377 normal subjects (193 males and 184 females, age range 6 to 81 years old), using our in-house enzyme immunoassay. We found sex differences in fasting GH levels to be only significant in the prepubertal children (Tanner stage I), being higher in girls than in age-matched boys (p0.05). Both sexes showed age-dependent changes in fasting GH levels (p0.001); highest levels were achieved at puberty and subsequently declined with advancing age. Hence, the physiological sex difference and age-dependency in GH secretion can also be demonstrated in single fasting samples.

Decreased urinary kallikrein excretion has been shown to be related to hypertension. Kallikrein levels also have been shown to be determined primarily by genes, with 51% of the total variance being due to a single gene. However, there exists strong spouse-spouse correlation, indicating that common environment plays a significant role. This study used 69 pairs of monozygous twins to investigate possible dietary, biochemical, and anthropometric determinants of kallikrein that could result in this high spouse correlation. Urinary sodium and potassium excretion differences were significantly related to kallikrein differences, with urinary potassium having the strongest relationship (r = 0.46, P = .0001). Urinary pH (r = 0.23, P = .03) and systolic blood pressure (r = -0.25, P = .03) differences were associated with urinary kallikrein excretion differences independently of urinary potassium. Information on nutrients was obtained from a dietary food frequency questionnaire that ascertains usual intake over the last 5 years. Kallikrein differences between monozygous twins were not explained by differences in nutrient intake as measured by this questionnaire. Therefore, urinary potassium and pH probably represent the more acute effects of recent dietary sodium and potassium intake on urinary kallikrein levels. Urinary potassium, pH, and systolic blood pressure differences explained 34% of the difference in kallikrein levels between monozygous twins. The significant difference in systolic blood pressure between twins, even after controlling for electrolyte excretion differences suggests an additional unmeasured environmental variable that is associated with decreased kallikrein excretion and elevated blood pressure.

We analyzed medical family history information from 51,053 families of high school students in Utah and Texas and cholesterol measurements from 853 youths and 1618 adults in Utah families with cardiovascular disease (CVD) to assess the utility of different approaches to risk-factor evaluation for youths. The major question addressed was in which youths should blood cholesterol be tested? Applying National Cholesterol Education Program recommendations suggested that 36% in Utah and 38% in Texas be tested. Heterozygous familial hypercholesterolemia (hFH) is the best documented and most serious cholesterol disorder readily diagnosed in youths. In Utah families ascertained for CVD in adults, blood cholesterol levels among youths were significantly bimodal with hFH present in 84% of youths in the upper cholesterol mode. Blood cholesterol levels in adults from the same families were less bimodal with hFH present in 38% of adults in the upper mode. More overlap existed between high and normal modes in adults than in youths. Data from this study suggest that family histories and cholesterol concentrations obtained from high school students may meet the needs of cholesterol screening, education, and follow-up in a controlled and cost-effective setting.

1. Among 45,258 Utah families surveyed, about 4% have a strong aggregation of early coronary disease. In detailed clinical evaluation, about 21% of such high risk coronary families were found to have familial dyslipidaemic hypertension (FDH) and about 3% were found to have heterozygous familial hypercholesterolaemia (hFH). 2. Common and potentially modifiable environmental factors seem to play an important role in these high risk families. Non-genetic obesity promotes the expression of FDH. A high fat diet promotes the expression of FH. Cigarette smoking promotes earlier death in all coronary prone families. 3. Practical approaches are suggested for helping coronary prone pedigrees by applying our understanding of genetic and environmental factors that promote earlier coronary disease onset.

Migration disorders are congenital brain malformations. These anomalies may be overlooked in CT studies. We present four cases with migration disorders. All have both CT and MRI studies. Comparison of the images of CT and MRI at corresponding levels is demonstrated. The superiority of MR images to CT in delineating the migration and sulcation disorders is discussed.

51 eyes of rhegmatogenous retinal detachment successfully reattached were prospectively studied with regard to the incidence of cystoid macular edema (CME). 14 eyes had CME 6 weeks after surgery, representing an incidence of 27.5%. No correlation was observed between CME and foveal involvement of the detachment, age of the patient, or the amount of subretinal fluid drained. CME is an important cause of postoperative visual impairment, and diagnosis is confirmed by fluorescein angiography. The angiographic features and classification of CME are described.

We have developed a unique, family-oriented approach to lowering plasma cholesterol concentrations in persons with familial hyperlipidemias. The approach includes individual clinic visits and group nutrition classes and uses dietary goals outlined in The New American Diet. A series of 13 nutrition classes is presented to small groups, usually composed of relatives from pedigrees with familial hypercholesterolemia or other familial hyperlipidemias. Dietary action goals, cooking demonstrations, food tasting, and finger-stick plasma cholesterol determinations are important components of the classes. Problem-solving discussion is encouraged in the group. Over the past 4 years, 143 hyperlipidemic individuals, along with at least 94 unaffected family members, have participated in 31 groups, which have met for at least six classes. Many clinic participants lower plasma cholesterol by 20% or more. Keys to the success of this program include emphasizing dietary therapy, using the family setting for nutrition intervention, providing hands-on experience with food and recipes, promoting problem solving for dietary action goals, measuring blood cholesterol during classes, and encouraging long-term follow-up for participants with physicians and dietitians.

The clinical, biochemical and immunological features of 180 patients with hyperthyroid Graves' disease managed at the Universiti Kebangsaan Malaysia (UKM) Endocrine Clinic from 1983 to 1987 were examined. The prevalence of the disease is highest in Chinese and lowest in Indians. The female: male ratio is 2.8:1. Hypokalaemic periodic paralysis and hypercalcaemia were present in 5.0% and 1.7% of the cases respectively. Pretibial myxoedema was extremely rare. Thyrotropin - binding inhibitory immunoglobulins, anti-thyroglobulin and anti-microsome antibodies were positive in 61.5%, 25.8% and 42.3% of the patients respectively. A eumetabolic state could be achieved in the majority of patients with antithyroid drugs alone. Definitive therapy with subtotal thyroidectomy or radioiodine were needed in 31.3% of cases.

Likelihood analysis was used to test for evidence that an allele at a major locus elevates rates of sodium-lithium countertransport (SLC) in a sample of 1,989 members of 89 Utah pedigrees. The pedigrees were ascertained through two or three sibs who died of stroke before age 74 years (stroke pedigrees), through hypertensive and normotensive probands of the Salt Lake Center of the Hypertension Detection and Followup Program (HDFP pedigrees), or through men who suffered a myocardial infarction before age 55 years (coronary pedigrees). Major-locus inheritance could be rejected in the total sample; transmission probability estimates of tau1 = .972, tau2 = .520, tau3 = .185 differed significantly from Mendelian transmission specified by tau1 = 1, tau2 = 1/2, tau3 = 0. However, heterogeneity between ascertainment groups was significant (chi2(18) = 40.06, P less than .01) and justified analysis within subsets of the sample. In the stroke pedigrees, evidence of major-locus inheritance was not found; polygenic heritability was estimated as .647. In the HDFP pedigrees, estimates of tau1 = .987, tau2 = .430, tau3 = .506 differed significantly from Mendelian transmission; the inferred model consisted of a mixture of two distributions incompatible with both Mendelian and environmental transmission but compatible with polygenic inheritance within distributions. In the coronary pedigrees, the hypothesis of Mendelian transmission could not be rejected. In the coronary pedigrees, the evidence supported an incompletely recessive allele with a frequency of .227 which elevated the level of SLC to a mean of .530 mmol/liter RBC/h.(ABSTRACT TRUNCATED AT 250 WORDS)