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Fluorescence visualization (FV) in the near-infrared (NIR) window promises to break through the signal-to-background ratio (SBR) bottleneck of traditional visible-light-driven FV methods. However, straightforward NIR-FV has not been realized, owing to the lack of methods to readily transduce NIR responses into instrument-free, naked eye-recognizable outputs. Now, an initiation-input-transduction platform comprising a well-designed NIR fluorophore as the signal initiator and lanthanide-doped nanocrystals as the transducer for facile NIR-FV is presented. The analyte-induced off-on NIR signal serves as a sensitizing switch of transducer visible luminescence for naked-eye readout. The design is demonstrated for portable, quantitative detection of phosgene with significantly improved SBR and sensitivity. By further exploration of initiators, this strategy holds promise to create advanced NIR-FV probes for broad sensing applications.

In order to test the electrical performance parameters of military power station accurately, according to the different test requirements of electrical performance, a test system of PC104 embedded industrial computer was designed, which is based on virtual instrument. The software system based on LabWindows/CVI is introduced, which contains achievements of tests’ method, control of signal sampling and load-shifting, management and output of test data. In the part of hardware design, signal sampling circuit and load-shifting circuit is introduced mostly. The actual test shows that the system can well satisfy the test requirement.

Systemic lupus erythematosus (SLE) is an autoimmune disease primarily affecting women (9:1 compared with men). To investigate the influence of female sex hormone estrogen on the development of female-biased lupus, we compared the expression of estrogen receptor alpha (ERα) gene and protein levels as well as expression of T-cell activation gene calcineurin in response to estrogen in peripheral blood lymphocytes (PBLs) from SLE patients and normal controls. PBLs were isolated from 20 female SLE patients and 6 normal female controls. The amount of ERα protein in PBL was measured by flow cytometry. The expression of ERα and calcineurin messenger RNA was measured by semi-quantitative reverse transcription-polymerase chain reaction. Calcineurin phosphatase activity was measured by calcineurin assay kit. The expression of ERα messenger RNA and ERα protein was significantly increased (p = 0.001 and p = 0.023, respectively) in PBL from SLE patients compared with that from normal controls. In addition, the basal calcineurin in PBL from SLE patients was significantly higher (p = 0.000) than that from normal controls, and estrogen-induced expression of calcineurin was increased (p = 0.007) in PBL from SLE patients compared with that from normal controls, a 3.15-fold increase. This increase was inhibited by the ERα antagonism ICI 182,780. The effects of ER antagonism were also found in calcineurin activity. These data suggest that overexpression of ERα gene and enhanced activation of calcineurin in response to estrogen in PBL may contribute to the pathogenesis of female dominant in SLE.

To investigate the associations of DNA methylation levels and mRNA expressions of DNA cytosine-5-methyltransferase 1 (DNMT1) and methyl CpG-binding domain 2 (MBD2) with rheumatoid arthritis (RA).The global methylation status of DNA was measured in 65 patients with RA and 64 healthy controls by the ELISA method. DNMT1 and MBD2 mRNA were also detected in 177 RA patients and 95 controls using the quantitative real-time polymerase chain reaction method.The global methylation of DNA was significantly decreased in the RA patients compared to the controls (p=0.005, 95% CI=0.0835-0.4503). The patients with RA had higher expressions of DNMT1 and MBD2 mRNA than the controls (p0.001, 95% CI=-0.0024 to -0.0053 and p0.001, 95% CI=-0.0079 to -0.0167, respectively). We also found that the MBD2 mRNA level was not related to the disease activity of RA. However, the expression of DNMT1 mRNA tended to be associated with the disease activity of RA (p=0.08). The levels of DNA methylation and DNMT1 mRNA were significantly decreased in the patients with anti-CCP antibody compared with those without (p=0.005, 95% CI=-0.7333 to -0.1373 and p=0.003, 95% CI=-0.0071 to -0.0022, respectively). The differences in the methylation level and expressions of DNMT1 and MBD2 were not significant between the patients treated with and without anti-TNFα biological agents (Enbrel or Humira).This study demonstrated that the RA patients have a significantly lower level of DNA methylation than the controls. Moreover, RA patients have higher expressions of DNMT1 and MBD2 mRNA. The anti-TNFα biological agents do not seem to affect DNA methylation and mRNA expressions of DNMT1 and MBD2 in RA patients.

The objective of this study was to investigate the associations between suppressor of cytokine signaling 1 (SOCS1) mRNA expression and SOCS1 polymorphisms with the development of rheumatoid arthritis (RA). One hundred and eighty-one patients with RA and 96 healthy controls were enrolled in this study. The SOCS1 mRNA level in peripheral blood mononuclear cells (PBMCs) was detected by quantitative real-time polymerase chain reaction. SOCS1 polymorphisms were determined by the polymerase chain reaction/restriction fragment length polymorphism method. We found that the expression of SOCS1 mRNA in PBMCs was significantly greater in patients with RA than in healthy controls. There were no significant differences in the expression of SOCS1 mRNA among patients with different disease activities. The increment in SOCS1 mRNA after stimulation with various cytokines was slightly lower in the patients with RA than in the healthy controls. This study also demonstrated that the SOCS1 polymorphisms were not associated with susceptibility to RA. In conclusion, the expression of SOCS1 mRNA in PBMCs is higher in patients with RA than in healthy controls. The increment in SOCS1 mRNA expression in PBMCs after stimulation with different cytokines seems to be lower in patients with RA than in healthy controls.

To investigate the role ofIκBαpromoter polymorphisms in the development of Behçet’s disease, eighty-six patients with Behçet's disease and 120 healthy controls were enrolled in this study. TheIκBα; -881A/G, -826C/T, -550A/T, -519C/T, and -297C/T polymorphisms were measured by the method of polymerase chain reaction/ restriction fragment length polymorphism. This study demonstrated that the genotype frequencies ofIκBα-826C/T and -826T/T were significantly higher in the patients with Behçet's disease than in the controls. Both in the dominant and in the recessive models, the patients with Behçet's disease have higher frequencies of the IκBα -826T containing genotype than the controls. The allele frequency ofIκBα-826T was significantly increased in the patients with Behçet’s disease. The frequencies of theIκBα-881A -826T -550A -519C -297C andIκBα-881A -826T -550A -519T -297C haplotypes were significantly higher in the patients with Behçet–s disease than in the controls. In contrast, the haplotype frequency ofIκBα-881A -826C -550A -519C -297C in the patients with Behçet’s disease was significantly decreased. This study also revealed that the Behçet’s disease patients with IκBα -826T/T have higher prevalence of skin lesions than those without IκBα -826T/T. In summary, the IκBα -826T allele,IκBα-881A -826T -550A -519C -297C andIκBα-881A -826T -550A -519T -297C haplotypes might be associated with susceptibility to Behçet’s disease. TheIκBα-826T/T genotype was related to the development of skin lesions in the patients with Behçet's disease.

We implemented a nationwide population-based study in Taiwan to compare the physical and biochemical parameters, diet and exercise lifestyles, and prevalences of diabetes, hyperlipidemia, and hypertension between males and females, and to clarify the determinants of diabetes, hyperlipidemia, and hypertension in Taiwan. In this cross-sectional study, 7,578 subjects were selected from the general population by stratified random sampling for the Surveillance of Taiwanese Civil Health in 2002. Blood samples were taken and information on body composition, demographics, exercise and dietary habits, and medical and drug histories were obtained from structured interviews administered by well-trained interviewers. A total of 6,600 subjects (87.1%), aged 15.6–95.0 years old, completed the survey. The overall prevalences of diabetes, hyperlipidemia, and hypertension were 9.9%, 22.8%, and 15.7%, respectively, and hyperlipidemia (27.0%) and hypertension (19.2%) were more prevalent in males. Males were more likely to have high-fat and high-cholesterol diets, compared with females. Although there were differences in the prevalences of hyperlipidemia and hypertension between the sexes, adjusted logistic regression analysis demonstrated little contribution of diet and exercise habits to the risks of diabetes, hyperlipidemia, or hypertension after adjusting for age, sex, waist-to-hip ratio, serum blood sugar levels, cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B, glutamate oxaloacetate transaminase, glutamate pyruvate transaminase, creatinine, uric acid, and blood pressure.

The relationship between cigarette smoking and cell damage is complicated, particularly considering the role of oxidative stress. The aim of this study was to identify the relationships among plasma nicotine metabolites, lipophilic antioxidants, and metabolic parameters in smokers and nonsmokers. This cross-sectional study recruited 100 subjects who visited the Department of Family Medicine at Kaohsiung Medical University Hospital. Excluding 14 ineligible cases, 46 smokers and 40 non-smokers were enrolled. Plasma nicotine metabolites, lipophilic antioxidants (including retinol, lycopene, alpha-carotene, beta-carotene, delta-tocopherol, gamma-tocopherol and alpha-tocopherol), related metabolic parameters, and body composition (including height, weight, body mass index, body fat, and waist circumference) were examined by comparison of means, correlations and regressions. Significant correlations among nicotine metabolites, age, sex, body composition and plasma lipophilic antioxidants were noted. Nicotine metabolites, age, body height and body weight were closely associated with plasma antioxidant levels (p0.05) in multiple linear regression. The levels of alpha-carotene, beta-carotene, gamma-tocopherol and lycopene were lower in smokers than in non-smokers (p0.01). The plasma level of high-sensitivity C-reactive protein (hsCRP), which is a marker for high cardiovascular risk, was higher in smokers than in non-smokers (p = 0.003). We conclude that the lower plasma antioxidant levels and the higher level of hsCRP in smokers may lead to decreased protective efficacy compared with non-smokers. Further studies are warranted to support our hypothesis.

To investigate the association of IkBα promoter polymorphisms with the development of primary Sjogren’s syndrome in Taiwan, 98 patients with primary Sjogren’s syndrome and 110 unrelated healthy controls were enrolled in this study. The IκBα −881 A/G, IκBα −826 C/T, IκBα −550 A/T, IκBα −519 C/T, and IκBα −297 C/T polymorphisms were determined by the methods of polymerase chain reaction/restriction fragment length polymorphism. This study demonstrated that the genotype frequencies of IκBα −826 C/T and IκBα −826 T/T, in comparison with that of IκBα −826 C/C, were significantly higher in the patients with primary Sjogren’s syndrome than in the controls. The allele frequency of IκBα −881 G was significantly decreased in the patients with primary Sjogren’s syndrome compared with that of the controls. In contrast, the allele frequency of IκBα −826 T was significantly higher in the patients with primary Sjogren’s syndrome than in the controls. The similar findings could also be found in the allele carriage frequencies. The patients with primary Sjogren’s syndrome had lower allele carriage frequencies of IκBα −881 G and IκBα −826 C, and a higher allele carriage frequency of IκBα −826 T. We also found that the estimated haplotype frequency of IκBα −881A-826T-550A-519C-297C was significantly increased in the patients with primary Sjogren’s syndrome in comparison with that of the controls. This study demonstrated that the IkBα −826T allele and IkBα −881A-826T-550A-519C-297C haplotype were associated with susceptibility to primary Sjogren’s syndrome in Taiwan. However, these findings may not be disease-specific but may be related to inflammatory responses.

Background. Cross-sectional studies investigated the impact of renin-angiotensin system (RAS) gene polymorphism on left ventricular mass index (LVMI) with conflicting results. We conducted a longitudinal study to investigate the influence of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) and angiotensinogen (AGT) M235T and angiotensin II type 1 receptor (AT1R) A1166C gene polymorphisms on the LVMI and geometry. Methods. Of 1500 people screened, 110 nondiabetic normotensive elderly Chinese persons were recruited and received echocardiography at baseline and at the 2nd and 4th year follow-up. No participants had a history of organic heart disease or chronic medication. The gene polymorphisms were analyzed by using polymerase chain reaction. Results. Participant age was 71.9 6 3.9 years (range 60‐81 years). The prevalence of concentric remodeling, eccentric hypertrophy, and concentric hypertrophy was significantly increased as well as LVMI after 4 years (all p , .05). These changes and the magnitude of LVMI increase were significantly higher in participants carrying the ACE D allele than nonD-allele carriers (all p , .05). This association was still significant in multivariate analyses (p � .02). A similar analysis showed a borderline significance in the AT1R but not in the AGT gene polymorphism. Conclusions. This longitudinal study showed that the aging process was associated with an increase of LVMI and changes of geometry. The RAS gene polymorphism, especially the ACE D allele, might modulate these changes in the Chinese population. This provides further knowledge that is essential in the assessment of cardiac disease and the determination of the left ventricular structure in older persons.

The evaluation of ecosystem health has become one of the main research topics of ecosystem science, thus more and more assessment methods and frameworks have been put forward in recent years. However, the attention people pay to ecosystem health is actually more about what the social functions the ecosystem affords, which depend on the integrity and maintenance of the ecosystem structure and function, and the intensity of disturbance from outside. Accordingly, this research commenced from three main aspects, selected the evaluation indices, and then established the Evaluation Index System of Beijing Forest Ecosystem Health (EIS-BFEH). In the EIS-BFEH, each of the three foundations contained an easily-operated and standard sub-index system, which compounded the specific natural and social conditions of Beijing and was concrete enough to measure and evaluate. Then with the method of the Analytical Hierarchy Process (AHP), the comprehensive index (CI) could be obtained, which represented the health of the forest ecosystem. As a case study, the forest ecosystems in the Badaling area were sampled, evaluated, compared and ranked by use of the EIS-BFEH. The result show that the health of natural forests is much better than that of plantations in the Badaling forest center: the average comprehensive index of the former is 7.9, while the latter is only 6.6. From the results, it could also be found that there are nine units in the healthy state, two units in the subhealthy state, and only one unit of Robinia pseudoacacia in the morbid state.

OBJECTIVES: To test the association between fasting glucose level and left ventricular mass (LVM) and left ventricular hypertrophy (LVH) in people aged 60 and older. DESIGN: Population-based prospective study with 4-year follow-up. SETTING: Department of Internal Medicine and Family Medicine, Kaohsiung Medical University (KMU), Chung-Ho Memorial Hospital, and Graduate Institute of Medicine and Public Health, KMU. PARTICIPANTS: Of 1,500 people screened, 105 without symptoms or signs of diabetes mellitus, hypertension, or cardiovascular disease were recruited from senior activity centers in Kaohsiung city. MEASUREMENTS: All received two-dimensional echocardiography and fasting glucose examination at baseline and at 2- and 4-year follow-up. LVH was defined as a LVM index (LVMI) greater than 122.4 g/m2 or 51 g/m2.7. RESULTS: Age ranged from 60 to 81 (mean 71.7±3.9). Baseline glucose ranged from 83 to 118 mg/dL (mean 99.7±7.9 mg/dL). LVMI was significantly higher at the 4-year follow-up (97.5±24.9 vs 104.5±27.5 g/m2 and 44.2±12.1 vs 47.2±13.4 g/m2.7, both P

To investigate the role of SLC 11A1 polymorphisms in the development of reactive arthritis, 91 patients with reactive arthritis and 163 healthy controls were enrolled in this study. The SLC 11A1 polymorphisms were determined by the method of polymerase chain reaction/restriction fragment length polymorphism. The genotype distributions of SLC 11A1 274, 823, 1703, and 1729+ 55 del 4 were significantly different between the patients with reactive arthritis and controls. The genotype frequency of SLC 11A1 274C/C was significantly decreased in the patients with reactive arthritis when compared with that of the controls. In contrast, the SLC 11A1 274C/T showed a significant association with reactive arthritis. The patients with reactive arthritis have a significantly higher frequency of SLC 11A1 823C/C than the controls. However, SLC 11A1 823T/T was resistant to the development of reactive arthritis. The allele frequencies of SLC 11A1 274T and 823C were significantly increased in the patients with reactive arthritis in comparison with those of the controls, independent of HLA-B27. On the contrary, the allele frequencies of SLC 11A1 274C and 823T were significantly decreased in the patients with reactive arthritis. The estimated haplotype frequency of SLC 11A1 274C 823T 1703G 1729+55del 4 TGTG+ was significantly decreased in the patients with reactive arthritis when compared with that of the controls. In contrast, the estimated haplotype frequency of SLC 11A1 274T 823C 1703G 1729+55 del 4 TGTG+ was significantly increased in the patients with reactive arthritis. This study shows that the SLC 11A1 274T and 823C alleles are associated with susceptibility to reactive arthritis independently of HLA-B27 in Taiwan. The SLC 11A1 274T 823C 1703G 1729+55 del 4 TGTG+ haplotype is associated with the development of reactive arthritis in Taiwan. In contrast, the SLC 11A1 274C 823T 1703G 1729+55 del 4 TGTG+ haplotype may be a protective factor.

To investigate the role of programmed cell death-1 (PD-1) gene polymorphisms in the development of systemic lupus erythematosus (SLE) in Taiwan, 109 patients with SLE and 100 healthy controls were enrolled in this study. The PD-1 gene polymorphisms were determined by the method of polymerase chain reaction/restriction fragment length polymorphism. This study showed that the genotype distributions of PD-1 7209 C/T polymorphisms were significantly different between the patients with SLE and controls (P=0.002, Pc=0.018). The frequencies of the PD-1 7209 C/C genotype and PD-1 7209 C allele were significantly higher in the patients with SLE than those of the controls (P=0.001, OR=2.6, 95% CI=1.5-4.6, and P=0.002, OR=2.1, 95% CI=1.3-3.4, Pc=0.018, respectively). Moreover, the association of PD-1 7209 C with susceptibility to SLE was independent of the PD-1 ligand. This study also showed that the PD-1-536 A 7146 G 7209 C 7499 G haplotype was associated with the development of SLE in Taiwan.

Objectives To investigate the role of inhibitor of kB-like ( IkBL ) gene polymorphisms in the pathogenesis of rheumatoid arthritis (RA) in Taiwan. Methods One hundred and twenty-nine patients with RA and 110 healthy controls were enrolled in this study. Polymerase chain reaction (PCR)/direct sequencing was used to determine the polymorphisms of IkBL −421 8T/9T, −324 C/G, −262 A/G, and −62 A/T. PCR/restriction fragment length polymorphism was used to determine the IkBL +738 T/C polymorphisms. Results The genotype distribution of IkBL −421 was significantly different between DR4 (+) RA patients and DR4 (+) controls ( p = 0.02). The allele frequency of IkBL −421 8T was significantly higher in DR4 (+) RA patients than in DR4 (+) controls ( p = 0.004, OR = 7.2, 95% CI = 1.7–29.2). The allele carriage frequency of IkBL −421 8T also tended to be increased in DR4 (+) RA patients in comparison with DR4(+) controls ( p = 0.07, OR = 14.6, 95% CI = 1.4–147.0). We also found that the allele frequency of IkBL −62 T was significantly higher in RA patients than in controls ( p = 0.04, OR = 1.5, 95% CI = 1.1–2.1). The allele carriage frequency of IkBL −62 T tended to be increased in RA patients ( p = 0.08, OR = 1.7, 95% CI = 1.0–3.0). The estimated haplotype frequency of IkBL −421 8T/−62 T tended to be increased in RA patients compared with controls ( p = 0.07, OR = 1.4, 95% CI = 1.0–2.0). Conclusion The IkBL −62 T may be associated with the development of RA in Taiwan. The IkBL −421 8T may also be related to susceptibility to RA in HLA-DR4 (+) individuals. This study shows that the estimated haplotype IkBL −421 8T/−62 T tends to be associated with susceptibility to RA in Taiwan.

Oxidative stress triggered by septic insult may be the major cause of multiple organ dysfunction syndrome (MODS) in intensive unit care patients. The inducible form of heme oxygenase-1 (HO-1) can be induced by cytokines, lipopolysaccharide, and reactive oxygen species during sepsis. These facts raise the question of whether the expression of HO-1 in leukocytes can indicate the level of oxidative stress of multiple organs in sepsis. Clinical peritonitis was simulated in an animal model by cecal ligation and puncture (CLP). The level of oxidative stress was examined by plasma lipid peroxidation (LPO). Liver function was analyzed by plasma aspartate aminotransferase, alanine aminotransferase, total bilirubin, and direct bilirubin. Lung function was evaluated by severity of edema. Renal function was measured by blood urea nitrogen and creatinine. The correlation between early HO-1 induction and LPO level or organ functional indicators of the same rat at late sepsis was analyzed by linear regression. The results showed that the protein content of HO-1 increased at 9 h after CLP, whereas expression of HO-1 mRNA in leukocytes was significantly increased (P < 0.01) at 6 h after CLP. Plasma level of LPO and the indices of hepatic, pulmonary, and renal function were significantly increased at 18 h after CLP. Moreover, highly negative correlations were observed between HO-1 mRNA expression at 6 h after CLP and level of LPO or severity of hepatic/renal dysfunction at 18 h after CLP. These results suggest that early HO-1 mRNA expression in leukocytes may represent oxidative stress and may predict the severity of liver and renal dysfunction during sepsis.

The major objective of the present study was to identify biologic and behavioral risk factors of cardiovascular disease (CVD) in the elderly population in Taiwan. It is hypothesized that the selected risk factors are significantly associated with the prevalence of CVD. Data came from a nationwide geriatric survey in 1991. Stratified proportional sampling was used to recruit 2,600 subjects. These were evaluated by family physicians working for the Departments of Family Medicine at four medical centers in four major cities in Taiwan. Univariate and multivariate logistic regression analyses were used to examine the associations between risk factors and the prevalence of CVD. The prevalence of CVD was 38.31%. Patients with CVD consistently had higher values for each selected risk factor except high-density lipoprotein-cholesterol (HDL-C) and glucose concentrations. The findings also indicated that hypertension, hypertriglyceridemia, low HDL-C concentration, ex-drinking status, and overweight were significantly associated with the prevalence of CVD among the elderly in Taiwan. The findings not only confirm the risk factors for CVD, but also invite more attention to be given to the importance of biologic and behavioral risk factors in CVD.

Objective:As there is little understanding of disability processes in Taiwanese elders, the present study aimed to identify medical predictors of the incidence of activities of daily living (ADL) disability. Method:A total of 903 subjects were studied over a 4-year period (1994–1998). The measurement instrument was the Chinese-version Multidimensional Functional Assessment Questionnaire (CMFAQ). Only the subjects free of ADL disability at baseline were included in separate logistic regression models to predict disability in physical and instrumental ADL. Results:The hypothesised associations between chronic conditions and future functional disability were cross-nationally confirmed. Arthritis, diabetes and hypertension were significantly predictive of the onset of physical ADL (PADL) disability; diabetes was the only medical predictor of instrumental ADL (IADL) disability. Age and educational level were significant predictors of PADL and IADL. Conclusions:Prevention programs for chronic disease need to pay more attention not only to the disabled population, but also to secondary prevention among those elders who have higher medical risk of developing disability.

Objective. The expression of autoimmunity in mice deficient in programmed death 1 (PD-1) suggests that PD-1 is a candidate gene involved in the development of human autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). We therefore tested the potential association between PD-1 and the development of SLE and RA by conducting case–control genetic-association studies. Methods. Ninety-eight SLE patients, 84 RA patients, and sex-matched control subjects for each disease group were recruited and genotyped for a single-nucleotide polymorphism, C+872T, in the human PD-1 gene. The significance of the association of the PD-1 gene with SLE or with RA was analyzed by statistical tests for the difference in genotype distribution between disease and control groups. Results. The human PD-1 gene was found to be significantly associated with disease development in RA patients, but not SLE patients. The risk of RA development appeared to be significantly increased by carriage of the T allele (odds ratio 3.32, P < 0.0001) or the C/T genotype (odds ratio 3.52, P < 0.00005). Conclusion. The PD-1 gene is significantly associated with RA susceptibility, suggesting the possibility that PD-1 may contribute to the pathogenesis of RA.

A "y" formed by nine nanoscale recording marks (see Figure) has been made successfully on an organic thin film by applying voltage pulses between a scanning tunneling microscopy (STM) tip and the highly ordered pyrolytic graphite substrate. The average size of the recorded marks is 1.1 nm in diameter, corresponding to a data storage density of similar to 10(13) bits cm(-2). The recording mechanism is discussed according to experiment and calculation.

Objectives: To investigate the association of tumor necrosis factor (TNF) microsatellite alleles with the pathogenesis of rheumatoid arthritis (RA) in Taiwan. Methods: The TNF a, b, c, d, and e microsatellites were determined in 112 patients with RA and 99 healthy controls by using polymerase chain reaction (PCR) and electrophoresis with sequencing gel. All of these patients and controls had known HLA-DR genotypes and TNF-308 polymorphisms. Results: The phenotypic frequency of TNFa9 was significantly higher in DR4(−) RA patients than in DR4(−) controls. However, the phenotypic frequency of TNFb6 was significantly higher in RA patients than in controls in the presence of HLA-DR4. The phenotypic frequency of TNFa3-e1 was significantly lower in DR4(+) RA patients than in DR4(+) controls, while a negative linkage disequilibrium was noted between TNFa3-e1 and HLA-DR4. TNF microsatellite alleles were not related to the prevalences of bone erosion, rheumatoid nodule, sicca syndrome, pulmonary fibrosis, and seropositivity of rheumatoid factor (RF) in patients with RA. Conclusion: The associations of TNF microsatellites with the susceptibility to RA in Taiwan are not completely independent of the HLA-DR associations. The association of TNFb6 with the susceptibility to RA depends on the presence of HLA-DR4, and the correlation of TNFa9 to RA depends on the absence of HLA-DR4. The negative association of TNFa3-e1 with RA may be secondary to the negative linkage disequilibrium between TNFa3-e1 and HLA-DR4. Moreover, TNFb6 and HLA-DR4 have a synergistic effect on the susceptibility to RA. TNFa3-e1 and TNF-308A have a synergistic effect on preventing from RA. The TNF microsatellite alleles are not related to the clinical manifestations and severity of RA patients in Taiwan.

Bloodletting acupuncture is one of the most classic methods of acupuncture therapy, and is still popularly used to treat acute lumbar sprain in the oriental world. However, most physiciants in the western world are not familiar with bloodletting acupuncture, though they may know ordinary acupuncture well. Furthermore based on the literature reviewed, there have been few studies which have investigated the effect of bloodletting acupuncture upon acute lumbar sprain. In this study, we tried to determine if bloodletting acupuncture is effective for acute lumbar sprain. In total, twelve patients were enrolled for analysis. Five patients treated with ordinary acupuncture upon the contralateral SI-3 (Hou-Hsi) point alone. Seven patients were first treated with bloodletting acupuncture to the engorged vein around the ipisilateral Bl-40 (Wei-Chung), and then followed by ordinary acupuncture upon the contralateral SI-3. It was demonstrated that bloodletting acupuncture to the engorged vein around the ipisilateral Bl-40 followed by ordinary acupuncture upon the contralateral SI-3 had more pain relief than ordinary acupuncture upon the contralateral SI-3 alone (83 ± 23% vs. 44 ± 28%) (P < 0.01). And bloodletting acupuncture to the engorged vein around the ipisilateral Bl-40 decreased pain by 56 ± 23%, similar to that of ordinary acupuncture upon the contralateral SI-3 alone (44 ± 28%). These findings suggest that bloodletting acupuncture to the engorged vein around the ipisilateral Bl-40 (Wei-Chung) has a substantial contribution for treatment of acute lumbar sprain.

Background In Taiwan, distributions of body composition are usually generated for children, adolescent, and middle-aged groups. This study describes three anthropometric measures (i.e., height, weight, and body mass index [BMI]) of elderly persons in Taiwan. Methods The data was derived from a prospective cross-sectional, population-based geriatric survey funded by the National Department of Health in Taiwan in 1991. A total of 2,600 subjects were successfully evaluated. A descriptive analysis was performed to generate distributions of height, weight, and BMI of elderly persons. Based on these descriptive data, the prevalence of overweight and obesity was estimated, and a cross-national comparison on the prevalence of obesity was made. Results Age-group-specific means and standard deviations for height, weight, and BMI of Taiwanese elderly persons were presented. By gender, the elderly men were taller and heavier than the elderly women: however, the women had a higher mean value of BMI (kg/m2). The prevalence of overweight was 27.3% in men and 34.9% in women; the prevalence of obesity was 3.2% in men and 6.4% in women. The prevalence of obesity for the elderly men and women in Taiwan was lower than in Kuwait, Sweden, the United States, and the Native Americans, but higher than in Japan. Conclusions The comparison indicates cross-cultural differences existing in the prevalence of obesity, which may be due to aging, nutritional status, or environmental factors. For future research, the relationship of anthropometric data to socioeconomic status and behavioral factors will be examined.

The purpose of this study was to determine the correlation between the prevalence of hepatitis C virus (HCV) infection with duration of drug use and other risk factors among drug users. This survey covered 899 male drug users from Kaohsiung Narcotic Abstention Institute and Kaohsiung prison. The prevalence of positive anti-HCV was 67.2% among intravenous drug users (IVDU) and 14.7% among non-intravenous drug users (non-IVDU). Among intravenous (IV) drug users, age and duration of drug use were independently related to HCV seropositivity. Seroprevalence rate for HCV in the IVDU group increased with increasing duration of injection use within the first seven years of drug use. However, the steepest trajectory in seroprevalence of HCV infection occurred within the first four months. Due to the high rate of HCV infection among drug users, investigation of risk behaviors should be routine in such a group. A high frequency of HCV infection was also found among short-term injectors, which indicated that early risk reduction intervention was an important measure in moderating HCV infection.

Many autoimmune diseases have been reported to be associated with malignancy. Mixed connective tissue disease (MCTD), however, has rarely been associated with malignancy. Thymoma is one of the neoplasms often reported to be related to various immunological disorders. Among the types of thymoma defined by WHO, malignant thymoma (thymoma type C) is the one least reported to be associated with autoimmune disease. Here, we report a case of malignant thymoma with concurrent MCTD, which manifested with acrosclerosis, Raynaud's phenomenon, arthritis (synovitis), and a high titer of anti-ribonucleoprotein antibody.

Serotonin syndrome is a disorder resulting from excess stimulation of serotonin and is associated with drug interaction, single-drug therapy, and overdose. We report a case involving a 32-year-old man who developed sudden agitation, diaphoresis, subjective fever, tremor, and insomnia. These symptoms were related to doubling the dose of citalopram in combination antidepressant therapy. Discontinuation of the agent resulted in early notable clinical resolution after 1 week. This is a rare report of serotonin syndrome induced by citalopram polytherapy. Although serotonin syndrome is rare, clinicians need to recognize it early.

Cytokines are involved in the pathogenesis of autoimmune diseases. Oncostatin M receptor (OSMR) activates JAK/STAT and MAPK pathways leading to the stimulation of a variety of cytokines and inflammatory substances. Many pro-inflammatory cytokines are involved in the inflammatory process of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). In this study, we carried out experiments to examine the relationship of OSMR promoter polymorphisms with RA and SLE patients. 241 patients of RA, 143 patients of SLE and 203 healthy controls were enrolled in their recruitment from the Kaohsiung Medical University Hospital. Genomic DNA was extracted from peripheral blood mononuclear cells and gene polymorphism was genotyped by TaqMan real-time polymerase chain reaction. The OMSR promoter region -100 G/T (rs22922016) genotype was in no relation to the susceptibility of RA, but -100 T/T (rs22922016) genotype could prevent the patients with sicca syndrome and the existence of anti-Ro antibodies. In contrast, the -100 G/T+T/T (rs22922016) genotypes were significantly associated with an increased risk of SLE (odds ratio, OR=1.62, 95% confidence interval (CI), 1.01-2.62). 94.38% of SLE patients with arthritis were belonged to the -1687C/C (rs540558) genotype. The T allele of promoter region -100 T/T (rs22922016) has protective effect and could ameliorate the disease condition in RA patients, whereas the same T allele was a risk allele in the susceptibility of SLE. The disease severity of rheumatoid arthritis and systemic lupus erythematosus can be partially affected by the OSMR promoter polymorphisms.

Aimed at the present maintenance training in the army, the virtual maintenance training system frame of a certain type of power station was designed by using the object model and virtual reality technology. The key technologies to build simulation models based on NGrain were studied, and the virtual maintenance training system was developed finally. Results show that the system has lots of advantages such as multiple training modes, friendly operation and low requests to hardware.

Since more and more complex or intelligent power electronic devices have been equipped, mobile power stations are more sensitive to overvoltage caused by lightning. The electromagnetic transient model of the mobile power station was built by PSCAD/EMTDC. After analyzing the faults induced by lightning overvoltage, a deep study of the simulation model was carried out to find the acting principles in power electronic devices and components. From simulation results we find out several laws to raise the lightning with-standing level of power stations concerning influencing factors such as the grounding resistance, SPD, etc‥ Aimed at the direct striking and the inducing lightning the key parts of mobile power stations were decided to take some innovation measures correspondingly. In the last, a modularized device was designed and equipped for the power station.

With the aim of investigating the role of suppressor of cytokine signaling 1 (SOCS1) in the pathogenesis of systemic lupus erythematosus, 107 patients with systemic lupus erythematosus, 101 healthy controls, and 151 patients with ankylosing spondylitis were enrolled in this study. SOCS1 mRNA level was measured by the method of quantitative real-time polymerase chain reaction. SOCS1 polymorphisms were detected by the polymerase chain reaction/restriction fragment length polymorphisms method. Systemic lupus erythematosus disease activity was evaluated with the SLEDAI. This study showed that the SOCS1 mRNA expression was significantly higher in the patients with systemic lupus erythematosus than in the healthy controls (p = 0.0014). Patients with active systemic lupus erythematosus had a higher expression of SOCS1 mRNA than the patients with inactive systemic lupus erythematosus (p = 0.035). There was no significant difference in the frequencies of the SOCS1-1478CA/del polymorphisms among the patients with systemic lupus erythematosus, healthy controls, and patients with ankylosing spondylitis. The genotype frequency of the SOCS1-1478 polymorphisms in the dominant model (CA/del+del/del versus CA/CA) was significantly decreased in the patients with thrombocytopenia compared with those without thrombocytopenia (pc = 0.035). Moreover, the allele frequency of SOCS1-1478del was also significantly lower in the patients with thrombocytopenia than in those without thrombocytopenia (p c = 0.02). In conclusion, this study demonstrated that the expression of SOCS1 mRNA was significantly increased in patients with systemic lupus erythematosus. Moreover, SOCS1 mRNA levels in patients with active systemic lupus erythematosus were significantly higher than those in the inactive patients. We also found that the systemic lupus erythematosus patients with thrombocytopenia have a lower frequency of SOCS1-1478del compared with patients without thrombocytopenia. Lupus (2010) 19, 696—702.

We describe a female aborigine from Taiwan with alpha-chain disease associated with multiple polypoid intestinal lymphocytic lymphoma and leukemic manifestation. Initially, the patient experienced intermittent diarrhea, abdominal pain, and leukemic manifestation. No evidence of bone marrow involvement was found. Alpha-chain protein was demonstrated in the serum. Gastroendoscopy and a series of radiographs of the small intestine revealed multiple polypoid tumors involving the entire length of the small intestine. Duodenal biopsy showed diffuse lymphocytic lymphoma. Immunohistochemical staining of tumor samples revealed features typical of alpha-chain disease. Cytogenetic analysis showed the same abnormal karyotypes of neoplastic clones in intestinal tumor cells and in circulating leukemic cells. The data suggest that alpha-chain disease can present initially with intestinal multiple polypoid lymphocytic lymphoma and leukemic manifestation without evidence of bone marrow involvement. The data also support the homing theory of lymphomas from mucosa-associated lymphoid tissue. © 1992 Wiley-Liss, Inc.

The purpose of this study is to investigate the association of IκBα with the development of ankylosing spondylitis (AS) in Taiwan. One hundred and fifty-four patients with AS and 112 unrelated healthy controls were enrolled in this study. The IκBα-881A/G, -826C/T, -550A/T, -519C/T, and -297C/T polymorphisms were determined by the polymerase chain reaction/restriction fragment length polymorphism method. This study demonstrated that the genotype frequencies of IκBα-826C/T and -826T/T, and allele frequencies of IκBα-826T were significantly higher in the patients with AS than in the controls. We also found that the estimated haplotype frequencies of IκBα-881A -826T -550A -519C -297C and IκBα-881A -826C -550A -519T -297C were significantly increased in the patient with AS in comparison with that of the controls. In contrast, the estimated haplotype frequency of IκBα-881A -826C -550A -519C -297C was significantly decreased in the patients with AS. This study demonstrates that IκBα-826T is associated with the development of AS. Furthermore, the IκBα-881A -826T -550A -519C -297C and IκBα-881A -826C -550A -519T -297C haplotypes are related to susceptibility to AS in Taiwan.

Background/Purpose: Longitudinal data on bone decline for Chinese elderly people are sparse, especially for the healthy aged male. We report the longitudinal change in bone mineral density (BMD) at the femoral neck, great trochanter and Ward's triangle in healthy older Taiwanese men. Methods: A prospective cohort study was conducted. We screened 1500 subjects aged ≥ 65 years. One hundred and seventy men were eligible for hip evaluation, and 167 had hip BMD measured. Two years later, 142 men completed follow-up BMD measurement. Linear regression was performed between aging and bone loss. Paired t test was used to determine changes in BMD between the intervals. Results: In the initial study, subjects showed significant bone loss through aging by linear regression at all three sites (p < 0.001). Two years later, there was a significant decrease in BMD at all three sites (p < 0.001). For the age cohort, all the age groups showed a significant decrease in BMD at the three study sites (p < 0.05), except those aged ≥ 75 years at Ward's triangle (p = 0.667) and the great trochanter (p = 0.1). There was a peak loss of BMD in men aged 65–69 years, as high as 5.57% annually at Ward's triangle. Conclusion: BMD was negatively related to aging in healthy men. The loss of BMD in the 65–69 years age group was faster at Ward's triangle than at other sites. Bone loss in Chinese men is of concern because it is greater than in Caucasian men.

To evaluate the significance of natural killer (NK) cell activity in the clinical assessment of patients with hepatocellular carcinoma (HCC), 32 patients combined with liver cirrhosis (LC) and HCC, and 29 LC patients were studied. The NK cell activity was markedly decreased in HCC patients and the LC group as compared with the control group, but there was no statistical difference between the NK cell activity of the HCC group and the LC group. The depression of NK cell activity in HCC patients was inversely correlated with the patient's age, and the HCC patients with venous invasion or with both lobes involved had lower NK cell activity. These results suggest that the decreased NK cell activity in HCC patients might be related to the coexistent liver disease, and marked decrease in NK cell activity might be one of the causes for the early development and invasion of HCC.

To search for an effective antiviral agent, this study tested the hypothesis that sho-saiko-to (Xiao-Chai-Hu-Tang) and crude saikosaponins possess the activity directly against HBV and could affect the expressions of viral antigens, HBeAg and HBsAg, in HepG2 2.2.15 cell model. The viral amount and viral antigens in the suspension were estimated by quantitative real time PCR and enzyme-linked immunosorbent assay (ELISA), respectively. The results showed that sho-saiko-to could inhibit the production of HBV (p < 0.0001), 20 μg/ml sho-saiko-to was efficacious at day-3 of treatment and 10 μg/ml at day-6. The calculated IC50 and CC50 of sho-saiko-to were 55.76 μg/ml and 372 μg/ml, respectively, with a selectivity index of 6.67. Crude saponin of B. chinense could also inhibit the replication of HBV (p < 0.0001). Owing to the anti-neoplastic activity of sho-saiko-to and saikosaponin, their calculated CC50 and selectivity index might be under-estimated. Sho-saiko-to also decreased the expression of HBeAg with the minimal effective concentration of 20 μg/ml. Sho-saiko-to contained too little saikosaponin. Therefore, the anti-HBV activity of sho-saiko-to might not be mediated by saikosaponin. Sho-saiko-to could be supplementary to nucleotide analogues to minimize the recurrence of viremia after its discontinuation.

The uncommon allele (TNF2) of a polymorphism in the promoter region of the tumor necrosis factor-alpha (TNF-alpha) gene has been reported to be increased in Caucasian systemic lupus erythematosus (SLE) patients (associated with HLA-DR3). To investigate whether TNF2 contributes towards susceptibility to Chinese SLE patients (not associated with HLA-DR3), 100 patients with SLE and 107 controls were studied. The frequency of TNF2 allele in controls was 0.140. There was a strong association between TNF2 allele and HLA-DR3 (P10(-8)) in controls. The frequency of TNF2 allele in SLE patients was 0.15. There was no difference in frequencies of TNF2 allele between patients and controls. This finding strongly suggests that TNF2 does not play a direct role in the susceptibility of SLE.

Rheumatoid arthritis is a systemic disease with manifestations in many organs. In most cases, involvement of the locomotor system dominates the clinical picture. However, extra-articular manifestations can be detected in almost any organ system with varied incidence in different series. Ophthalmic presentations include Sjogren's syndrome, episcleritis, and scleritis. The most severe form of scleritis, scleromalacia perforans, is a very rare ophthalmic manifestation. We present the case of a 60-year-old man who had had rheumatoid arthritis for more than 10 years. He had scleromalacia perforans but no other extra-articular manifestations.

Hypertrophic osteoarthropathy (HOA) is characterized by clubbed fingers and periosteal new bone formation. Etiologically, it can be divided into primary and secondary HOA, but its pathogenesis is uncertain. We report a 42-year-old male patient who suffered from painful clubbing fingers and toes. Serial examinations revealed periosteal new bone formation in the four limb long bones and a solid mass lesion in the right upper lung field. Pathologic examination of the resected mass lesion showed squamous cell carcinoma. After surgery and chemotherapy, the severity of clubbed fingers decreased and joint pain improved. Follow-up bone scan also suggested regression of the uptake of radioactivity in the four limb bones. We concluded that the HOA in this case was probably caused by lung cancer.

An investigation was conducted to measure the levels of erythrocyte complement receptor type 1 (CR1) in patients with various rheumatic diseases other than systemic lupus erythematosus, and to evaluate the clinical significance of this receptor in patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Erythrocyte CR1 was measured in 37 normal controls and 106 patients with various rheumatic diseases. The levels of erythrocyte CR1 decreased significantly in patients with AS, juvenile rheumatoid arthritis, Sjogren's syndrome, and RA, while there was no statistical difference in levels of erythrocyte CR1 between normal controls and patients with gouty arthritis. This suggests that erythrocyte CR1 deficiency may occur in immune-mediated rheumatic diseases, but not in nonimmune-mediated rheumatic diseases such as crystal-induced arthritis. In this study, we noted that the levels of erythrocyte CR1 were not related to the disease activity and severity of AS. The levels of erythrocyte CR1 were also not correlated with the clinical and laboratory parameters of disease activity in RA patients. However, there was a negative association between the levels of erythrocyte CR1 and titer of rheumtoid factor in RA patients. Further study is needed to determine whether or not the level of erythrocyte CR1 is related to prognosis in patients with RA.

Coke oven and by-product workers are potentially exposed to coke oven emissions (COE), which contain hundreds of chemicals and are primarily composed of polycyclic aromatic hydrocarbons (PAH) and volatile organic compounds. Some of these compounds are hepatotoxins. The objective of this study was to examine the relationship between work in coke oven and by-product plants and serum activities of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), the most commonly performed liver-function tests. The exposed group was composed of current workers who had been employed at least 3 months in the two coke-operation work areas, including one coke oven plant and one by-product plant (Area I: n = 117; Area II: n = 96) of a large steel company in Taiwan. Control subjects (Area III: n = 131), not visiting either coke-operation area in the last 3 months, were collected from the administrative and nonproduction areas in the same company. PAH exposure, as a surrogate of COE, was measured monthly by PM-10 size-selective high-volume-area air samplers in or around these three areas between June and December 1990, as well as between November 1992 and June 1993. The mean total respiratory particulate PAH exposure levels (10 microns) between November 1992 and June 1993 in Area I, II, and III were 6.8 x 10(3), 2.1 x 10(3), and 6.5 x 10(1) ng/m3, respectively. AST, ALT, and hepatitis B surface antigen tests were performed in 1994. Workers who showed either AST or ALT levels greater than reference levels (abnormal25 IU/L) were regarded as showing "elevated liver enzyme levels." Workers in Area I had AST levels that were 17% higher (95% confidence interval [CI], 3% to 32%]) and ALT levels that were 35% higher (95% CI, 10% to 65%)] than those in Area III after controlling for appropriate confounders. The adjusted odds ratio (Area I vs Area III) for elevated liver enzymes was 4.4 (95% CI, 1.5 to 13.4). In addition, coke oven (n = 91) and by-product workers (n = 26) from Area I had ALT levels 37% and 45% higher, respectively, compared with control subjects from Area III, after adjusting for appropriate confounders. Similar effects are also seen for AST. Workers in Area II had slightly, but not significantly, elevated AST and ALT levels. These results indicate that workers most heavily exposed to COE exhibit elevated aminotransferase levels.

Background and Purpose We investigated the influence of alcohol consumption and cigarette smoking on all types of stroke and cerebral infarction, in particular among a representative sample of elderly residents in Taiwan. Methods This study was a component of a nationwide survey of health and living status of residents aged 65 years or older in Taiwan in which subjects received detailed physical, neurological, and laboratory examinations. Inquiries were made about medical history, and information on the amount and duration of drinking and smoking was obtained. Diagnoses of stroke were made according to the results of brain computed tomography at the onset of disease or were based on criteria established by the World Health Organization. Results Of the 2600 subjects, there were 155 elderly persons with stroke (prevalence, 6%). Excessive drinking of more than 367.6 g/wk of alcohol was associated with a high prevalence of cerebral infarction. Consumption of ≤367.5 g/wk of alcohol did not have an influence on stroke prevalence. The relationship between duration of alcohol drinking and stroke was equivocal. More than 30 pack-years of cigarette smoking was a significant risk factor for all types of stroke and cerebral infarction in particular. Using multiple logistic regression to control for possible confounders, it was found that smoking was an independent risk factors for all stroke and was of borderline significance for cerebral infarction. Although excessive drinking was a significant risk factor for cerebral infarction in univariate analysis, this effect was lost after adjustment for other confounders. Conclusions Cigarette smoking was a more important risk factor for stroke and cerebral infarction than excessive drinking of alcohol.

Excessive lead exposure in indoor firing ranges workers is a documented hazard (1-3), but the incidence has not previously been reported in Taiwan. Eight indoor range workers with elevated blood lead levels employed by an arsenal were discovered during routine medical examination. Two of the cases show mild anemia and two of the cases show early mild peripheral neuropathy.

Systemic lupus erythematosus (SLE) is an important autoimmune disease with multiple organ system involvement. From preliminary studies, we have found that six Chinese herbs: Atractylodes ovata, Anqelica sinensis, Cordyceps sinensis, Liqustrum lucidum, Codonopsis pilosula and Homo sapiens can improve defective in vitro interleukin-2 (IL-2) production in patients with SLE. In order to investigate the in vivo effects of these herbs, we used NZB/NZW F1 mice, a typical lupus animal model used to test these herbs. It was found that C. pilosula, H. sapiens and C. sinensis could prolong the life span of female NZB/NZW F1 mice and inhibited anti-ds DNA production. Although A. sinensis could prolong the life span of experimental mice, it did not inhibit the production of anti-ds DNA antibody. These herbs may have great potential for the management of human SLE in the future.

To evaluate the role of severe liver damage on natural killer cell activity, 29 patients with liver cirrhosis were examined. The natural killer cell activity was measured with a 4-hr chromium release assay, and the K562 cell line was employed as target cells. The natural killer cell activity was significantly decreased in cirrhotic patients compared with normal controls and patients with chronic active hepatitis. Cirrhotic patients with Pugh's C grade of severity of liver disease had lower natural killer cell activity. The depression of natural killer cell activity in cirrhotic patients was inversely correlated with prothrombin time ratios, and the natural killer cell activity in cirrhotic patients with hepatic encephalopathy was lower than in patients without hepatic encephalopathy. Thus, the diminished natural killer cell activity in cirrhotic patients might be related to the severity of liver damage.

The National Health Insurance (NHI) and social welfare agencies have implemented the Elderly Health Examination Program (EHEP) for years. No study has ever attempted to evaluate whether this program is cost-effective. The purposes of this study were, firstly, to understand the prevalence and incidence rates of hypertension and, secondly, to estimate the cost and effectiveness of the EHEP, focusing on hypertension screening. The data sources were: (1) hypertension and clinical information derived from the 1996 and 1997 EHEP, which was used to generate prevalence and incidence rates of hypertension; and (2) claim data of the NHI that included treatment costs of stroke patients (in- and outpatients). Hypothetical models were used to evaluate the cost-effectiveness of the hypertension screening program in various conditions. Sensitivity analysis was also employed to evaluate the effect of each estimation indicator on the cost and effectiveness of the hypertension screening program. A total of 28.3% of the elderly population in Kaohsiung (25,174 of 88,812) participated in the 1996 EHEP; 14,915 of them participated in the following 1997 EHEP, with a retention rate of 59.3%. Criteria from the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) (systolic blood pressure/diastolic blood pressure>or=160/95 mmHg or taking antihypertensive drugs) were used; we found that prevalence and incidence rates of hypertension were 24.6% and 6.6%, respectively. Hypertension rates are increasing in the aging process as shown in both prevalence and incidence models. In comparison with non-participants, the prevalence model indicates that each hypertension patient who had attended the EHEP not only saved NT$34,570-34,890 in medical and associated costs, but also increased their lifespan by 128 days. The present findings suggest that the EHEP is a cost-effective program with health and social welfare policy implications. With the relatively low participation rate of the EHEP, health and social agencies need to put more effort into the promotion of this free health examination program to attract potential participants. In doing so, the population at risk for hypertension would be identified for early treatment, and the probability of having stroke could be decreased. Consequently, health care expenditures for treatment and caregiving of stroke patients would be minimized. Finally, it should be noted that the sensitivity and values of selected parameters can modify the results of cost-effectiveness analysis. Interpretations of the effects of prevention services on costs and effectiveness need to be treated with caution.

Antiphospholipid syndrome (APS) is an antibody-mediated hypercoagulable state characterized by recurrent venous and arterial thromboembolic events. The presence of serum antibodies are collectively termed as antiphospholipid antibodies (aPL) and is the hallmark of the disease. Interest in the pathogenesis has mostly been focused on the blood coagulation factor. However, endothelial cells might play an important role. When stimulated, cell membrane would flip to expose negatively charged phospholipids and activation markers such as adhesive molecules may appear. We consider that these changes may play an important role in the initiation of the thrombotic process when endothelial cells encounter a PL. In this study, we incubated human umbilical vein endothelial cells (HUVECs) with IgG isolated from patients with APS and found that the HUVECs were activated by the expression of negatively charged phospholipids, as shown by high annexin V binding and negative propidium iodide staining and by an increase in the level of intracellular cell adhesion molecule-1 on the cell surface. The above findings indicate that endothelial cells can be activated on exposure to aPL and trigger the thrombotic event.