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Enhanced hemodynamics via geometric alteration is believed to play a role in the favorable redistribution of intimal hyperplasia (IH) in infragenicular supplementary vein cuffs. We aimed to elucidate the consequence of altering geometric configuration in anastomotic hemodynamics in cuff models. A well-validated numerical scheme was used to simulate pulsatile flows in three cuffed anastomotic models with length-to-height ratio (LHR) of 1.4, 2.2 and 3.2, and a St. Mary's boot with LHR of 2.2 at a mean flow rate of 130 mL/min. Characteristic flow patterns and wall shear stress (WSS) distributions were compared. A cohesive vortex is only present in the cuff of LHR = 1.4 and in the boot. The vortex in the cuffs becomes increasingly disorganized with increasing cuff LHR. The area of flow separation at the graft toe, prominent in the cuff of LHR = 3.2, is significantly reduced in the cuff of LHR = 1.4 and eliminated in the boot. All cuffs are characterized by flow separation, flow reversal and a sharp drop in WSS immediately distal to the cuff toe, phenomena not observed in the boot. The cuff configuration, specifically the LHR, is critical in controlling local hemodynamics. A large LHR could lead to reduced cuff performance. The study suggests the benefits of geometric optimization for reconstruction of cuffed anatomoses.

There are four themes in this teaching exercise for Professor McCance. The first challenge was to explain how a premature infant with Bartter's syndrome could survive despite having such a severe degree of renal salt wasting. Second, the medical team wanted to know why there was such a dramatic decrease in the natriuresis in response to therapy, despite the presence of a permanent molecular defect that affected the loop of Henle. Third, Professor McCance was asked why this patient seemed to have a second rare disease, AQP2 deficiency type of nephrogenic diabetes insipidus. The fourth challenge was to develop a diagnostic test to help the parents of this baby titrate the dose of indomethacin to ensure an effective dose while minimizing the likelihood of developing nephrotoxicity. The missing links in this interesting story emerge during a discussion between the medical team and its mentor.

This study was carried out to develop a two-layered finite element model of the oesophagus. The outer muscle and inner mucosal layer were constructed individually with different mechanical properties and zero-stress opening angles. With the model, two simulations were performed. First, the distention of oesophageal wall under the pressurized state was investigated, from which the effects of residual strains on the stress distribution were evaluated. Second, the buckling modes were determined using a linear eigenvalue analysis. The self-contact capability in ABAQUS was applied to simulate the folding of mucosa under the muscle contraction. The first simulation indicated that, by taking the residual strains into account, the mucosa undertook a very small portion of stress and the luminal pressure almost transmitted completely to the outer muscle layer. On the other hand, the folding of mucosa was shown to be able to reduce the contractile force of circular muscle to maintain the lumen closure. In conclusion, the preliminary study demonstrated the feasibility of simulating the oesophageal peristaltic transport using finite element analysis.

Blackfoot disease (BFD) is an endemic peripheral arterial disease confined to the southwestern coast of Taiwan. The cause of the disease has been ascribed to the high-arsenic artesian well water. The purpose of this study was to examine the possible association between the long-term exposure to artesian well water and the change in microvascular circulation in the absence of peripheral arterial insufficiency. A total of 45 men living in the BFD-hyperendemic villages and another 51 age- sex- body-mass index-matched men who lived in nonendemic villages nearby were recruited into this study. All subjects were free from peripheral vascular disease (resting ankle-brachial index1.00), clinical claudication, cigarette smoking, diabetes mellitus, hypertension, ischemic heart disease, cerebral infarction and obesity. Laser Doppler flowmetry was used to measure the peripheral microcirculation on the big toes both at 36 degrees C (basal perfusion, Pb) and after a hyperthermic test at 42 degrees C (Ph). The time required to reach Ph (T), and the average rate (R) of increase from Pb to Ph measured by (Ph-Pb)/T were also calculated. Results showed that those living in the BFD-hyperendemic area had a lower Pb [32.8 +/- 6.0 perfusion units (PU) vs. 67.0 +/- 4.3 PU, p0.001], a lower Ph (193.2 +/- 13.6 vs. 231.1 +/- 6.3 PU, p0.005), a longer T (3.04 +/- 0.19 vs. 1.31 +/- 0.08 min, p0.001) and a slower rate of increase from Pb to Ph (48.0 +/- 4.8 vs. 76.2 +/- 5.4 PU/min, p0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Background: Metabolic syndrome (MS) and chronic kidney disease (CKD) are both strongly associated with coronary artery disease (CAD). Components of MS also cause CKD. The incremental effect of CKD on CAD prevalence in MS patients referred for stress imaging studies is unknown. Methods: From January to December 2005, consecutive subjects referred for a stress imaging study were prospectively enrolled. CAD was defined as fixed or reversible defects on nuclear imaging and as resting or stress-induced wall motion abnormalities on echocardiography. MS was defined using NCEP-ATP III criteria. CKD definition was based on calculated glomerular filtration rate. The independent effect of CKD on stress results was assessed using multiple variable logistic regression. Stepwise model selection was used for variable reduction, and areas under the receiver operating characteristic curves (ROC) were calculated. Results: Of 1,122 patients enrolled (mean age 61.4 years, 97% male), 535 (47%) had MS. Among MS patients, 156/535 (29%) had CKD while 116/587 (19%) subjects without MS had CKD. Subjects with CKD were older (p < 0.001) in subjects with and without MS. The presence of CKD affected prevalence of CAD in the non-MS group only, almost doubling it (20% vs. 38%, p < 0.001). Further, using the ordered nature of the 5 CKD stages, worsening severity of CKD had greater prevalence of CAD, in non-MS subjects only (p < 0.001). Conclusions: MS attenuates the effect of CKD on CAD prevalence, regardless of CKD severity. CKD almost doubles the prevalence of CAD in non-MS subjects. CKD severity is associated with greater CAD burden in the non-MS group.

In April 2004, an outbreak of acute diarrheal illness occurred among the Orang Asli (aborigine) in the Cameron Highlands, Pahang State, Peninsular Malaysia, where rotavirus was later implicated as the cause. In the course of the epidemic investigation, stool samples were collected and examined for infectious agents including parasites. Soil transmitted helminthes (STH), namely Ascaris lumbricoides (25.7%), Trichuris trichiura (31.1%) and hookworm (8.1%), and intestinal protozoa, which included Giardia lamblia (17.6%), Entamoeba histolytica/E. dispar (9.4%), Blastocystis hominis (8.1%) and Cryptosporidium parvum (2.7%), were detected. Forty-four (59.5%) were infected with at least one parasite, 24 (32.4%), 12 (16.2%) and 8 (10.8%) had single, double and triple parasitic infections, respectively. STH were prevalent with infections occurring as early as in infancy. Giardia lamblia, though the most commonly found parasite in samples from symptomatic subjects, was within the normally reported rate of giardiasis among the various communities in Malaysia, and was an unlikely cause of the outbreak. However, heavy pre-existing parasitic infections could have contributed to the severity of the rotavirus diarrheal outbreak.

Background The effect of traditional risk factors on the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and stroke was rarely studied previously. We investigated such effect in Taiwanese type 2 diabetic patients. Materials and methods A total of 872 (422 men and 450 women) patients aged 63·5 (SD: 11·6) years were recruited. Among them, 92 cases (48 men and 44 women) had stroke. Polymerase chain reaction was used to classify the genotypes as II, ID and DD. Analyses were performed in separate sexes. Results The adjusted odds ratios for stroke for ID vs. II and DD vs. II were 0·837 (0·413–1·697) and 1·778 (0·596–5·300), respectively, for men; but were 1·700 (0·824–3·505) and 3·706 (1·375–9·985), respectively, for women. In models assuming recessive (DD vs. II + ID), dominant (DD + ID vs. II) and additive (II = 0, ID = 1 and DD = 2) transmission, none of the odds ratios was significant for men; but were all significant for women: 2·784 (1·137–6·818), 1·996 (1·006–3·962) and 1·877 (1·155–3·050), respectively. In models using patients without risk factors (hypertension, obesity, smoking or dyslipidaemia ) as a referent group and comparing them to patients with the risk factor and with ID/II, and with DD genotypes, all models (except for smoking) favoured an increasing trend of risk with patients having the risk factor and DD genotype at the highest risk in women. Similar trends for hypertension and dyslipidaemia were also observed in men. Conclusion Traditional risk factors play an important role in the association between the ACE genotypes and stroke. Patients with DD genotype and having traditional risk factors are at the highest risk.

Portal venous gas is a well-established radiological finding in neonates. With the advancement in diagnostic imaging, more cases are being reported in adults. We present a 55-year-old man with radiological findings of both portal venous gas and pneumatosis intestinalis secondary to ischaemic necrotising enterocolitis, with subsequent fatality. The significance of finding portal venous gas and its possible aetiology is discussed.

Epidemiological evidence shows an increasing prevalence of type 2 diabetes in Taiwan. The aim of this study was to assess the yearly incidence for this country during 1992-1996.Data obtained by telephone interviews of 93,484 diagnosed diabetic patients enrolled in Taiwan's National Health Insurance programme formed the basis of this study. A total of 36,153 incident cases of type 2 diabetes (17,097 men and 19,056 women) were identified and incidence rates calculated. The trends of obesity and parental diabetes were also evaluated.The overall 5-year incidences for men and women were 187.1 and 218.4 per 100,000 population, respectively. The trends from 1992-1996 were increased for all age groups in men and for most age groups in women. A 2.8-fold increase in incidence was observed for the youngest age group (35 years), in which the increase in incidence was higher than in the older age groups. Men showed a higher fold increase in incidence than did women (3.5 vs 2.1). Obesity at interview increased from 39.2% in 1992 to 47.6% in 1996 (p0.001) and was significant for all ages. Parental diabetes showed no yearly change when all patients were analysed together, but there was a trend towards a decrease in the youngest age group (35 years) and a trend towards an increase in the oldest age groups (/=55 years).An increasing incidence of diagnosed type 2 diabetes was observed for each sex in most age groups in Taiwan, but was most marked in the youngest age group. A parallel increase in obesity was observed with the increasing incidence of diabetes.

We report a rare case of gastrointestinal tumor of the anus with an unusual presentation as a perianal lipoma. A 65-year-old man presented with a 2-month history of a painless perianal lump clinically resembling a perianal lipoma. Endoanal ultrasonography revealed a 3 x 3 cm2 mass in the intersphincteric plane. Following initial excision of the lesion, histological analysis revealed a stromal lesion comprising fascicles of spindle cells with a mitotic count of 4 per 50 x high power field. Immunohistochemical analysis displayed positive reactivity for CD34 with focal staining for CD117; S100, smooth muscle actin and desmin were not expressed. No evidence of local or distant metastatic disease was found on computed tomography of the abdomen and pelvis. The patient subsequently underwent abdominoperineal resection. The resected specimen contained a mural nodule measuring 0.7 cm, located 5 cm from the distal margin and 2 mm from the radial margin. Histological analysis confirmed a stromal tumor composed of spindle cells with mitoses up to 2 per 10 x high power field. The patient's recovery was uneventful and he was free of recurrence at the 1-year follow-up. Gastrointestinal stromal tumors of the anal canal are an extremely rare occurrence, and may mimic benign perianal lesions. Tumor size and mitotic count are the most important factors in prognosticating outcome. Oncologic resection and protracted follow-up must factor in their predilection for late recurrence and metastatic spread. The role of adjuvant therapy with STI571 here remains to be clearly defined.

Endogenous endophthalmitis is an inflammation of ocular tissues that can lead to deterioration of and loss of vision. Rarely, this can complicate the course of a patient with pyogenic liver abscess.Over an 18-month period, 68 patients were treated for pyogenic liver abscesses. Three patients, all of whom were male and with diabetes, were diagnosed with a Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis. Open surgical or percutaneous drainage of the liver abscess was undertaken and the symptomology and outcome of the endophthalmitis reviewed.There was no mortality in our series. Two patients presented with simultaneous abdominal and ocular symptoms and one patient had ocular symptoms 3 days after surgical drainage of the liver abscess. Despite aggressive treatment, all patients had permanent deterioration of visual function with one patient becoming blind and requiring evisceration of the infected eye.Ocular symptoms in patients treated for pyogenic abscesses must be dealt with urgently with an ophthalmologic consultation. Increased awareness of this complication and a high index of suspicion are paramount for salvage of visual function.

Twenty-two displaced talar neck fractures were treated by open reduction and internal fixation. Four open fractures were operated within 8 hours and 18 closed injuries were treated at an average interval of 13.8 hours after injury. Fractures were classified according to Hawkins' classification into 14 type II, 7 type III and 1 type IV. At an average follow up of 4.4 years, 18 cases obtained excellent or good results. Result was fair in 2 cases of delayed union and 1 case of avascular necrosis. Another case of avascular necrosis developed osteoarthritis of the ankle and had poor result. The overall incidence of avascular necrosis of the body of the talus was 9%.

The design and development of a simulator for endovascular repair of abdominal aortic aneurysm (AAA) is described. The simulator consists of an interchangeable model of a human AAA based on computed tomography data and is produced by means of computer-aided design and manufacture (CAD/CAM) techniques. The model has renal, iliac, and femoral arteries, and is perfused with a temperature controlled blood–analog fluid under simulated physiological flow conditions. “Fluoroscopic imaging” is simulated by a computerized imaging system that uses visible light. A movable video camera relays images in the antero–posterior and lateral planes of the AAA to a monitor. The imaging system allows “arteriography” and “road-mapping” to be performed so as to facilitate accurate deployment of endovascular stent-grafts. The system has been used for teaching and demonstrating endovascular techniques to clinicians, as well as the evaluation of new stent-graft devices. Its successful incorporation into endovascular workshops has demonstrated its role in the training of clinicians in endovascular repair of AAA. © 1998 Biomedical Engineering Society.

Two cases of carbon monoxide poisoning involving 3 victims occurred in Cameron Highlands in the months of August and September 1995. Two of the victims were found dead in the bathrooms where they were taking a bath while the other one survived. Blood toxicology from the post mortems revealed high levels of carbon monoxide. The only significant source of carbon monoxide in both cases were the gas water heaters which were installed in the bathrooms. A multigas detector was used to monitor the level of carbon monoxide in one of the bathrooms and carbon monoxide was found to be produced to 1200 ppm in 16 minutes during operation of the heater. Carbon monoxide poisoning from gas water heaters installed in bathroom is a significant hazard.

To investigate the nature of exposure factors, and effectiveness of countermeasures in head injuries in children and adolescent of Taiwan area, we conducted a retrospective study on 820 children and adolescents with head injuries consecutively admitted to Chang Gung Memorial Hospital from January 1985 to December 1989. We analyzed the data by chart review and divided the cases into four age-groups: group A (0-4 years old), group B (5-9 years old), group C (10-14 year old) and group D (15-17 years old). The boy to girl ratio was 2.43. The largest proportions of head injuries were the adolescents in group D. The most common cause of head injury was traffic accidents (74%); while the falls were contributed the main cause in other studies. In all group A, B and D, the majority of traffic accidents were pedestrian injury; while in group D, the motorcyclists or car drivers were responsible for the accidents. Fall from height was the major cause of fall in all four age-groups, but it was fall from bicycle or during play or sports in group C. Injuries were most common in summer and clustered at afternoon in all patients. Majority of head injuries occurred outdoors. Most children and adolescents suffered from mild head injury, but there were still 203 cases with severe head injury (24%). Eighty-one cases (9.9%) were either discharged in critical condition or died at the hospital. There were no significant differences in mortality among four age-groups.

To evaluate the relationship of body composition with physical activity and other anthropometric factors, a group of 437 healthy Chinese men and women were recruited. Body composition was measured using the bioelectric impedance technique. Levels of physical activity (LPA) were classified as light, moderate and heavy. Anthropometric factors evaluated included body mass index (BMI), ponderal index (PI), waist-to-hip ratio (WHR), triceps skinfold thickness (TSF), mid-arm circumference, mid-forearm circumference, arm muscle circumference (AMC) and arm muscle area (AMA). Sex was found to be highly associated with body composition, with females having a higher percentage of body fat and males having a higher percentage of body lean mass. This gender difference was independent of age, physical activity or other anthropometric factors. An increased level of physical activity was associated with higher body lean mass and lower body fat. Sex, LPA, TSF, PI and WHR were all entered into the regression equations to estimate body composition. Sex and physical activity have an independent effect on body composition and the commonly used estimators for adiposity and fat distribution such as BMI, PI, TSF and WHR are closely correlated with body composition.

The purpose of this study was to evaluate risk factors associated with peripheral vascular disease (PVD) in patients with non-insulin-dependent diabetes mellitus (NIDDM). A group of 100 patients (50 men and 50 women) aged 50 years or over with PVD and another group of 200 age-sex-matched patients (100 men and 100 women) without PVD were studied. The mean +/- standard error of ages for subjects with and without PVD were 60.8 +/- 0.6 years and 59.7 +/- 0.3 years, respectively. Doppler ultrasound was used to measure the systolic pressures of the brachial, posterior tibial and dorsal pedal arteries bilaterally. The diagnosis of PVD was made by an ankle-brachial index (ABI)0.90 and the diagnosis of non-PVD by an ABI1.00. The association of PVD with diabetic duration, body mass index (BMI), cerebral infarction (CI), coronary heart disease (CHD), proteinuria, diabetic retinopathy, neuropathy, hypertension, and cigarette smoking was evaluated. In addition, biochemical data including fasting plasma glucose, hemoglobin (HD)Alc, cholesterol, triacylglycerol, high- and low-density lipoprotein cholesterol, uric acid, blood urea nitrogen (BUN) and creatinine (Cr) were studied. In univariate analysis, PVD was associated with an increased level of systolic blood pressure (SBP), BUN and Cr, cigarette smoking, CI, CHD, proteinuria and retinopathy. In stepwise logistic regression analysis, the level of SBP, cigarette smoking and CI remained statistically significant. The log odds of PVD could be expressed as: -2.834 + 0.013 (SBP in mmHg) + 0.577 (cigarette smoking) + 1.320 (CI). PVD is the result of aggregation of atherosclerotic risk factors; among those factors noted in this study, SBP, cigarette smoking and CI are important.

In this study, we evaluated the correlation of four types of hand strength (hand grip, tip pinch, palmar pinch and key pinch) with age, sex, body weight, body height, body mass index, triceps skinfold thickness, mid-arm circumference and mid-forearm circumference in a group of 437 Chinese adults (195 men and 242 women) who ranged in age from 28 to 78 years. All of the hand strengths studied correlated positively with gender, body weight, body height, mid-arm and mid-forearm circumference and negatively with age and triceps skinfold thickness in the analyses of simple correlation coefficients. Men were found to be more powerful than women in all hand strength types in different age groups. The magnitude of strength decline with age was more prominent in grip strength than pinch strength including palmar, tip and key. Stepwise multiple regression analyses showed that sex, age and mid-forearm circumference were most predictive of all types of hand strength. Body height was an additional independent predictor of grip and palmar pinch. Body mass index, body weight, mid-arm circumference and triceps skinfold thickness were not independent predictors associated with hand strength.

Tai Chi Chuan (TCC; shadow boxing) is a traditional Chinese conditioning exercise. To evaluate its beneficial effect on cardiorespiratory function, 21 male and 20 female TCC practitioners, ranging in age from 50 to 64 years, voluntarily participated in this study. The control group comprised 23 male and 26 female sedentary subjects. Breath-by-breath measurement of the cardiorespiratory function was obtained during the incremental exercise of leg cycling. At the maximal exercise level, the oxygen uptake (VO2), O2 pulse and work rate of the TCC group were significantly higher than the respective values of the control group (p0.01). At the ventilatory threshold, the TCC group also showed a higher VO2, O2 pulse and work rate (p0.05). The results imply that TCC training may be beneficial to the cardiorespiratory function of older individuals. To estimate the exercise intensity of TCC, heart rate (HR) was monitored in 15 men and 15 women while they performed the classical Yang TCC. During the steady-state performance of TCC, the mean HR was 130 +/- 14 bpm for men and 127 +/- 13 bpm for women. The mean HR during TCC exceeded 70% of their HRmax. Our data substantiate that TCC is aerobic exercise of moderate intensity, and it may be prescribed as a suitable conditioning exercise for the elderly.