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Distal radius fracture is a common wound. It is reduced by surgery under anesthesia. Emergence agitation can often occur after anesthesia. It is associated with increased morbidity and hospital costs. However, there have been almost no reports in the medical literature on the occurrence of emergence agitation in adults. This study aimed to compare emergence agitation between isoflurane and propofol anesthesia in adults after closed reduction of distal radius fracture. Forty adults (ASA I-II) undergoing closed reduction of distal radius fracture were randomly assigned to either the isoflurane or propofol group and anesthesia was maintained with isoflurane or propofol. The bispectral index was monitored and maintained within 40-60. After reduction of fracture and fixation with plaster, patients were transported to the post-anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). AFPS score of 3 or 4 was considered to be emergence agitation. Pain scores were measured by the numeric rating scale (NRS) on arrival and at peak value at PACU. Eight (40.0%) patients in the isoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation (P = 0.031). There was no correlation between peak NRS and AFPS. Propofol may decrease the incidence of emergence agitation compared to isoflurane in adults undergoing closed reduction of distal radius fracture.

SUMMARY: 3D diffusion-weighted steady-state free precession imaging (3D DW-SSFP) with isotropic resolution was performed to delineate structures of the human lumbosacral plexus (LSP). 3D DW-SSFP clearly revealed detailed anatomy of the LSP and its branches. Our data suggest that the sequence based on 3D DW-SSFP can be used for high-resolution MR imaging of the peripheral nervous system.

Venous blood samples, 24-h total food duplicate samples, and rice samples were collected from 52 adult non-smoking women in the city of Tainan, southern Taiwan, in 1994, and analyzed for cadmium (Cd) and lead (Pb) by wet-digestion followed by graphite furnace atomic absorption spectrophotometry. Daily dietary intake was 10 micrograms for Cd and 22 micrograms for Pb as geometric means, of which Cd and Pb in rice accounted for 34% and 1.4% of daily Cd and Pb intakes, respectively. The counterpart values for blood were 1.11 ng/ml and 44.5 ng/ml for Cd and Pb, respectively. International comparison with recently published data suggests that the exposure to Cd in Tainan should be among the lowest in the world.

Background/Aims We sought to determine the outcomes of long-term use of lamivudine combined with hepatitis B immune globulin according to the titer of antibody to hepatitis B surface antigen in preventing recurrent hepatitis B in Chinese patients after liver transplantation. Methods Eighty-five patients with detectable hepatitis B envelope antigen in serum before liver transplantation were retrospectively enrolled in the study. Twenty-eight patients used lamivudine monotherapy as a control group. Fifty-seven patients used lamivudine combined with hepatitis B immune globulin therapy according to the titer of antibody to hepatitis B surface antigen. Results In the lamivudine monotherapy group, seven patients had recurrent hepatitis B after transplantation, with 1-, 2-, and 3-year recurrence rates of 10.70%, 21.90%, and 25.8%, respectively. In the combination therapy group, three patients had recurrent hepatitis B after transplantation, with 1-, 2-, and 3-year recurrence rates of 0.00%, 5.50%, and 13.40% ( P = .03). YMDD mutants were detected in 6 of the 10 patients with recurrent hepatitis B. HBV-DNA load before transplantation was significantly associated with recurrent hepatitis B after transplantation in the overall patients ( P = .04). Conclusions Long-term use of lamivudine combined with hepatitis B immune globulin, according to the titer of antibody to hepatitis B surface antigen was efficacious and cost effective to prevent recurrent hepatitis B in Chinese patients after liver transplantation.

Background The intermittent Pringle manoeuvre during hepatectomy results in a better clinical outcome when the accumulated ischaemia time is less than 120 min. The aim of this study was to investigate hepatic gene expression related to microcirculatory modulation and ultrastructural changes in patients having the intermittent Pringle manoeuvre. Methods Forty patients who underwent hepatectomy for liver tumours were randomly assigned to liver transection with intermittent Pringle manoeuvre (Pringle group, n = 20) or without the manoeuvre (control group, n = 20). The clinical data and hepatic expression of endothelin (ET) 1 and endothelial nitric oxide synthase (eNOS) combined with liver ultrastructure were compared. Results The Pringle manoeuvre resulted in less blood loss (8·9 versus 12·4 ml/cm2; P = 0·034), a shorter transection time (2·7 versus 4·1 min/cm2; P = 0·015) and a lower serum bilirubin level on postoperative day 2 (26 versus 35 µm/l; P = 0·04). The hepatic messenger RNA content of ET-1 decreased by 38 per cent of the basal level in the Pringle group, whereas it increased by 28 per cent in the control group (P = 0·026). More patients in the control group showed swelling of mitochondria in hepatocytes and disruption of sinusoidal lining cells (12 of 20 patients versus three of 20 in the Pringle group; P = 0·008). Conclusion The intermittent Pringle manoeuvre results in less disturbance of the hepatic microcirculation and better preservation of liver sinusoids after hepatectomy.

Human herpesvirus 8 (HHV-8) is a recently discovered gammaherpesvirus that is the etiologic agent of Kaposi sarcoma (KS). The natural history of primary HHV-8 infection, including clinical outcome and host immune responses that may be important in preventing disease related to HHV-8, has not been elucidated. The present study characterized the clinical, immunologic, and virologic parameters of primary HHV-8 infection in 5 cases detected during a 15-year longitudinal study of 108 human immunodeficiency virus type 1 seronegative men in the Multicenter AIDS Cohort Study. Primary HHV-8 infection was associated with mild, nonspecific signs and symptoms of diarrhea, fatigue, localized rash, and lymphadenopathy. There were no alterations in numbers of CD4+ or CD8+ T cells or CD8+ T-cell interferon γ (IFN-γ) production to mitogen or nominal antigen. CD8+ cytotoxic T-lymphocyte precursor (CTLp) and IFN-γ reactivity were detected during primary HHV-8 infection, with broad specificity to 5 lytic cycle proteins of HHV-8 encoded by open reading frame 8 (ORF 8; glycoprotein B homolog of Epstein-Barr virus), ORF 22 (gH homolog), ORF 25 (major capsid protein homolog), ORF 26 (a minor capsid protein homolog), or ORF 57 (an early protein homolog), in association with increases in serum antibody titers and appearance of HHV-8 DNA in blood mononuclear cells. CD8+ T-cell responses to HHV-8 decreased by 2 to 3 years after primary infection. This antiviral T-cell response may control initial HHV-8 infection and prevent development of disease.

Twin seroepidemiological surveys on prevalence of hepatitis B and C virus (HBV and HCV, respectively) infection were conducted on 100 adult women in total, 50 each in the provincial capital of Changchun and in a farming village in the vicinity in Jilin Province, northeast China. Positivity to three markers on HBV (ie HBsAg+, anti-HBs+, and anti-HBc+) was examined by RIA methods, and to one on HCV (anti-HCV+) by EIA. The results were evaluated in combination with two foregoing studies in Shandong and Shaanxi Provinces, and with special reference to possible urban-rural differences in prevalence. The prevalence of HBsAg+ cases was rather low (ie 9% when two groups were combined), but that of anti-HBs+ and anti-HBc+ cases was high, being 50% and 45%, respectively. Thus, the rate of HBV+ cases was 62%. The rate for HCV+ cases was 3%. The comparison of the prevalence between the city group and the village group showed that the rates for anti-HBs+ and HBV+ were significantly or marginally higher in the former group than in the latter, respectively. The HCV+ prevalence rate for the city group (4%) also tended to be higher than the corresponding rates for the village group (2%), although the difference was statistically insignificant. When evaluated together with the observation in Shandong and Shaanxi Provinces, it appears possible to generalize that the HBV infection prevalence is not higher and probably lower in rural areas than in urban areas, and that such may also be the case for the HCV infection prevalence.

The presence of simian virus 40 (SV40) in human brain tumors remains a controversial issue. Even if SV40 does exist in brain tumors, the questions of whether it is associated with brain tumorigenesis and by what mechanisms are unknown.SV40 large tumor antigen (Tag) was investigated by immunoprecipitation, silver staining, and Western blot analysis in 65 brain tumor cases and 8 cases of normal brain tissue. Tag-p53 and Tag-pRb complexes were screened by immunoprecipitation and Western blot analysis in 18 and 15 Tag positive tumor tissues, respectively.Tag was found in all 8 cases of ependymoma and 2 cases of choroid plexus papilloma, 90% of pituitary adenoma cases (9 of 10), 73% of astrocytoma cases (11 of 15), 70% of meningioma cases (7 of 10), 50% of glioblastoma multiforme cases (4 of 8), and 33% of medulloblastoma cases (2 of 6). Five oligodendroglioma cases, 1 pineocytoma case, and 8 cases of normal brain tissue were negative for Tag. The Tag-p53 complex was detected in all 18 Tag positive tumors tested and the Tag-pRb complex was detected in all 15 Tag positive tumors tested.SV40 Tag not only is expressed in brain tumors; it also can form specific complexes with tumor suppressors p53 and pRb. SV40 is correlated with brain tumorigenesis. The inactivation of p53 and pRb due to the formation of Tag-p53 and Tag-pRb complexes possibly is a significant mechanism in the etiopathogenesis of brain tumors.

A small-scale seroepidemiological survey on hepatitis B and C virus infection was conducted in the vicinity of Bangkok, Thailand, in 1998. Adult women working in a health sciences institution were invited to participate in the study, and 52 subjects (19 to 57 years of age) volunteered to offer peripheral blood. They were non-smoking and non-habitually drinking, and about two thirds of the subjects were married. The sera from the blood samples were assayed for HBsAg, anti-HBs, anti-HBc, and anti-HCV positivities. The serum assay showed that none of the subjects was positive to HBsAg or anti-HCV, but a half of the subjects (50%) were either positive to anti-HBs, to anti-HBc or to the both, thus having experienced HBV infection in the past. The prevalence of the positivities was significantly higher among those at 35-57 years of age than those younger than 35 years. Comparison of the present findings with the results reported in literature suggested that the risk of HBV infection should have been higher than that of HCV infection, that the observed positivity of HBV infection was probably lower than ever reported, and that anti-HCV positivity should be the lowest.

In an attempt to investigate possible urban-rural difference in prevalence of hepatitis B and C virus (HBV and HCV, respectively) infection in continental China, triplet surveys on HBV and HCV infection markers (ie, HBsAg, anti-HBs, anti-HBc, and anti-HCV) and serum enzyme levels (AST, ALT and gamma-GTP) were conducted in 1997 on groups of apparently healthy adult women (49 to 50 subjects per group); one group (the City group) was in Xian, the provincial capital of Shaanxi Province, and two others (the Village A group and the Village B group) were in farming villages in the Province some 200 and 25 km away from Xian, respectively. Comparison among the three groups showed that there was no urban-rural difference in prevalence of HBV and HCV infection positive (HBV+ and HCV+) cases and that the overall prevalence of HBV+ and HCV+ cases was 70% and 3%, respectively. HBsAg+ prevalence was however higher in the villages (8% when the two villages were combined) than in the city (2%). HBV infection was not associated in general with apparent increase in emission enzyme levels in the serum, whereas HCV infection might be associated with an increase in ALT, AST and gamma-GTP. The present observation in combination with other previously published results suggests that urban-rural difference will not be remarkable in HBV and HCV infection prevalence in Continental China and that the public health problem is more serious with HBV infection and quite less so with HCV infection.

Background—Vitamin C may be protective against gastric cancer though infection withHelicobacter pylori is associated with a reduction in intragastric concentrations of vitamin C.Aims—To examine the effects ofH pylori infection, gastric juice pH, the severity and extent of gastric inflammation, and CagA antibody status of the individual on gastric juice and mucosal vitamin C concentrations.Patients—One hundred and fifteen patients undergoing routine gastroscopy for investigation of dyspepsia.Methods—High performance liquid chromatography was used to determine vitamin C concentrations. CagA antibody was detected by western blot analysis.Results—Gastric juice ascorbic acid concentration was significantly lower in patients infected withH pylori compared with those uninfected (19.3 μmol/l (interquartile range (IQR) 10.7–44.5) versus 66.9 μmol/l (IQR 24.4–94.2), p=0.003). The reduction in gastric juice ascorbic acid concentration was inversely related to the severity of gastritis (p=0.01). CagA positive patients had significantly lower gastric juice ascorbic acid concentrations than CagA negative ones (14.8 μmol/l (IQR 7.9–52.2) versus 39 μmol/l (IQR 19.9–142.2), p=0.05). Decreased gastric juice dehydroascorbic acid concentrations were observed in patients with gastric atrophy and intestinal metaplasia. Mucosal ascorbic acid concentrations were also significantly lower in infected patients than uninfected patients (p=0.04).Conclusions—The reduction in gastric vitamin C concentrations is related to gastric juice pH, the severity and extent of gastritis, the presence of H pylori, and the CagA antibody status of the individual. These findings may have implications in H pyloriassociated carcinogenesis.

A seroepidemiological survey of HBsAg, HBeAg, anti-HBs, anti-HBc, anti-HBe and anti-HCV positivities was conducted in 1997 in Manila, The Philippines. Adult women (21 to 59 years of age) were invited to donate peripheral blood for the study, and 50 people volunteered. They were nonsmokers, nonhabitual drinkers, and mostly married; none of them was a professional blood donor. The serum assay showed that all subjects were negative for HBsAg and HBeAg. Overall, a half (50%) of the study subjects were positive for any one of the HBV infection markers (i.e. HBV+). The older group (25 women at 36-59 years of age) showed significantly higher prevalence than the younger group (25 women at 21-35 years of age) of positivity to all three HBV antibody markers and therefore HBV positivity also. None of the study subjects was positive for anti-HCV. Comparison of the present findings with the results reported in the literature for the 1980s suggests that the risk of HBV infection and most probably that of HCV infection also has decreased in this 10-year period in the Philippines.

In order to make urban-rural comparison of the prevalence of hepatitis B and C virus (HBV and HCV, respectively) infection in China, a twin survey was conducted in 1996 on two groups (50 subjects each) of 21-55 year-old, apparently healthy women for infection markers and serum enzyme levels; one group (the urban group) was in Jinan, the provincial capital of Shandong Province, and the other (the rural group) was in a farming village in Zhangqiu area some 30 km away from Jinan City. Comparison between the two groups showed that there was no significant (p0.10) difference in the prevalence of HBsAg+, anti-HBs+, anti-HBc+ and the cases positive to any of three HBV infection markers (i.e. HBV+). No age-dependent difference was detected within or between the groups. Thus the overall positivity rate was 8% for HBsAg+, 47% for anti-HBs+, 48% for anti-HBc+, and 64% for HBV+. No anti-HCV+ case was found either in the urban group or in the rural group. Liver function remained normal in all cases studied. The results together with perusal of published data suggest the urban-rural difference will not be remarkable, if present, in HBV and HCV infection in the regions studied, and possibly in China as a whole.

BACKGROUND: Longstanding Helicobacter pylori infection may increase the risk of developing gastric adenocarcinoma. The sequence of chronic active gastritis leading to gastritis with atrophy and subsequent intestinal metaplasia is thought to be a key step in gastric carcinogenesis. Ornithine decarboxylase (ODC) activity is increased in some pre-malignant gastrointestinal conditions and is essential for malignant transformation in vitro. AIMS: To measure ODC activity in the antrum of H pylori infected and non-infected subjects and to relate this to histological abnormalities associated with recent and longstanding H pylori infection. METHODS: Six antral mucosal biopsy specimens were obtained from 75 patients for detailed histological assessment and measurement of ODC activity. Samples were measured in duplicate and results expressed as median, interquartile range in pmol/mg protein/h. RESULTS: ODC activity was significantly higher in H pylori positive (164, 88-259 pmol/mg/h) than H pylori negative subjects (99.8, 55-158 pmol/mg/h, p = 0.003). However the presence of gastritis, irrespective of the severity of inflammation or activity had no influence on ODC activity. Gastritis with atrophy was associated with increased ODC activity, which was closely related to the severity of the atrophy (p = 0.01). Similarly, ODC activity was significantly increased in subjects with intestinal metaplasia (196, 83-25) compared with those without intestinal metaplasia (111.7, 65-175, p < 0.04). CONCLUSIONS: These results indicate that the histological changes associated with longstanding H pylori infection rather than inflammation alone are associated with increased polyamine biosynthetic activity. This may be relevant to H pylori associated gastric carcinogenesis.

In order to make quantitative comparison between food composition table-based estimates and instrumental measures by inductively coupled plasma atomic emission spectrometry (ICP-AES), total food duplicates were collected from 232 adult women in 10 study regions in 9 Prefectures in Japan. Daily dietary intake of 5 elements, sodium (Na), potassium (K), phosphorus (P), calcium (Ca) and iron (Fe), were estimated from the weights of food items in each duplicate by use of food composition tables. Parallel to this the intakes were measured by wet-ashing of food duplicate homogenates followed by ICP-AES analysis. Because the emission intensity of K was significantly modified by Na co-present at various concentrations, K was measured after Na concentration was reduced to the value 150 mg/L by dilution. The comparison of the two sets of the results, the estimated values and the measured values, showed that the estimated values were significantly larger than the measured values in the cases of Na, K, Ca and P (the ratio of the estimated to the measured values: 118% for Na, 115% for K, 109% for Ca; and 130% for Fe), whereas the two values essentially agreed with each other in the case of P (ratio: 93%). The differences were too large for any nutritional evaluation to be made when the method of Bland and Altman is applied. The significance of the differences in relation to nutritional evaluation of element intake is discussed.

SUMMARY Aim: To compare H. pylori eradication rates using omeprazole in conjunction with either amoxycillin or clarithromycin. Background: Omeprazole with amoxycillin is the most widely used dual therapy regimen for eradication of H. pylori. A recent open study suggested a high eradication rate combining omeprazole with the newer macrolide, clarithromycin. Methods: A randomized prospective trial in 54 patients was conducted to compare 2 weeks of treatment with omeprazole 40 mg once daily and either amoxycillin 500 mg three times daily or clarithromycin 500 mg three times daily. H. pylori eradication was assessed using the 13C urea breath test. Results: Eradication was achieved in 18/26 (69.2%) of subjects treated with omeprazole and amoxycillin and 18/25 (72.0%) of those treated with omeprazole and clarithromycin (P= N.S.). Minor side effects, most commonly altered taste, were reported by 16% of patients and were more frequent in those randomized to clarithromycin (P= 0.01). Conclusions: These regimens are similarly effective. However, clarithromycin is more expensive, associated with a greater frequency of side effects and, unlike amoxycillin, resistance by H. pylori has been reported. This suggests that clarithromycin may be a useful alternative when there is penicillin allergy or previous treatment failure, but it should not replace amoxycillin as first choice in omeprazole-based dual therapy.