Search

Increased neovascularization is commonly observed in hemorrhagic plaques and associated with rupture of atherosclerotic lesions. This study aims to investigate whether hemin accumulated at the site of hematoma promotes neovascularization through affecting the growth and function of endothelial progenitor cells (EPCs) and the possible mechanism involved. Here we demonstrated that hemin promoted a significant increase in neovessel formation in matrigel plugs embedded in vivo and enhanced the proliferation and endothelial gene expression in EPCs in vitro. VEGF-induced migration response and the capability to incorporate into the vascular networks were markedly enhanced in hemin-treated EPCs. Hemin induced the phosphorylation of ERK and AKT but not p38 or JNK. The inhibition of AKT or ERK activation significantly attenuated the effect of hemin on cell proliferation. However, the enhanced migration response induced by hemin was significantly suppressed by the inhibition of AKT but not ERK. Hemin induced significant increase in reactive oxygen species (ROS) production and hemin-induced angiogenic response of EPCs was substantially reduced by treatment with N-acetylcysteine. Collectively, these data support that hemin-induced ROS mediates the activation of AKT and ERK signaling pathways, which in turn promotes the cell proliferation and function of EPCs. J. Cell. Physiol. 219: 617-625, 2009. (c) 2009 Wiley-Liss, Inc.

Background: Hip fracture results in severe and often permanent reductions in overall health and quality of life for many older adults. As the U.S. population grows older and more diverse, there is an increasing need to assess and improve outcomes across racial/ethnic cohorts of older hip fracture patients., Methods: We examined data from 42,479 patients receiving inpatient rehabilitation for hip fracture who were discharged in 2003 from 825 facilities across the United States. Outcomes of interest included length of stay, discharge setting, and functional status at discharge and 3- to 6-month follow-up., Results: Mean age was 80.2 (standard deviation [SD] = 8.0) years. A majority of the sample was non-Hispanic white (91%), followed by non-Hispanic black (4%), Hispanic (4%), and Asian (1%). After controlling for sociodemographic factors and case severity, significant (p <.05) differences between the non-Hispanic white and minority groups were observed for predicted lengths of stay in days (Asian: 1.1; 95% confidence interval [CI], 0.5-1.7; non-Hispanic black: 0.8; 95% CI, 0.6-1.1), odds of home discharge (Asian: 2.1; 95% CI, 1.6-2.8; non-Hispanic black: 2.0; 95% CI, 1.8-2.3; Hispanic: 1.9; 95% CI, 1.6-2.2), lower discharge Functional Independence Measure (FIM) ratings (non-Hispanic black: 3.6; 95% CI, 3.0-4.2; Hispanic: 1.6; 95% CI, 0.9-2.2 points lower), and lower follow-up FIM ratings (Hispanic: 4.4; 95% CI, 2.8-5.9)., Conclusions: Race/ethnicity differences in outcomes were present in a national sample of hip fracture patients following inpatient rehabilitation. Recognizing these differences is the first step toward identifying and understanding potential mechanisms underlying the relationship between race/ethnicity and outcomes. These mechanisms may then be addressed to improve hip fracture care for all patients.

Heme oxygenase-1 (HO-1) is a stress-inducible enzyme with multiple protective functions in cardiovascular systems. Studies have shown that the timely cardiac HO-1 overexpression at acute phase of ischemic infarction (MI) provides protection via its anti-apoptotic and anti-inflammatory effects. Here we demonstrate that a delayed HO-1 transduction mediated by a recombinant adeno-associated virus in ischemic hearts of mice with permanent coronary artery ligation significantly attenuated left ventricular fibrosis and cardiac dysfunctions examined at 4 weeks post MI. HO-1-mediated protection was correlated with enhanced vascularization in the ischemic myocardium. HO-1 gene transfer resulted in a notable increase in the number of c-kit(+)- stem cells recruited to the infarcted area at 10 days after ligation. HO-1-mediated stem cell recruitment was also demonstrated in the heart of non-ischemic mice receiving intravenous infusion of green fluorescent protein-bearing bone marrow stem cells. Additional experiments revealed that vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1 (SDF-1) were highly induced in HO-1 transduced myocardium. Mononuclear cell infiltration was evident and colocalized with angiogenic factors in the same region. Flow cytometry analysis of the mononuclear cells isolated from HO-1-transduced left ventricles revealed that over 50% of cells expressed CD34, a marker of hematopoietic stem cells and endothelial progenitor cells. VEGF and SDF-1 blockade by neutralizing antibodies significantly attenuated HO-1-mediated neovascularization and protection in infarcted mice. These data suggest that cardiac HO-1 gene transfer post MI provides protection at least in part by promoting neovascularization through inducing angiogenic factors and the recruitment of circulating progenitor/stem cells.

This qualitative study aimed to explore patients' perspectives on good nursing for comparison with nurses' perspectives, as identified in a previous study. Purposive sampling was employed to recruit 53 patients and six family members from three medical centers and three regional hospitals, in northern, central, and southern Taiwan. The 59 participants were clustered into nine groups for focus-group interviews for data collection purposes, from March to June, 2003. Most of the participants were male (62.7%), and their mean age was 51.9 years (SD=15.6), with a range from 18 to 81 years old. All of the participants were hospitalized for at least three days and had the physical and mental strength to participate in a 60-90 minute group interview. The interviews were both hand-recorded and audio-taped on site, with permission from the participants, and then transcribed into verbatim narratives for data analysis. Content analysis was used to identify items in relation to good nursing/not-good nursing across narratives. The findings showed that four major categories of good nursing inductively emerged, including: (1) Providing professional nursing as a guardian angel, (2) Demonstrating professional skills with humanity, (3) Being accountable and competent, and (4) Showing self-improvement. The findings indicated that professional nursing competence is the essence of good nursing. Treating patients as relatives is also perceived as good nursing. In comparing the patients definitions of good nursing with those of nurses it was observed that there are similarities in terms of the main categories of the definitions. Patients, however, tend to use negative examples or normative moral terms, such as "should" or "ought to" to connote what is expected of good nursing and how good nursing is expressed in the context of patient-nurse interaction.

Unlabelled: Ethnic differences in discharge destination among older patients with traumatic brain injury., Objective: To estimate the association between ethnicity and discharge destination in older patients with traumatic brain injury (TBI)., Design: A retrospective analysis., Setting: Nationally representative sample of older patients from the Uniform Data System for Medical Rehabilitation in 2002 and 2003., Participants: Patients (N=9240) aged 65 years or older who received inpatient rehabilitation services for TBI., Interventions: Not applicable., Main Outcome Measures: Discharge destination (home, assisted living facility, institution) and ethnicity (white, black, Hispanic)., Results: Multinomial logit models showed that older Hispanics (odds ratio [OR]=2.24; 95% confidence interval [CI], 1.66-3.02) and older blacks (OR=2; 95% CI, 1.55-2.59) with TBI were significantly more likely to be discharged home than older whites with TBI, after adjusting for relevant risk factors. Older blacks were also 78% less likely (OR=.22; 95% CI, .08-.60) to be discharged to an assisted living facility than whites after adjusting for relevant risk factors., Conclusions: Our findings indicate that older minority patients with TBI were significantly more likely to be discharged home than white patients with TBI. Studies are needed to investigate underlying factors associated with this ethnic difference.

An 8-year-old boy was hospitalized with fresh bloody stool passage for 1 week. He underwent colonoscopy that revealed 1 large polyp in the rectosigmoid junction. The polyp was too large to be encircled by the snare. Laparoscopic-assisted colonoscopic polypectomy was performed successfully to remove this large polyp without the need for segmental resections. This patient treated using this technique were discharged 2 days after the procedure and returned to full activity within 3 to 4 days. There were no complications.

This qualitative study used an in-depth interview method to explore nurses' perspectives on good nursing practices. A balanced stratified sampling approach was employed to recruit 83 nurses from 18 hospitals that were relatively evenly distributed around Taiwan. Fifteen nurses educated to the masters' level and well trained in the in-depth interview approach collected research data from January through May 2002. Interviews were audiotaped and transcribed in verbatim narratives. Content analysis was used to identify good nursing practices common across narratives. Four good nursing practice categories emerged inductively. These included (1) good decision making and execution, (2) dexterous professional skills, (3) good patient-nurse relationships, and (4) a mature self. Findings present quality nursing care as a relationship that combines professionalism and humanism. In order to provide better care, a nurse must incorporate knowledge from empirical research into his or her practice and internalize his or her value as a nurse. A discussion of the process of self-maturation acquisition and reflective learning offers new insights to guide the construction of nursing education curricula and activities for clinical nursing practice. Further research in good nursing is suggested.

Phaeosphaeria species are important causal agents of Stagonospora leaf blotch diseases in cereals. In this study, the nucleotide sequence and deduced polypeptide of the trifunctional histidine biosynthesis gene (his) are used to investigate the phylogenetic relationships and provide molecular identification among cereal Phaeosphaeria species. The full-length sequences of the his gene were obtained by PCR amplification and compared among cereal Phaeosphaeria species. The coding sequence of the his gene in wheat-biotype P. nodorum (PN-w) was 2697 bp. The his genes in barley-biotype P. nodorum (PN-b), two P. avenaria f. sp. triticea isolates (homothallic Pat1 and Pat3), and Phaeosphaeria species from Polish rye and dallis grass were 2694 bp. The his gene in heterothallic isolate Pat2, however, was 2693 bp because the intron had one fewer base. In P. avenaria f. sp. avenaria (Paa), the his gene was only 2670 bp long. The differences in the size of the his gene contributed to the variation in amino acid sequences in the gap region located between the phosphoribosyl-ATP pyrophosphohydrolase and histidinol dehydrogenase sub-domains. Based on nucleotide and deduced amino acid sequences of the his gene, Pat1 was not closely related to either PN-w or the Paa clade. It appears that rates of evolution of the his gene were fast in cereal Phaeosphaeria species. The possible involvement of meiotic recombination in genetic diversity of the his gene in P. nodorum is discussed.

Heme oxygenase-1 (HO-1) is an enzyme with potent immunoregulatory capacity. To evaluate the effect of HO-1 on autoimmune diabetes, female NOD mice at 9 weeks of age received a single intravenous injection of a recombinant adeno-associated virus bearing HO-1 gene (AAV-HO-1; 0.5 x 10(10)-2.5 x 10(10) viruses/mouse). In a dose-dependent manner, HO-1 transduction reduced destructive insulitis and the incidence of overt diabetes examined over a 15-week period. HO-1-mediated protection was associated with a lower type 1 T-helper cell (Th1)-mediated response. Adaptive transfer experiments in NOD.scid mice demonstrated that splenocytes isolated from AAV-HO-1-treated mice were less diabetogenic. Flow cytometry analysis revealed no significant difference in the percentages of CD4(+)CD25(+) regulatory T-cells between saline-treated and AAV-HO-1-treated groups. However, the CD11c(+) major histocompatibility complex II(+) dendritic cell population was much lower in the AAV-HO-1-treated group. A similar protective effect against diabetes was observed in NOD mice subjected to carbon monoxide (CO) gas (250 ppm CO for 2 h, twice per week). These data suggest that HO-1 slows the progression to overt diabetes in pre-diabetic NOD mice by downregulating the phenotypic maturity of dendritic cells and Th1 effector function. CO appears to mediate at least partly the beneficial effect of HO-1 in this disease setting.

A 5586 bp sequence (accession no. DQ278491), which includes the RNA polymerase II gene (RPB2) encoding the second largest protein subunit (RPB2), was obtained from the wheat biotype Phaeosphaeria nodorum (PN-w) by PCR amplification. The 3841 bp full length RPB2 gene contains two exons and a 52 bp intron, and encodes a complete 1262 amino acid protein. Similar to the C-terminals of the beta subunits of prokaryotes and yeast RNA polymerases, the deduced RPB2 protein contained many structural features needed for gene transcription. Based on the phylogenetic analysis with the deduced RPB2 polypeptide sequences, the PN-w was closely related to the maize pathogen Cochliobolus heterostrophus. Size differences were found in the full length RPB2 gene of cereal Phaeosphaeria species, mainly due to differences in intron size. No nucleotide substitutions were found in homothallic P. avenaria f.sp. triticea (Pat1) and barley biotype P. nodorum (PN-b) isolates used in this study. The nucleotide and deduced amino acid sequences of the RPB2 gene in Pat1 were closely related to that in PN-w.

Full-length coding sequences of the beta-tubulin gene (tubA) were PCR-amplified and sequenced from 42 Phaeosphaeria isolates, including 16 P. nodorum and 23 P. avenaria species from cereals, two Polish isolates from rye (Secale cereale L.), and one isolate from dallis grass (Paspalum dilatatum Poir). A tubA gene of size 1556bp was identified in wheat- and barley-biotype P. nodorum (PN-w and PN-b), P. avenaria f. sp. avenaria (Paa), homothallic P. avenaria f. sp. triticea (P.a.t.) (Pat1) and the P.a.t. isolate (Pat3) from the State of Washington. The tubA gene length polymorphisms were detected in two P.a.t. isolates (Pat2) from foxtail barley (Hordeum jubatum L.), one from dallis grass and two Polish isolates from rye. These size differences were due to the variation of intron lengths among these three Phaeosphaeria species. All Phaeosphaeria isolates have identical 1344bp exons that can be translated into a 447 amino acid beta-tubulin. Like glyceraldehyde-3-phosphate dehydrogenase, the beta-tubulin amino acid sequence was identical in all Phaeosphaeria species used in this study, with the exception of the two Pat2 isolates. Six amino acid differences were evident in the beta-tubulin of these Pat2 isolates.

Aims: The cerebral processing of painful thermal (heat/cold) stimulation have been extensively studied, but little is known about cerebral activation to non-painful warm and cold stimuli. This study aimed to investigate the comparative EEG effects of warm vs. cold stimulus in man., Materials and Methods: The left nondominant hands of 13 healthy male subjects were stimulated by non-painful warm (40-43 degrees C) and cold (12-15 degrees C) water. The somatic sensations were continuously assessed with an analogue visual scale device. EEG data (32 channels) recorded before, during and after the warm and cold stimulations were analysed quantitatively., Results: No significant difference in intensity of sensation was found during warm and cold stimulations. Different patterns of EEG activity were superimposed on the similar background of EEG activation during and after warm and cold stimulations. Significant decrease of theta activity in contra-stimulus frontal region was observed during cold stimulation rather than warm stimulation. EEG power spectra in theta, alpha-1 and alpha-2 bands significantly increased after cold stimulation compared to baseline. EEG coherence in delta, alpha-1 and alpha-2 bands significantly increased in the contra-stimulus hemisphere during stimulations., Conclusion: This suggests that similar neural networks may process somatic warm and cold sensory inputs differently and the differential EEG patterns may be encoded by the qualities of thermal stimuli.

Unlabelled: L-p-Boronophenylalanine (BPA) has been applied as a potential boron carrier for the treatment of malignant glioma in clinical boron neutron capture therapy (BNCT) since 1994. To provide the pharmacokinetics of BPA for clinical use of BNCT in Taiwan, 4-borono-2-(18)F-fluoro-L-phenylalanine-fructose ((18)F-FBPA-Fr) was synthesized and the biologic characteristics of this radiotracer in glioma-bearing rats were investigated., Methods: Radiolabeled (18)F-F(2) was produced via the (20)Ne(d,alpha)(18)F reaction, and (18)F-acetyl hypofluorite ((18)F-AcOF) was generated by passing (18)F-F(2) through a column filled with tightly packed KOAc/HOAc powder. The effluent containing (18)F-AcOF was bubbled into BPA in trifluoroacetic acid, then purified by high-performance liquid chromatography, and further composited with fructose to afford (18)F-FBPA-Fr. Male Fischer 344 rats bearing F98 glioma in the left brain were used for biologic studies. The biodistribution of BPA-Fr and (18)F-FBPA-Fr was determined, and the microautoradiography and PET imaging of (18)F-FBPA-Fr were performed, on the 13th day after tumor inoculation., Results: The radiochemical purity of (18)F-FBPA-Fr was >97% and the radiochemical yield of (18)F-FBPA-Fr was 20%-25%. In glioma-bearing rats, the accumulation ratios of B-10 for glioma-to-normal brain were 2.05, 1.86, 1.24, and 1.10 at 0.5, 1, 2, and 4 h, respectively, after administration of 43 mg BPA-Fr via the tail vein. The accumulation ratios of (18)F-FBPA-Fr for glioma-to-normal brain were 3.45, 3.13, 2.61, and 2.02, whereas the tumor-to-heart blood ratios were 1.72, 2.61, 2.00, and 1.93, respectively, for the same time points. The uptake characteristics of BPA-Fr and (18)F-FBPA-Fr in F98 glioma were similar with a maximum at 1 h after the drugs' administration. The results obtained from the biodistribution studies indicated that 0.5-1 h after BPA-Fr injection would be the optimal time for BNCT. Biodistribution, PET images, and brain microautoradiography of (18)F-FBPA-Fr all confirmed this finding., Conclusion: (18)F-FBPA-Fr showed specific tumor uptake in F98 glioma-bearing rats and could be used as a probe for BPA-Fr in BNCT. This study provides useful information for the future clinical application of BNCT in brain tumor therapy.

Skin pain differs from muscle pain in quality and affective dimension, but it is unknown how the brain processes the nociceptive inputs from skin and muscle differently. To delineate the differential effects of nociceptive inputs from skin and muscle, the EEG topography and power spectra were analysed on the basis of two databases acquired from two separate studies regarding skin (Neurosci. Lett. 305 (2001b) 49) and muscle pain (Exp. Brain Res. 141 (2001c) 195). The same experimental protocol was applied to the same subject-group in the two separate experiments. In the two independent experiments, skin pain and muscle pain were, respectively, induced by intracutaneous and intramuscular injection of capsaicin in the left forearm. Visual analogue scale (VAS) and EEG data acquired before, during the vehicle and capsaicin injections were quantitatively compared. The results showed that the VAS profiles for skin and muscle pain are highly similar in spite of distinct qualities perceived. Skin pain produced a similar but not identical EEG topographic pattern as muscle evoked. Muscle pain induced a significant increase of beta-2 activity in the extensive frontal, parietal and occipital areas compared to skin pain. No difference was found between the vehicle-induced non-painful sensations in skin and muscle. These results implicate that the nociceptive inputs from muscle and skin are processed differently in the similar neural matrix of the brain.

In order to understand the prevalence of childhood streptococcal pharyngitis, isolation of group A Streptococcus (GAS) was attempted from throat swabs of pharyngitis patients. Children aged between 1 and 15 years presenting to the outpatient department with pharyngeal erythema were prospectively enrolled in the study. Demographic data and presenting symptoms and signs for each patient were recorded and a throat swab was taken. Of 1175 throat cultures obtained, GAS was isolated in 252 cases (21.4%). Of these, 142 (56.3%) were boys and 110 (43.7%) girls. A higher proportion of boys was found with GAS pharyngitis (1.29: 1). The mean age of GAS culture-positive patients was 7.8 +/- 2.3 years old. Patients aged between 6 and 11 years were more prevalent in GAS pharyngitis. Ninety (35.7%) of our GAS pharyngitis patients occurred between March and May. A second smaller peak occurred between October and December. The following factors showed independent positive correlation with GAS infection: sore throat (p < 0.001), no coryza (p = 0.011), tonsillar swelling (p < 0.001), anterior cervical adenopathy (p = 0.029) and scarlatiniform rash (p < 0.001). However, GAS was found in less than half of the patients who had these clinical manifestations. In conclusion, pharyngeal infection with GAS in children is not uncommon. The prevalence of GAS pharyngitis is related to patient gender, age, and month of the year. Diagnosis of GAS pharyngitis based on clinical features alone is unreliable.

Objectives: This study explores the roles of place attachment, nonfamily social involvement, place valuation, and individual characteristics in the process of becoming at home in assisted living residences., Methods: Purposive sampling and cross-sectional data by means of a questionnaire completed by current assisted living residents in four states (N = 297) were used to estimate a structural equation model to explain becoming at home., Results: Place attachment to town and community is a necessary but not sufficient explainer of older adults' process of becoming at home. Nonfamily social involvement plays a pivotal role through which place attachment works to explain becoming at home. Both place valuation and nonfamily social involvement exhibit direct positive effects on the outcome., Discussion: Findings support a transactional interpretation of assisted living as home. The relationship between place attachment to one's community and full integration into assisted living is more complex than currently acknowledged.

Percutaneous endoscopic gastrostomy (PEG) is now accepted as the preferred technique to establish long-term enteral feeding. A total of 30 pediatric patients (21 males and 9 females, aged from 5 months to 14 years) underwent PEG in the National Taiwan University Hospital from December 1994 to February 2001. The underlying diseases of the patients receiving PEG were neurological dysfunction ( n=26), gastrointestinal disease ( n=2) and metabolic disorders ( n=2). All patients received intravenous sedation and PEG was performed successfully. Prophylactic antibiotic treatment was given for 1 day. Tube feeding began 48 h after the placement. The Z-score of weight before and 6 months after PEG was -1.54+/-1.74 and -0.98+/-1.46, respectively, which is significant (paired t-test, p<0.0001). Accelerated weight gain was found after PEG. Complications of PEG in our patients included local wound infection ( n=15), gastrocolic fistula ( n=1), pneumoperitoneum ( n=1), dislodgement of tube ( n=6) and tube occlusion ( n=2). Of these patients 12 received button replacement after PEG and the gastrostomy tube was discontinued in 2 patients when they resumed adequate oral intake. Removal of PEG was performed in 2 patients due to complications of gastrocolic fistula and severe dislodgement. Our results encourage the use of PEG as a long-term route for nutritional supply.

Identifying children with acute pharyngitis caused by group A beta-hemolytic Streptococcus (GABHS) is an important task for pediatricians. This study examined the value of certain clinical symptoms and signs in predicting a positive culture result. A total of 442 children who presented at the outpatient department with pharyngeal erythema were enrolled. The clinical features of patients with positive throat cultures for GABHS were compared to those with negative culture results. Throat cultures were positive for GABHS in 120 (27%) patients. Patients aged between 5 and 10 years had a higher prevalence of GABHS pharyngitis. Significant differences between the groups with and without GABHS pharyngitis were noted for the presence of sore throat (p < 0.001), tonsillar swelling (p < 0.001), anterior cervical adenopathy (p = 0.004), and scarlatiniform rash (p < 0.001), but not for the presence of fever, cough, rhinorrhea, abdominal pain, headache, tonsillar exudate, or palatal petechiae. Despite these strong associations, none of these symptoms or signs had both high sensitivity and specificity, and the positive predictive values of these individual findings were never greater than 50%. The results indicate that diagnosis based on clinical grounds alone is unreliable although there are certain individual symptoms and signs that are associated with GABHS pharyngitis. These symptoms and signs may be helpful in modifying estimates of probability of infection with GABHS. Throat cultures in suspected patients remain mandatory.

Clinical pain is often characterized by repetitive and persistent occurrence in deep structures, but few studies investigated repetitive tonic pain in humans. To determine cerebral responses to repetitive tonic pain, psychophysical responses, and electroencephalographic (EEG) activation to five trials of repeated tonic muscle pain induced by hypertonic saline were examined and analyzed in 13 male subjects. The study was composed of two experimental sessions performed in separate days. Five sequential injections of hypertonic saline (5.8%) were used to induce repeated muscle pain in the left forearm, and five sequential injections of isotonic saline (0.9%) acted as control. Visual analogue scales (VAS) for pain intensity and 32-channels EEG activities were recorded simultaneously. Five trials of relatively stable muscle pain were induced by intramuscular injections of hypertonic saline, but no evident pain was induced by the injections of isotonic saline. Significant decreases in alpha-1 and -2 activities in posterior part of the head were found during repeated muscle pain in comparison with non-pain. In comparison with baseline, alpha-1 and -2 activities reduced significantly during the first two trials, and gradually resumed in the following three trials of muscle pain. However, beta-2 activity increased consistently throughout the five trials of muscle pain compared to baseline. Alpha-1 activity was negatively, but beta-2 activity was positively correlated to the pain intensity and pain area on the skin. Throughout five injections, the reduction of alpha-1 activity was contrary to the changes of pain intensity. These results indicates that pain-related EEG activities were encoded by the pain intensity. The thalamo-cortical system and descending inhibitory neuronal networks may be involved in the regulation of pain intensity.

The specificity of electroencephalogram (EEG) activity in relation to processing of human pain needs further elucidation. This study was designed to determine if nociceptive input and general arousal responses to external stimulation exert different effects on EEG activity. Continuous aversive auditory stimuli (90 dB for 2 min) and painful injection of hypertonic saline (5.8%, 0.2 ml) into the left brachioradialis muscle were administered to 12 male subjects during separate sessions in a counterbalanced design. Intensity, arousal and unpleasantness were assessed during the muscle pain and auditory stimulation using a visual analogue scale and arousal-affective scales. The EEG data (32 channels) was acquired before, during and after application of painful and aversive auditory stimuli. Aversive auditory stimulation and intramuscular injection of hypertonic saline induced similar degrees of arousal and unpleasantness associated with a similarity of intensity of sensation of pain and auditory sensation. However, muscle pain induced a significant decrease of alpha-1 activity (8-14 Hz) at T6, PC2, PC6, Pz, P4, O2 and POz sites compared to the baseline, but aversive auditory stimulation did not produce any significant changes in alpha-1 activity compared to baseline. The alpha-1 EEG powers at P3, Pz, P4, PC1, PC2 and POz, and alpha-2 at Pz and POz sites were significantly decreased during muscle pain when compared with aversive noise stimulation. These results indicate that specific EEG patterns are associated with human pain processing.

The variation rate within the coding region of UDP-glucuronosyl transferase 1A1 (UGT1A1) gene in Taiwan Chinese was found to be 29.3%. This study sought to determine whether that high variation rate of UGT1A1 gene is a risk factor for neonatal hyperbilirubinemia. The study subjects consisted of 123 newborn infants suffering from unconjugated hyperbilirubinemia who had no known risk factors for hyperbilirubinemia and 218 healthy control neonates. The promoter area, exons 1 to 4, coding region of exon 5, and the flanking intronic regions in UGT1A1 gene were determined by the PCR in all subjects. Wild UGT1A1 gene, variation in the promoter, variation at nucleotide 211, variation at nucleotide 1091, and compound heterozygous variation of UGT1A1 gene were found. The percentage of neonates with wild UGT1A1 gene and the percentage of neonates with variation at nucleotide 211 were significantly different between the study subjects and controls. The percentages with bilirubin >or=342 micro M (20.0 mg/dL) and with persistent hyperbilirubinemia in the subjects carrying homozygous variation at nucleotide 211 (Gly71Arg) were significantly higher than the neonates carrying wild type or other genotypes. In conclusion, this study has demonstrated that variation at nucleotide 211 of the UGT1A1 gene is a risk factor for the development of neonatal hyperbilirubinemia. Pediatricians should closely follow hyperbilirubinemic newborn infants who carry homozygous 211 G to A variation in UGT1A1 gene.

Background & Aims: Coinheritance of the A(TA)7TAA promoter variant in the uridine 5'-diphosphate-glucuronosyl transferase 1A1 (UGT1A1) gene and glucose-6-phosphate dehydrogenase (G6PD) deficiency is crucial to hyperbilirubinemia in white male neonates. A variation rate of 29.3% was determined within the coding region of the UGT1A1 gene in Taiwanese subjects, suggesting the hypothesis that this variation may influence incidence of hyperbilirubinemia in male neonates with G6PD deficiency., Methods: The full sequence of the UGT1A1 gene was identified for 212 G6PD-deficient and 232 control male neonates by using polymerase chain reaction (PCR)., Results: Both study and control groups were divided into 5 subgroups according to their UGT1A1 genotypes. Most subjects carried G to A variation at nucleotide 211 for both genotypes of heterozygous variation within coding region and homozygous variation. No significant differences were noted for the frequencies of the 5 UGT1A1 genotypes, gestation age, and birth weight comparing the G6PD-deficient and control groups. The incidence of hyperbilirubinemia, however, was significantly higher for the study group than for the controls. This difference was noted only for the subgroup bearing the homozygous variant of the UGT1A1 gene. In the subgroup of homozygous variation, the serum bilirubin value was significantly higher for G6PD-deficient neonates than for controls. All 11 G6PD-deficient neonates with the homozygous 211 G to A variation suffered from hyperbilirubinemia., Conclusions: The results indicate that carriage of the homozygous 211 G to A variation within the coding region in the UGT1A1 gene is an additive risk factor for neonatal hyperbilirubinemia in G6PD-deficient Taiwanese male neonates.

To explore the effects of tonic cold pain in man, the pain rating (intensity and distress), skin temperature, and continuous EEG recording were conducted before, during, and after cold pressor test (CPT) in 15 young healthy males. The acquired electroencephalogram (EEG) data was analysed in four ways: (1) comparison of EEG topographic patterns and power spectra across baseline, CPT, and post-CPT; (2) dynamic EEG changes during CPT; (3) correlation of EEG activities at the isolated focal maxima across the three experimental stages; and (4) spatial correlation of EEG powers among the focal sites during CPT. Compared to baseline, CPT induced significant differences in EEG topographic patterns and power spectra, which showed the following characteristics. (A) The delta and theta activities increased in frontal areas with maxima at F8. (B) The alpha activities decreased in the posterior part of the head with maxima at POz. (C) The beta activities increased in the peripheral bi-temporal regions. (D) The decrease of alpha and increase of beta activities occurred immediately after the onset of CPT, but the increase of delta activity showed a relatively gradual process. (E) Individual consistency was significantly observed in delta power at F8 and alpha-1 power at POz across the stages. (F) Two independent spatial clusters of EEG activation, fronto-temporal delta-theta-beta activities and posterior parietal alpha activities emerged during CPT. This new evidence and the detailed EEG effects in CPT may enhance our understanding of the dynamics in cerebral processing of tonic noxious information. Alpha reduction may reflect the attention processing in nociceptive input, and the delta/theta/beta activation may be related to the motivational modulation of the brain.

To clarify the specific effects of muscle pain on electroencephalogram (EEG) activation in man, painful and non-painful sensations were produced by intramuscular injections of capsaicin and vehicle solution in the left brachioradialis muscle, with identical procedures in 15 male volunteers. Thirty-one channel EEG data acquired before, during and after the two injections were analysed and compared in respect of topography and power spectrum. Although the painful and non-painful muscular stimulations evoked similar EEG topographic patterns, statistics demonstrated that distinct EEG activation over different areas of the head were induced by the painful and non-painful stimulation compared with the baselines. The decreases in theta and alpha-1 (8-10.5 Hz) activity in central and posterior parietal parts were evoked by non-painful stimulation, but the decreases in alpha-1 and alpha-2 (11-13.5 Hz) activities in the posterior part of the head were induced by painful stimulation. The alpha-2 activity augmented during the waning pain following a decrease in the overt pain. Comparing the EEG changes between baseline, non-painful and painful stimulations as well as waning pain, we found that the increase in beta-2 activity during muscle pain was significant over the extensive areas of the head, whereas a significant increase in alpha-2 activity took place at the posterior part of the head during waning pain following a marked decrease in overt pain. These results may imply that the painful and non-painful muscular stimulations evoke distinct EEG activation in different neural networks of the human brain and the intensity of nociceptive input from muscle may encode the variety of topographic EEG changes.

To examine the specific effects of cutaneous pain on electroencephalographic (EEG) activities, tonic painful and non-painful sensations in left forearm were induced by intradermal injection of capsaicin 100 microg/20microl and the same volume of vehicle, respectively, in 15 healthy males. The EEG data acquired in five experimental conditions: (i) baseline A; (ii) non-painful vehicle injection; (iii) baseline B; (iv) painful capsaicin injection and (v) waning pain, were analyzed and compared with analysis of variance. Only the painful capsaicin injection evoked significant decreases of theta, alpha-1 and alpha-2 powers over the centro-parieto-occipital regions compared with baseline B. No significant difference in EEG activation between the non-painful vehicle injection and painful capsaicin injection was found. This implicates that the observed topographic EEG activation is not specific for pain but probably related to the cutaneous stimulation.

Background: Several metabolic disorders such as encephalopathy and hepatic dysfunction have been described as Reye's-like syndrome because they present with similar clinical manifestations that mimic Reye's syndrome. We performed a retrospective study to explore the underlying metabolic etiologies of Reye's-like syndrome in patients treated at National Taiwan University Hospital., Methods: From January 1991 to June 1998, 19 children with a syndrome fitting the Reye's-like syndrome description were identified for study. Urine organic acid analysis, plasma amino acid analysis, liver pathology, and skin fibroblast enzyme assays were studied during the acute stage of illness., Results: The etiologies of patients' syndromes included urea cycle disorders (n = 7), glycogen storage disease type Ia (4), primary carnitine deficiency (2), hereditary fructose intolerance (1), methylmalonic acidemia (2), and 3-hydroxy-3-methylglutaric acidemia (1). Fatty acid oxidation defects were suspected in the remaining two cases., Conclusions: A significant number of patients who present with Reye's-like syndrome have an underlying inherited metabolic disorder. In patients with Reye's-like syndrome, an accurate diagnosis is essential to ensure normal growth and development and to prevent recurrence of the condition.

A prematurely born 5-year-old boy with chronic lung disease, hypoxic-ischemic encephalopathy, cerebral palsy, repeated aspiration pneumonia, and stroke underwent percutaneous endoscopic jejunostomy (PEJ) to alleviate repeated aspiration pneumonia. Studies, including 24-hour esophageal pH monitoring, 99mTc gastric emptying time, upper gastroesophageal barium radiography, and endoscopic examinations showed severe gastroesophageal reflux and prolonged gastric emptying. Percutaneous endoscopic gastrostomy (PEG) was performed first, followed by placement of a polyurethane J-tube (9 French) through the preexisting gastrostomy site. We passed the style-guided J-tube through the pyloric ring endoscopically and advanced it to the jejunum. The position of the J-tube was confirmed by radiologic study. Feeding with an elemental formula, 20 mL/hour, commenced immediately after the procedure, and the rate was gradually increased to 50 mL/hour. No further episodes of aspiration pneumonia have occurred since J-tube placement. Our initial experience with jejunal feeding through a PEJ is encouraging.

A study was undertaken to evaluate the safety and immunogenicity of a combination vaccine (TETRAMUNE) of conjugate Haemophilus influenzae type b (Hib) vaccine (HibTITER) and DTP (Diphtheria, Tetanus and Pertussis) vaccine. A total of 93 healthy children were randomized to receive either TETRAMUNE (combined group), or DTP and HibTITER administered concurrently (separate group) in separate syringes at approximately 2, 4 and 6 months of age in Taiwan. Serologic responses were largely comparable between the two vaccine groups; almost all subjects were seropositive to Hib PRP (polyribosylribitol phosphate) and were protected against diphtheria and tetanus after 2 doses of vaccine and mounted prominent responses to the components of Bordetella pertussis. Subjects in the combined group did not experience more adverse reactions compared with those in the separate group. We concluded that HibTITER was highly immunogenic and safe when administered concurrently with DTP vaccine to Taiwanese children. TETRAMUNE was also safe and immunogenic and might reduce the number of injections to achieve the same protection.

A gene encoding the rice 16.9-kDa class I low-molecular-mass (LMM) heat-shock protein (HSP), Oshsp16.9, was introduced into Escherichia coli using the pGEX-2T expression vector to analyze the possible function of this LMM HSP under heat stress. It is known that E. coli does not normally produce class I LMM HSPs. We compared the survivability of E. coli XL1-Blue cells transformed with a recombinant plasmid containing a glutathione S-transferase (GST)-Oshsp16.9 fusion protein (pGST-FL cells) with the control E. coli cells transformed with the pGEX-2T vector (pGST cells) under heat-shock (HS) after isopropyl beta-D-thiogalactopyranoside induction. The pGST-FL cells demonstrated thermotolerance at 47.5 degrees C, a treatment that was lethal to the pGST cells. When the cell lysates from these two E. coli transformants were heated at 55 degrees C, the amount of protein denatured in the pGST-FL cells was 50% less than that of the pGST cells. Similar results as pGST-FL cells were obtained in pGST-N78 cells (cells produced a fusion protein with only the N-terminal 78 aa in the Oshsp16.9 portion) but not in pGST-C108 cells (cells produced a fusion protein with C-terminal 108 aa in the Oshsp16.9 portion). The acquired thermotolerant pGST-FL cells synthesized three types of HSPs, including the 76-, 73-, and 64-kDa proteins according to their abundance at a lethal temperature of 47.5 degrees C. This finding indicates that a plant class I LMM HSP, when effectively expressed in transformed prokaryotic cells that do not normally synthesize this class of LMM HSPs, may directly or indirectly increase thermotolerance.

Cystic lymphangioma is a developmental malformation of the lymphatic system. It is extremely rare for this type of tumor to arise from retroperitoneum in newborns. We present a male mature newborn infant with a retroperitoneal cystic lymphangioma proven by autopsy. The clinical manifestation of chylous ascites may mimic retroperitoneal cystic lymphangioma. The finding in supine abdomen X ray and abdominal sonography may help us to make some differential diagnosis.

A study was undertaken to evaluate the safety and immunongenicity of a conjugate Haemophilus influenzae type b (Hib) vaccine (HibTITER) when administered concurrently with DTP (diphteria, tetanus and pertussis) vaccine in separate syringes. A total of 90 healthy children (45 per group) were randomized to receive either TETRAMUNE, a vaccine combining HibTITER with whole-cell DTP (group A), or DTP and HibTITER administered concurrently (group B) in separate syringes at approximately 2, 4 and 6 months of age in Taiwan. All children in group B achieved anti-Hib PRP (polyribosylribitol phosphate) antibody titers above 0.15 microgram/ml and 91% developed antibody titers above 1.0 microgram/ml following the third immunization. Incidences of adverse reactions were comparable between groups A and B. Besides, the incidences of adverse reactions were not significantly more frequent compared with DTP vaccination alone. We concluded that HibTITER was highly immunogenic and safe when administered concurrently with DTP vaccine to Taiwanese children. TETRAMUNE was also safe and the number of injections may be reduced in the future.

A male newborn had a well-circumscribed, solid mass on the right anterior chest wall at birth. Computed tomography disclosed an infiltrating soft-tissue mass over the right 6th to 9th ribs near the costochondral junction. Surgical excision was done at the age of 5 days. Pathologic examination showed lipoblastomatosis.

A 9-year-old girl developed a progressive unsteady gait for one month. Hyperactive reflexes of the four extremities and a spasticity of the lower extremities were found. Bilateral Babinski responses were elicited. An intradural extramedullary mass of upper thoracic spinal cord was demonstrated using magnetic resonance imaging and was confirmed as an intradural extramedullary epidermoid cyst at surgery. This epidermoid cyst was from congenital origin. No congenital anomalies such as spina bifida or dermal sinus were associated. The epidemiology, clinical features, radiology, surgical treatment and pathology of this benign tumor are discussed.

A novel cDNA clone, Oshp18.0 cDNA, encoding a rice (Oryza sativa L. cv. Tainong 67) 18.0-kDa heat-shock protein (HSP), was isolated from a cDNA library of heat-shocked rice seedlings by use of the rice HSP cDNA, Oshsp17.3 cDNA, as a probe. The sequence showed that Oshsp18.0 cDNA contains a 749-bp insert encoding an ORF of 160 amino acids, with a predicted molecular mass of 18.0 kDa and a pI of 7.3. Sequence comparison reveals that Oshsp18.0 cDNA is highly homologous to other low-molecular-weight (LMW) HSP cDNAs. Also, the results of hybrid-selected in vitro translation clearly establish that Oshsp18.0 cDNA is the rice 18.0-kDa LMW HSP-encoding cDNA clone. The recombinant Oshsp18.0 fusion protein produced in Escherichia coli was of the size predicted, and was recognized by the class-I rice 16.9-kDa HSP antiserum. The results suggest that Oshsp18.0 cDNA is an 18.0-kDa class-I LMW HSP- encoding cDNA clone from rice.

It is difficult to obtain large amounts of purified low-molecular-mass heat shock proteins (LMM HSPs), which are unique to plants, for biochemical and physiological studies. Therefore, an attempt was made to produce such a HSP by applying recombinant DNA technology. We fused the cDNA for a rice class I 16.9-kDa HSP, pTS1, to the gene for glutathione S-transferase (GST) of Schistosoma japonicum and we obtained large amounts of the fusion protein from transformed Escherichia coli cells. In addition, we found that the 16.9-kDa HSP obtained by cleavage of the recombinant protein could also form a protein complex of approximately 310 kDa under nondenaturing conditions as can the small, native, class I HSPs from heat-shocked rice seedlings. An assay in vitro to examine the thermoprotection of rice soluble proteins from heat denaturation revealed the strong stabilizing effect of the recombinant HSP.

A cDNA clone pCZ1, with a 1.1 kb insert, was isolated from a NaCl-adapted tobacco cell cDNA library that encodes an apparently full-length 29 kDa protein (251 amino acids) with a calculated pI of 5.7. The encoded peptide had a high amino acid sequence identity with bovine 14-3-3 protein which was originally found as an abundant protein in the animal central nervous system. Recently, proteins with sequence identity to 14-3-3 protein have also been found in plants, insects and yeast, and appear to have diverse physiological functions. Similar to the bovine brain 14-3-3 protein, the recombinant pCZ1 protein stimulated ADP-ribosylation of protein substrate by ADP-ribosyltransferase from the plant and animal pathogenic bacterium Pseudomonas aeruginosa. This recombinant protein also inhibited protein kinase C activity in vitro. Southern blot analyses indicated that most likely five genes encoding 14-3-3-like proteins are present in tobacco. The pCZ1 cDNA insert hybridized to a single mRNA of 1.1 kb from cultured tobacco cells. The level of this mRNA transcript in tobacco cells was downregulated upon adaptation to NaCl but was unaffected by short-term treatment with NaCl, ABA or ethylene. In tobacco plants, expression of transcript that hybridized to pCZ1 was tissue specific, and was most abundant in roots and flower parts. Monoclonal antibody raised against GF14 protein, a maize protein with substantial sequence identity with 14-3-3 protein detected two bands on SDS-PAGE of total proteins from unadapted tobacco cells and only a single band from cells adapted to NaCl. The GF14 antibody was also used to illustrate that the G-box element of a salt-induced gene is associated with a 14-3-3-type protein.

This article describes the applications (both real and potential) of a new antiviral strategy, based on the use of antisense, catalytic RNAs (ribozymes) as therapeutic agents. An understanding of both antisense inhibition of gene expression and RNA autocleavage reactions are essential to the use of this technology. In addition, for the successful application of this technology in clinical settings, an interdisciplinary approach involving clinicians, molecular and cellular biologists, will be necessary. The following treatise will highlight several salient features of ribozyme technology, emphasizing its application as an antiviral as well as discuss some problems and potential solutions pertinent to the clinical application of this technology.

Parental attitude and adjustment were examined in 20 epileptic children (ages 6.8-16.6 yrs), using semi-structured interview. The results indicated that parental understandings of epilepsy were generally poor and incorrect. Fifteen (75%) of 20 parents had their own interpretations of causality and 19 (95%) had unrealistic hope for early and complete cure. Parents tended to overprotect and overrestrict their children. Sixteen (80%) concealed the illness for fear of social prejudice, therefore the social support systems were generally poorly utilized. As in other chronic diseases, all parents went through feelings of shock, denial, anger, guilt, fear, anxiety and depression. Family relationships were not affected much, however, poor communications were commonly found between parents and children. Thirteen (65%) parents never talked to their children about epilepsy. We concluded that parents of epileptic children showed negative attitudes toward their children and had difficulties in their psychosocial adjustment probably related to social stigmata and misunderstanding of the illness. Therefore, communication between physician and parents in both medical and psychosocial aspects should be encouraged.

A randomized controlled trial of several strategies designed to reduce the use of laboratory tests by house staff was performed in two parts. Part 1 compared cost education, cost audits, and both methods combined, all after a baseline observation period. Significant reductions were achieved only in the combination group for the categories of total tests (9.4%) and Sequential Multiple Analysis (SMA)-12 (10.8%), but not for charges, SMA-6, or complete blood cell counts (CBCs). Part 2 compared a group subjected to faculty chart review with a control group. Significant reductions in total charges (9.8%), total tests (15.1%), SMA-12s (20.6%), SMA-6s (12.5%), and CBCs (18.5%) were observed in the intervention group, as compared with the control group. Among the methods examined, faculty chart review seems to be the most effective method of reducing the amount of laboratory testing performed by house staff.

The chemicals fenitrothion, nitroso fenitrothion, amino fenitrothion and 3-methyl-4-nitrophenol were tested for mutagenicity to Salmonella typhimurium strains TA98 and TA100, both in the presence and absence of rat liver S-9 mix. The strong mutagenicity of nitroso fenitrothion to both strains either in the presence or absence of S-9 mix contrasted with the observation that fenitrothion displayed no mutagenicity in these tester strains. The results suggest that the normal nitroreductases present in TA98 and TA100 cannot metabolize fenitrothion to a mutagenic metabolite. This inability of the tester strains to effect partial nitroreduction results in the failure of this screening system to predict the potential genotoxicity of this pesticide.