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

Colorectal carcinoma (CRC) is characterized by unlimited proliferation and suppression of apoptosis, selective advantages for tumor survival, and chemoresistance. Lipopolysaccharide (LPS) signaling is involved in both epithelial homeostasis and tumorigenesis, but the relative roles had by LPS receptor subunits CD14 and Toll-like receptor 4 (TLR4) are poorly understood. Our study showed that normal human colonocytes were CD14(+)TLR4(-), whereas cancerous tissues were CD14(+)TLR4(+), by immunofluorescent staining. Using a chemical-induced CRC model, increased epithelial apoptosis and decreased tumor multiplicity and sizes were observed in TLR4-mutant mice compared with wild-type (WT) mice with CD14(+)TLR4(+) colonocytes. WT mice intracolonically administered a TLR4 antagonist displayed tumor reduction associated with enhanced apoptosis in cancerous tissues. Mucosa-associated LPS content was elevated in response to CRC induction. Epithelial apoptosis induced by LPS hypersensitivity in TLR4-mutant mice was prevented by intracolonic administration of neutralizing anti-CD14. Moreover, LPS-induced apoptosis was observed in primary colonic organoid cultures derived from TLR4 mutant but not WT murine crypts. Gene silencing of TLR4 increased cell apoptosis in WT organoids, whereas knockdown of CD14 ablated cell death in TLR4-mutant organoids. In vitro studies showed that LPS challenge caused apoptosis in Caco-2 cells (CD14(+)TLR4(-)) in a CD14-, phosphatidylcholine-specific phospholipase C-, sphingomyelinase-, and protein kinase C-ζ-dependent manner. Conversely, expression of functional but not mutant TLR4 (Asp299Gly, Thr399Ile, and Pro714His) rescued cells from LPS/CD14-induced apoptosis. In summary, CD14-mediated lipid signaling induced epithelial apoptosis, whereas TLR4 antagonistically promoted cell survival and cancer development. Our findings indicate that dysfunction in the CD14/TLR4 antagonism may contribute to normal epithelial transition to carcinogenesis, and provide novel strategies for intervention against colorectal cancer.

Cytotoxicity and mutagenicity of tremolite, erionite and the man-made ceramic (RCF-1) fibre were studied using the human– hamster hybrid A L cells. Results from these fibres were compared with those of UICC Rhodesian chrysotile fibres. The A L cell mutation assay, based on the S1 gene marker located on human chromosome 11, the only human chromosome contained in the hybrid cell, has been shown to be more sensitive than conventional assays in detecting deletion mutations. Tremolite, erionite and RCF-1 fibres were significantly less cytotoxic to A L cells than chrysotile. Mutagenesis studies at the HPRT locus revealed no significant mutant yield with any of these fibres. In contrast, both erionite and tremolite induced dose-dependent S1− mutations in fibre-exposed cells, with the former inducing a significantly higher mutant yield than the latter fibre type. On the other hand, RCF-1 fibres were largely non-mutagenic. At equitoxic doses (cell survival at ∼ 0.7), erionite was found to be the most potent mutagen among the three fibres tested and at a level comparable to that of chrysotile fibres. These results indicate that RCF-1 fibres are non-genotoxic under the conditions used in the studies and suggest that the high mesothelioma incidence previously observed in hamster may either be a result of selective sensitivity of hamster pleura to fibre-induced chronic irritation or as a result of prolonged fibre treatment. Furthermore, the relatively high mutagenic potential for erionite is consistent with its documented carcinogenicity. © 1999 Cancer Research Campaign

The prevalence of goitre was determined in several communities in rural parts of Pahang. Urine specimens were collected randomly among the participants. Drinking water from various sources such as river and spring, and water from gravity feed systems was also collected to determine the iodine content by using the ashing method. The results were compared to that of Kuala Lumpur City. lt was found that the prevalence of goitre in rural areas was between 20 and 70% depending on village, ethnic group, age and gender. The interior parts of the jungle where Aborigines lived was moderately endemic with goitre prevalence of goitre more than 20% and urinary iodine content 2.0-5.0 μg I/dl). A nearby Malay traditional village which was studied had mild endemia (prevalence 10-30% and urinary iodine content 5.0-10.0 μg I/dl) while a Felda Malay resettlement scheme and Kuala Lumpur City did not have endemic goitre. Endemic goitre in rural areas was associated with low iodine content in drinking water. Even though Kuala Lumpur had low iodine content in its drinking water there was no endemic goitre, indicating that other factors were more important.

The relationship between malnutrition, goitre and thyroid hormones was studied among Aborigines and Malays in Ulu Langat, Malaysia. Fifty Aborigines aged=7years were selected randomly for anthropometric, clinical and hormonal assessment. Fifty Malays of similar age from the nearby Malay village were chosen as controls. The Aborigines had a higher prevalence of malnutrition and goitre compared to the Malays. The prevalence of goitre was 26.5% amongst Aborigines and 19.6% among the Malays. All the nutritional indexes measured were significantly different between the two communities, especially among females. The differences corresponded to significant differences in levels of thyroid-stimulating hormone (TSH) measured using a highly sensitive TSH assay. By univariate analysis the increase in TSH corresponded to the decrease in body mass index (BMI). On the other hand, no association was found between BMI and goitres. No thyroid autoantibodies were detected and all subjects were clinically euthyroid and had normal thyroxine and triidothyronine levels. However, consumption of cassava conferred a four-fold risk of developing goitres. The high prevalence of goitres in malnourished subjects in this region which is not known to be iodine deficient could be due to cassava consumption.

Insulin-like growth factor-I (IGF-I)and fasting growth hormone levels were measured in a group of 255 children (163 males and 92 females. age ranged 6-17 years) of varying pubertal development and body mass index (BMI); well-nourished (BMI18). mildly-malnourished (BMI = 15-18) and moderately-malnourished (BMI15). In well-nourished children IGF-I levels increased significantly (P = 0.02) with pubertal development. where girls at Tanner 5 had significantly higher (p = 0.03) IGF-I levels than the boys. Whilst there was no change in fasting GH levels with nutritional status, IGF-I levels of prepubertal boys and girls decreased significantly with BMI (P0.001 and P = 0.01 respectively). Hence. measurement of IGF-I levels is a sensitive biochemical index in the assessment of mild and moderate form of malnutrition in prepubertal children.

This article presents results of a statistically designed program conducted to validate the feasibility of using the relationship of mechanical properties and metal volume fraction in fiber/metal laminates to make property predictions. Experimental and analytical practices employed to obtain these mechanical properties for tension, compression, in-plane shear, and bearing are described. Results from this pilot study conclude that the use of metal volume fraction may be useful for the prediction of strength mechanical properties in fiber/metal laminates. However, this needs further study to validate the concept. If the hypothesis is valid, the number of laminate configurations to be tested to qualify a fiber/metal laminate family can be minimized. The findings imply that a metal volume fraction approach using a rule-of-mixtures can be exploited to estimate design properties for a multitude of fiber/metal laminate variants, which is economically beneficial to preliminary stages of aircraft design.

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) is a common autosomal recessive disorder. Our objective was to identify the 21-hydroxylase active gene, CYP21A2 mutations in Malaysian 21-OHD patients using different techniques.Blood samples were obtained from 97 Malaysian 21-OHD patients, which included 40 siblings from 19 families. We used various techniques which include restriction enzyme digestion, Southern blot, multiple ligation-dependent probe amplification (MLPA) and sequencing to elucidate CYP21A2 mutations.Homozygous and compound heterozygous mutations were identified in 95 of the 97 patients (98%). Deletions of CYP21A2 were found in 43 patients (44.3%). Deletions identified in CYP21A2 gene were the usual 30-kb deletion comprising 3'UTR CYP21A1P, C4B and 5'CYP21A2, complete deletion of CYP21A2 gene, deletion in exons 1-3, exons 1-6 and exons 1-8 of CYP21A2. The common mutations identified in CYP21A2 gene were deletion/conversion (22.6%), p.R356W (22%), IVS2-13A/CG (21.3%), p.I172N (5.3%), p.Q318X (5.3%), and p.P30L (1.03%). This is the first report of the mutation frequency in CYP21A2 gene among the Malay ethnic group. Two novel mutations, c.Y97insT and p.L345P were identified in our patients. Our results show good phenotype-genotype correlation in most of the cases, although clinical variations were identified in some patients.The study has found various mutations including deletions in CYP21A2 gene in Malaysian patients with 21-hydroxylase deficiency using the MLPA technique that is being widely used in present laboratory settings.

Hospital UKM (Universiti Kebangsaan Malaysia) introduced the use of insulin pump therapy in children and adolescents with Type 1 Diabetes in Malaysia in April 2004. This study aims to evaluate the effectiveness of pump therapy and its impact on metabolic control among patients from our institution. Insulin pump therapy resulted in sustainable improvement in glycemic control throughout the six years of treatment with reduction in HbA1c in the first two years of pump use was statistically significant. The BMI SDS showed an increase trend but the changes before and after pump use was insignificant. There is also high level of treatment satisfaction reported among our insulin pump patients.

This paper is a continuation of the research work reported on earlier in Part I: a study of tension test specimens for laminated hybrid composites. Effects of specimen size and alignment of the tensile testing machine were investigated. It is demonstrated that the variation of strength with size is significant, and alignment of the testing machine is critical. In summary, the use of a straight-sided specimen for tension testing of fibre-metal laminates is recommended. However, if one can maintain good control of alignment from the tensile testing machine, use of a dogbone-type test specimen is also applicable. The effect of specimen size on the strength of fibre-metal laminates is also examined in this study. The strength of fibre-metal laminates exhibits no size (width) effect over the range 6.4 to 38.1 mm, holding the strain rate constant.

Excellent fatigue, static strength and damage tolerance characteristics together with low density make fibre-reinforced aluminium laminates a prime candidate sheet material for application in fatigue- and fracture-critical aircraft structures. Their use requires that mechanical property design allowables be established for incorporation in design handbooks (e.g. MIL-HDBK-5). An experimental programme based on statistical design was conducted to establish a meaningful test procedure for determination of fibre-metal laminate bearing strength design allowables. The test procedures investigated are the pin-type bearing test method (ASTM E-238) and the bolt-type bearing test method, a modified method based on the procedure for bearing strength determinations in plastics (ASTM D-953). Results are presented from an experimental programme which measured the bearing strengths of two grades of S-2 glass-based and one grade of aramid-based aluminium laminates. The influences of lateral constraint and ply orientation on bearing strength and failure mode are shown. The bolt-type bearing test method, which combines the attributes of the two aforementioned methods, is recommended. The study also showed that the bearing properties for edge distance ratio e/D = 2 can be predicted by correlation with the aluminium volume fraction in fibre-reinforced aluminium laminates. In addition, diagrams of joint structural efficiency, shown to be comparable to those of aluminium alloy sheets, have been established.

This paper presents the results of a statistically designed programme conducted to validate feasibility of using the relationship of mechanical properties and metal volume fraction in fibre-metal laminates to make property predictions. Experimental and analytical practices employed to obtain these mechanical properties for tension, compression, in-plane shear, and bearing are described. Results from this pilot study show that use of the metal volume fraction may be useful for the prediction of strength mechanical properties in fibre-metal laminates. However, this needs further study to validate the concept. If the hypothesis is valid, the number of laminate configurations to be tested to qualify a fibre-metal laminate family can be minimized. The findings imply that the metal volume fraction approach using a rule of mixtures can be exploited to estimate design properties for a multitude of fibre-metal laminate variants, which is economically beneficial to the preliminary stages of aircraft design.

Statistical strength and size effect of Nicalon fibre bundles are studied. The Weibull type of statistical theory underlying predictions of bounding Nicalon fibre bundle strength is presented and discussed. The relationship of bundle strength to single Nicalon filament strength and a model explaining the correlation are also discussed. The predicted values for Nicalon fibre bundles were in close agreement with the experimental data. Characterization of Nicalon fibres or bundles provides an insight into the ultimate mechanical performance of ceramic-matrix composites.

In order to improve the accuracy of interface capturing and keeping the computational efficiency, an adaptive VOF method on unstructured grid is proposed in this paper. The volume fraction in each cell is regarded as the criterion to locally refine the interface cell. With the movement of interface, new interface cells (0 ≤ f ≤ 1) are subdivided into child cells, while those child cells that no longer contain interface will be merged back into the original parent cell. In order to avoid the complicated redistribution of volume fraction during the subdivision and amalgamation procedure, a predictor‐corrector algorithm is proposed to implement the subdivision and amalgamation procedures only in empty or full cell ( f = 0 or 1). Thus volume fraction in the new cell can take the value from the original cell directly, and the interpolation of the interface is avoided. The advantage of this method is that the re‐generation of the whole grid system is not necessary, so its implementation is very efficient. Moreover, an advection flow test of a hollow square was performed, and the relative shape error of the result obtained by adaptive mesh is smaller than those by non‐refined grid, which verifies the validation of our method.

Data from several different studies are reviewed suggesting that a subset of hypertension is associated with metabolic abnormalities involving lipids, insulin, and often obesity, all aggregating strongly in families. Persons with 'familial dyslipidaemic hypertension (FDH)' have an especially high risk of early coronary disease. The clinical and biochemical features of FDH are compared with Reaven's Syndrome X, familial combined hyperlipidaemia, dense LDL subfractions, diabetes, impaired glucose tolerance, central and general obesity, pre-diabetes, pre-hypertension, and heterozygous lipoprotein lipase deficiency. Some contribution from major gene effects is suggested in specific subsets reported in several different genetic studies reviewed in this report. It seems likely that multiple metabolic abnormalities are genetically heterogeneous. The data also suggest significant contributions from environmental factors such as diet and physical activity.

Micropenis may be an important sign of underlying hypogonadism or pituitary hypofunction in the neonatal period. Penile lengths of normal newborns have been reported in many Western populations. However, the data may not be applicable in the Asian or the multiracial Malaysian population. Our study aimed to establish the normal penile length and testicular volume in term newborn infants in the major ethnic groups in Malaysia.The stretched penile length and testicular volume were measured in 340 normal term newborn infants (195 Malays, 129 Chinese and 16 Indians).The mean penile length in Malay term newborn infants was 35 +/- 4 mm, which was similar to Chinese infants. The mean testicular volume was 2.5 +/- 0.6 ml in Malay and 2.4 +/- 0.5 ml in Chinese infants. There was no significant difference between the groups. The sample size for the Indian group during the study period was inadequate.Using -2.5 standard deviations as the cut-off for micropenis, a Malay or Chinese newborn infant in Malaysia with a penile length of less than 25 mm is considered to have a micropenis and further evaluation is warranted.

Newborn screening for congenital hypothyroidism (CH) was implemented in Hospital UKM in December 2004 using cord blood sample. From the audit over a period of 25 months, a total of 13,875 newborn babies were screened with a coverage of 98.8%. From this cohort, the mean recall rate was 0.32%; unfortunately the mean percentage of recalled babies that came for retesting was only 79.5%. In addition, the mean sample rejection rate was high, i.e. 2.2%. Two babies were diagnosed to have CH. These findings implied that whilst the coverage of screening was good, there is a need for regular surveillance of performance of both clinical and laboratory personnel. In addition, a more concerted effort should be carried out to promote community awareness of such a programme.

In Malaysia, Diabetes in Children and Adolescents Registry (DiCARE) was launched nationwide in August 2006 to determine and monitor the number, the time trend of diabetes mellitus (DM) patients, their socio-demographic profiles, outcome of intervention and facilitate research using this registry. This is an on going real time register of diabetic patientsor = 20 years old via the e-DiCARE, an online registration system. To date were 240 patients notified from various states in Malaysia. The mean age was 12.51 years (1.08-19.75) and 46.4% were boys. The mean age at diagnosis was 8.31 +/- 4.13 years old with an estimated duration of diabetes of 4.32 +/- 3.55 years. A total of 166/240 (69.2%) have T1DM, 42/240 (17.5%) have T2DM and 18/240 (7.5%) have other types of DM. Basis of diagnosis was known in 162 patients with T1DM and 41 patients with T2DM. In T1DM patients, 6.0% of the girls and 19.1% boys were overweight or obese. As for T2DM, 64.3% had their BMI reported: 66.7% girls and 91.6% boys were overweight or obese. Most patients (80.4%) practiced home blood glucose monitoring. Patients were seen by dietitian (66.7%), diabetes educator (50.0%), and optometrist or ophthalmologist (45.0%). Only 10.8% attended diabetic camps. In the annual census of 117 patients, the mean HbAlc level was 10.0% + 2.2 (range 5.2 to 17.0%). The early results of DiCARE served as a starting point to improve the standard of care of DM among the young in the country.

Genes on the Y chromosome are essential for normal sex determination and sex differentiation of male genitalia. However, genes on the X chromosome and other autosomes have been shown to be anti-testes and have a detrimental effect on this process. Addition of X chromosomes to the 46,XY karyotype results in seminiferous tubules dysgenesis, hypogonadism and malformed genitalia. We report a term male newborn with 49,XXXXY syndrome presenting with ambiguous genitalia, multiple extra-gonadal anomalies, facial dysmorphism, and radioulnar synostosis.

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

A series of nanoscale alkaline-free aluminosilicate mesoporous molecular sieves were prepared by microwave hydrothermal techniques for 5 to 120 minutes. These nanoscale nanoporous materials own high surface area (600≈1000 m2/g), pore volume (1.0≈2.0 m3/g), narrow pore size distribution and nano-particle size between 20 and 100 nm and four-coordinated aluminum site in major, which were characterized by XRD, N2 adsorption/desorption, TEM, SEM, ICP, 27Al solid-state NMR and cumene cracking reation. Microwave irradiation temperature and time play an important role on their properties of products. These nanoscale aluminosilicate mesoporous catalysts exhibited much higher cumene cracking activity than those prepared by hydrothermal method. The 31P MAS NMR of adsorbed trimethylphosphine oxides (TMPO) observed by Liu et al. revealed the existence of strong Bronsted acid sites at 83 ppm, which is comparable to TMPO adsorbed in conventional zeolites or dissolved in concentrated HCl or H2SO4.

Interest in selenium pollution and remediation technology has escalated during the past two decades. Although not known to be essential for plants, selenium is an essential micronutrient for humans and animals, having important benefits for their nutrition. At high concentrations, however, selenium becomes toxic to animals and humans. A major selenium controversy in the 1980s emerged in California at the Kesterson National Wildlife Refuge; hence, scientists, environmental regulators, politicians, and the general public in the United States became aware of selenium's potential as an environmental contaminant. Consequently, extensive research has been conducted in the western United States, and a vast amount of financial resources have been allocated to develop management strategies and remediation technologies for reducing the impact of naturally occurring selenium on the biological environment. A plant-based technology, defined as 'phytoremediation', has received increasing recognition as a low-cost, environmentally friendly approach for managing the toxic effects of selenium. Plants have the ability to absorb and sequester selenium and to convert inorganic selenium to volatile forms of organic compounds that are released harmlessly into the atmosphere. The present review summarizes recent research findings and information about strategies on using phytoremediation systems to detoxify selenium-contaminated soils and waters in natural and agricultural ecosystems.

To observe the roles of Galphaq/11 mediated- and platelet-derived growth factor (PDGF) mediated-signal transduction pathways in proliferation and migration of vascular smooth muscle cells (VSMC) after arterial injury, a vascular cell proliferation model was established by balloon injury in rat aorta and the morphologic changes in injured vascular walls after the injury were studied. Activities of angiotensin converting enzyme (ACE) and aorta phospholipase C (PLC) were tested, and levels of platelet-derived growth factor receptor-beta (PDGFR-beta) and Galphaq/11 protein were measured by Western blot analysis. At l day after operation, injured aortic segments showed denudation in endothelial cells. Medial VSMC proliferation and intimal hyperplasia were not observed. As compared with the sham group, ACE activities were increased by 382.7 percent; (P0.0l), but the expression of PDGFR-beta and PLC activities did not show significant changes (P0.05). In addition, the level of Galphaq/11 protein was decreased by 20.0 percent; (P0. 05). At l4 days after operation, sections of injured aorta showed marked intimal thickening with large numbers of VMSCs proliferating throughout intima and media. In comparison with the sham group, ACE activity, PLC activity and the level of PDGFR-beta were increased by 420.2 percent; (P0.01), 186.2 percent; (P0.05) and 85.0 percent; (P0.05), respectively. While the level of Galphaq/11 protein was decreased by 33.1 percent; (P0.01). The above data suggest that the PDGF-mediated signal transduction pathway plays an important role in VSMC proliferation.

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

The present study was undertaken to explore the mechanism of G protein-mediated signal transduction pathway during endothelin-1 (ET-1) pre-treatment and ischemic preconditioning (IP). Rats were divided into four groups: ET-1, IP, ischaemia-reperfusion (IR) and control groups. ET-1 pre-treatment model was prepared by administrating 0.5 nmol/(L.kg) ET-1 into rat left ventricle, whereas IP model was prepared by ligating the left coronary artery for 5 min followed by 30 min reperfusion. All the animals were subjected to 60 min regional ischaemia and 30 min reperfusion alternately and then parameters of ventricular arrhythmia and expression of cardiac Galphaq/11 and Gialpha2 were measured. The results showed that the scores of ventricular arrhythmia decreased significantly in both ET-1 and IP treated groups as compared with IR group. In comparison with control group, Galphaq/11 increased by 77.8% (P0.05) and 110.6% (P0.01) in IP and ET-1 group respectively. Gialpha2 showed no significant difference in IP group, while it decreased by 31.0% (P0.01) in ET-1 group. In conclusion, activation of G alphaq/11 may be related to the protecting mechanism of ET-1 pre-treatment and IP, whereas Gialpha2 may only play a role in ET-1 pre-treatment.

The objective of this study was to investigate the role of signal transduction pathway mediated by Galphaq/11 of the aorta in blood pressure regulation during the development of two-kidney one clip (2K1C) Glodblatt hypertension in the rat. Levels of Galphaq/11-subunit and extracellular signal regulated kinase 1/2 (ERK1/2) of the aorta were measured by Western blot analysis at week 1, 2, 4 or 8 after operation. Phospholipase C (PLC) activity of the aorta was measured by using (3)H phosphatidylinostol (4,5) bisphosphate as a substrate. Both systolic and diastolic blood pressure increased markedly in 2K1C rats at week 2, 4 or 8, whereas, the increase in Galphaq/11 and ERK1/2 expression of the aorta began at week 1 after operation (increased by 57.53% and 40.16%, respectively), and maintained at a high level during week 2 8 compared with time matched controls (P0.01). PLC activities in the aorta were also increased significantly in 2K1C groups at week 4 and 8 compared with the time matched controls (P0.05). The results indicate that Galphaq/11-mediated signal transduction pathway of the aorta is activated in 2K1C hypertension, and may contribute to the initiation and maintenance of renal hypertension.

Alteration of G proteins in rat heart during ischemia-reperfusion was studied. Levels of Gi alpha 2, Gi alpha 3 and Gs alpha in sarcolemma and light vesicle were measured by Western blot analysis. Adenyl cyclase activities were determined by radioimmunoassay. During ischemia-reperfusion, cardiac function parameters were decreased significantly. Expressions of Gs alpha remained unchanged. Compared with the control group, levels of Gi alpha 2 and Gi alpha 3 in sarcolemma in ischemia-reperfusion group increased by 37.4% (P0.01) and 42.4% (P0.01), respectively with, however, no changes in light vesicle; Activities of adenyl cyclase decreased during ischemia-reperfusion. The results suggested that the increased expression of cardiac Gi may contribute to the dysfunction of adenyl cyclase signal transduction system and the impaired cardiac function during ischemia-reperfusion.

To study the alterations of heme oxygenase-1 mRNA in neonatal rat cardiomyocytes (NRCMs) induced by lipopolysaccharide (LPS) and the role of heme oxygenase-1 (HO-1) in the LPS induced disorders of myocardium function, 10 (L, 6 h), 30 (M, 6 h), 50 micrograms/ml (H, 6 h) LPS and 10 micrograms/ml LPS + 10 mumol/ml Zn-protoporphyrin-IX (ZnPPIX; L + I, 6 h) and 10 mumol/ml ZnPPIX alone (I, 6 h) were added to the medium for a 6-hour culture of NRCMs, and 10 micrograms/ml LPS for 9 h (L, 9 h) and 18 h (L, 18 h) cultures. LDH release and MDA contents of the cells were measured. When NRCMs were collected, Trypan blue stain method was used to examine the mortality (the rate of Trypan blue uptake) of NRCMs. HO-1 mRNA expression was examined by Northern blot. The results showed that HO-1 mRNA expression of NRCMs increased gradually along with the increase of LPS concentration below the level of 30 micrograms/ml. When the final concentrations of LPS were 10 and 30 micrograms/ml, the HO-1 mRNA expression of NRCMs increased by 81.2% and 126.3% respectively compared with control. When the final concentration of LPS was 50 micrograms/ml, the HO-1 mRNA expression decreased to the level of 10 micrograms/ml group. When the final concentration was 10 micrograms/ml, the HO-1 mRNA expression increased gradually along with the culture time. After a 9- or 18-hour culture, the HO-1 mRNA expression of NRCMs increased by 93.6% and 105.8% respectively compared with control. Only when NRCMs had been cultured with 30, 50 micrograms/ml LPS and 10 micrograms/ml LPS + 10 mumol/ml ZnPPIX for 6 h and 10 micrograms/ml LPS for 18 h, the rate of Trypan blue stain uptake, MDA contents and LDH release significantly increased. With 10 micrograms/ml LPS alone and 10 mumol/ml ZnPPIX alone for 6 h, the above parameters were not significantly increased (P0.05). The results demonstrate that LPS induces HO-1 mRNA expression of NRCMs dose- and time-dependently to some extent. The inducible HO can protect NRCMs from injury and thus play an important role in pathogenesis of myocardium under LPS.

Familial type III hyperlipoproteinemia (HLP) is characterized by the presence of beta-migrating VLDL (beta-VLDL) and increased risk of cardiovascular disease. Assessment of plasma beta-VLDL is achieved by measuring the ratio of VLDL-cholesterol (VLDL-C) to total plasma triglycerides (TGs) or by detecting beta-VLDL in total VLDL. The objective of this study was to compare the clinical utility of the ratio of remnant-like particle-cholesterol (RLP-C) to total TGs with that of the current methods for diagnosing type III HLP.Detection of beta-VLDL by electrophoresis of VLDL was used to define type III HLP. Twenty-eight patients with type III HLP and 43 subjects lacking beta-VLDL were investigated. Fasting TG concentrations were2.26 mmol/L in all subjects. Subjects were separated into three groups: group 1, serum total cholesterol/=5.18 mmol/L (n = 11); group 2, total cholesterol5.18 mmol/L and TGs between 2.26 and 9.04 mmol/L (n = 51); and group 3, TGs9.04 mmol/L (n = 9).In group 2, a RLP-C-to-total TG molar ratio/=0.23 (/=0.10 when using mg/dL) and a VLDL-C-to-total TG molar ratio/=0.69 (/=0.30 when using mg/dL) correctly classified 94% and 90% of the subjects, respectively. The utility of the RLP-C-to-total TG ratio in diagnosing type III HLP decreased in patients in the other two groups.When used in an appropriate target population, the RLP-C-to-total TG ratio is a convenient and effective alternative to ultracentrifugal and electrophoretic methods for diagnosing type III HLP.

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

The finding that the systemic renin-angiotensin system (RAS) is not activated in most types of chronic renal disease has led to the suggestion that a local, intrarenal RAS may be an important determinant in the relentless progression of renal disease. Therefore, cell specific changes in various components of the RAS in response to renal mass reduction and angiotensin converting enzyme (ACE) inhibition were examined. Thirty Sprague-Dawley rats were randomly assigned to sham surgery, subtotal nephrectomy (STNx) alone or STNx treated with the ACE inhibitor, perindopril, and sacrificed after 12 weeks. In sham rats, renin mRNA and protein were only present in the juxtaglomerular apparatus. In contrast, in STNx kidneys, renin and angiotensin II expression were noted predominantly in renal tubular epithelial cells in association with overexpression of the prosclerotic cytokine, transforming growth factor-beta1 (TGF-beta1). In perindopril-treated STNx rats expression of renin and TGF-beta1 were similar to control animals. These finding indicate that following renal mass reduction there is pathological tubular expression of various components of the RAS. Furthermore, in contrast to the juxtaglomerular apparatus, tubular renin expression was reduced with ACE inhibition. These changes within the intrarenal RAS may be pathogenetically linked to the development of tubulointerstitial injury.

Clinical diagnosis of congenital hypothyroidism (CH) is difficult at birth without neonatal screening. In line with the priorities of the national health services in Malaysia towards preventive medicine, early diagnosis and treatment of CH is emphasised. We conducted a pilot study at Kuala Lumpur's Maternity Hospital between April 1995 and November 1995 to estimate the incidence of CH and also evaluated the problems associated with large-scale neonatal screening using a commercial TSH kit on cord bloodspots.A total of 11,000 newborns were screened using cord blood spots taken at birth.Two hundred and fifty newborns (2.27%) hand cord TSH20 mlU/L and had to be recalled for re-evaluation. Of these, 4 had cord TSH of100 mlU/L; three were confirmed to have congenital hypothyroidism and one had transient hyperthyrotropinaemia. Our study estimated the incidence of CH to be one in 3,666 live births in Kuala Lumpur, Malaysia. Clinical features of hypothyroidism are subtle during the early weeks of life. However, prolonged neonatal jaundice (3/3), widely opened posterior fontanelle (3/3) and dry skin (3/3) were the common features in all our cases by 2-6 weeks of life.This study suffered a high dropout rate. Twenty-six percent of the patients were not traceable after discharge and 48% did not respond to our recall. We stress the importance of public education and awareness in contributing to the cost-effectiveness of the screening program.

Traditional risk factors for coronary heart disease (CHD) include only the patient's age and family history and whether there is evidence of hypertension, elevated LDL, low HDL, diabetes or history of smoking. In recent years, considerable progress has been made in identifying a new generation of risk factors, including Lp(a). triglycerides, subfractions of HDL and LDL, modified LDL, apo E pheno/genotype, homocysteine and fibrinogen. At the same time, studies have broadened our knowledge of traditional markers. These advances have enabled physicians to make a better assessment of patient risk for CHD and to prescribe more appropriate treatment.

Local macrophage proliferation has been shown to be a major mechanism of macrophage accumulation in several immunologically-induced animal models of renal diseases. This study has explored whether local proliferation of macrophages and myofibroblasts contribute to their accumulation in rat remnant kidney model and investigated the role of angiotensin II (Ang II) in these cellular pathological events by blocking the angiotensin II activity with ramipril, and angiotensin converting enzyme (ACE) inhibitor, or valsartan, an Ang II type 1 receptor antagonist. There was local proliferation of macrophages and myofibroblasts within renal parenchyma following renal ablation, contributing significantly to macrophage and myofibroblasts accumulation, renal dysfunction and fibrosis. Both treatment resulted in inhibition of local proliferation of macrophages and myofibroblasts and this was associated with attenuation of renal injury. In conclusion, inhibition of local macrophage and myofibroblast proliferation may be an important mechanism by which Ang II blockade attenuated renal injury following renal ablation.

Oxidized LDL, not the native LDL, promotes atherosclerosis. However, ox-LDL is usually undetectable in the blood circulation. Autoantibodies against ox-LDL (gamma ox-LDL), on the other hand, are not only measurable in the blood but may also reflect the extent of in vivo oxidation of native LDL and provide any early sign of risk for atherosclerosis. Current assay for gamma ox-LDL needs improvement. Routine clinical application of this assay has to wait until all parameters of this assay are defined and characterized.

The effect of quantum barrier (QB) thickness on performances of InGaN/GaN multiple-quantum-well light-emitting diodes (MQW LEDs) with relatively large barrier layer thicknesses has been investigated. It is found that the density and averaged size of V-defects increases with QB thickness, resulting in larger reverse- and forward-bias current in LEDs. Electroluminescence measurement shows that LED with thinner QB has higher internal quantum efficiency but lower efficiency droop-onset current density, which should be ascribed to the faster saturation of carrier leakage into V-defects. Correspondingly, above the droop-onset current density, severer Auger recombination and carrier overflow are induced by higher carrier density due to the less V-defect related carrier leakage, leading to the more serious droop phenomenon in LEDs with thinner QB.

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

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

To study the effects of Arg-Gly-Asp-Ser (RGDS), a synthetic short peptide of fibrinogen degradation, on the Ca2+ transport function of cardiac sarcoplasmic reticulum in rat septic shock.RGDS 5 mumol.kg-1 was injected i.v. at 4 h and 14 h after cecal ligation and puncture (CLP) operation on rats. Highly purified membrane of sarcoplasmic reticulum (SR) was prepared from rat hearts. Assays were made of ATP-dependent Ca2+ uptake by cardiac SR and [3H] ryanodine binding to SR.The initial rate and the capacity of SR Ca2+ uptake were increased by 104% (P0.01) and 12% (P0.05), respectively, paralleled by an increase in Ca(2+)-ATPase activity and a decrease in calcium accumulation of myo- cardium of septic rats, whereas the Bmax and Kd values of Ca2+ activated [3H]ryanodine binding to SR were unaffected after RGDS administration.The results indicated that RGDS have cardioprotective effects of maintaining Ca2+ homeostasis of cardiac myocytes by enhancing SR Ca2+ uptake in rat septic shock.

In the present study, rat cardiac sarcoplasmic reticulum (SR) phospholamban (PLB) phosphatase was partially purified by chromatography on DEAE-Sephacel. This PLB phosphatase was indentical to phosphatase-1. It was shown on electrophoresis of SDS-PAGE autoradiography that the PLB phosphatase in rats during early sepsis (ES) depressed dephosphorylation of substrates (32P-phosphorylase a and 32P-SR). However, dephosphorylation of the substrates by the partially purified phosphatase during late sepsis (LS) was same as that in control rats. The partially purified PLB phosphatase activity in ES rats was significantly decreased, but showed no change in LS rats. The results above were confirmed by a studing of the substrate concentration (enzyme concentration, time)--enzyme reaction velocity curve in showing that both affinity and maximum initial velocity (Vmax) of the phosphatase in the ES rats were decreased, but had no change in those in the LS rats.

The underlying mechanism of Ca2+ uptake function of cardiac sarcoplasmic reticulum (SR) was investigated in the rat septic shock model produced by cecal ligation and puncture (CLP). The results are as follows. During the early phase of sepsis, the initial rate of ATP-dependent Ca2+ uptake by SR was decreased, while both the capacity of Ca2+ uptake and the activity of Ca(2+)-ATPase were unaffected. In the late sepsis, the impairment in SR function was even greater as the initial rate and the capacity of Ca2+ uptake by SR were significantly decreased, and this was paralleled by a reduction in Ca(2+)-ATPase activity. Although Ca2+ affinity (Km value) to calcium pump and the A0.5 values for Mg2+ and ATP activation on the Ca2+ uptake rate were unchanged, during sepsis the phosphorylation of SR vesicles by adding of catalytic subunit of the cAMP-dependent protein kinase (PKA), calmodulin, or the fragment of PKC into Ca2+ uptake buffer, failed to stimulate Ca2+ uptake activities of SR isolated from early or late septic rats. These data suggest that depression of cardiac SR function is aggravated as sepsis develops, the impairment of SR Ca2+ uptake is possibly based on a mechanism of defective phosphorylation of SR rather than the ionic and energic regulatory actions of Ca2+, Mg2+, ATP on cardiac SR.

The present study was undertaken to observe the changes of Ryanodine receptor of cardiac junctional sarcoplasmic reticulum (SR) in relation to membrane lipid microenvironment alteration during septic shock. The results showed that the Bmax for 3H-ryanodine binding to cardiac junctional SR was decreased by 41.3% (3.9 +/- 0.1 vs. sham 6.6 +/- 0.7 pmol/mg, P0.01) while the Kd value was unaffected during late septic shock (CLP 18 h). Ca2+ activated 3H-ryanodine binding significantly and reached a saturation value when Ca2+ concentration was 5 x 10(-5) mol/L, while the S0.5 and the Hill coefficient values remained unchanged during septic shock. Caffeine, ATP, and AMP-PCP activated while Mg2+, ruthenium red inhibited 3H-ryanodine binding in both groups but the A0.5 (concentration requires for half maximum activation) and the IC50 (concentration requires for half-maximum inhibition) for the above mentioned activators and inhibitors, were respectively unaffected during septic shock. Digestion of cardiac SR isolated from control rats with phospholipase A2 inhibited 3H-ryanodine binding, which could be dramatically recovered by the incorporation of phosphatidylcholine (PC), or phosphatidylserine (PS), or phosphatidylethanolamine (PE) into the isolated cardiac SR. Incorporation of above phospolipids into SR isolated from septic rats reversed shock-induced inhibition of 3H-ryanodine binding. It is concluded that the mechanism responsible for the inhibition of 3H-ryanodine binding of junctional SR during septic shock may be related to modification of membrane lipid microenvironment in response to PLA2 overactivation during septic shock.

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