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Objective: To explore the relationship between yin-deficiency constitution (YDC) and biochemical indexes by way of observing the endocrinal and immune functions in subjects with YDC., Methods: On the basis of epidemiological investigation, 60 subjects with YDC and 50 with gentle constitution (GC) were selected according to the pertinent criteria. From each subject, 8 mL of fasting venous blood was drawn at 8:00-9:00 in the morning, with the serum separated by centrifugation 3 000 r/min for 5 min and preserved at -70 degrees Celsius in a freezer. Serum levels of corticosterone, cortisol, adrenocorticotrophic hormone (ACTH), cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), free triiodothyronine (FT3), free thyroxine (FT4), throtropic stimulation hormone, interleukin 1beta (IL-1beta) and interleukin 2 (IL-2) were detected by double-antibody sandwich ELISA; cAMP/cGMP ratio was calculated, and the difference between the two constitutions in terms of these indexes was analyzed., Results: Serum FT3 was 4.16 + or - 1.38 pmol/L in subjects with YDC, which was higher than that in subjects with GC (3.71 + or - 0.55 pmol/L), but levels of cortisol (124.58 + or - 45.36 ng/mL), ACTH (58.92 + or - 14.55 pg/mL), cGMP (66.00 + or - 18.02 pmol/mL) and FT4 (12.33 + or - 3.12 pmol/L) in YDC were lower than those in GC (13.43 + or - 2.31 pmol/L), showing significant difference (P<0.05)., Conclusion: YDC is related to some extent with the disturbances in the hypothalamus-pituitary-adrenal axis, hypothalamus-pituitary-thyroid axis, cyclic nucleoside system and immune function.

Objective: To investigate the effect of iron on the growth, physiology and photosynthesis of cyanobacteria., Methods: A gradient of iron concentrations was employed to investigate the growth, photo-pigments (chlorophyll A and phycocyanin), and cell chemical contents (C, N, P) of Microcystis aeruginosa in response to different iron additions., Results: The specific growth rate during the exponential growth phase, as well as the cell chlorophyll A and the phycocyanin content, was limited by iron below 12.3 tmol Fe x L(-1). The growth was inhibited when the iron concentration was at 24.6 micromol Fe x L(-1). The cell chlorophyll A and the phycocyanin content were saturated when the iron concentration was above 12.3 micromol Fe x L(-1) and declined slightly at 24.6 micromol Fe x L(-1). At a low iron concentration (about 6.15 micromol Fe x L(-1) and less), the cell nitrogen and carbohydrate content were iron limited, and the variation of the cell phosphorus content was similar to that of the nitrogen and carbohydrate, with a transition point of 12.3 micromol Fe x L(-1)., Conclusion: The variation of cynobacteria growth is synchronous with that of the photo-pigments or the cell chemical content, and there exist relationships among photosynthesis, growth and internal chemical content, which could be useful for the growth estimation from the cell characteristics.

With maritime transport of crude oil from Alaska to California, there is significant potential for a catastrophic spill which could impact migrating salmon. Therefore, this study compared the lethal and sublethal metabolic actions of the water-accommodated fraction (WAF) and the chemically enhanced WAF (CEWAF, via Corexit 9500) of Prudhoe Bay crude oil in smolts of Chinook salmon (Onchorhyncus tshawytscha). After 96-h exposure to the CEWAF, the resulting LC50 was some 20 times higher (i.e., less toxic) than that of the WAF. Muscle and liver samples from surviving fish were collected and low-molecular weight metabolites were analyzed using one-dimensional (1)H and projections of two-dimensional (1)H J-resolved NMR. Principal component analysis (PCA), employed to analyze NMR spectra and identify most variance from the samples, revealed age-related metabolic changes in the fish within the replicated studies, but few consistent metabolic effects from the treatments. However, ANOVA results demonstrated that the dose-response metabolite patterns are both metabolite- and organ-dependent. In general, exposure to either WAF or CEWAF resulted in an increase of amino acids (i.e., valine, glutamine and glutamate) and a decrease of both organic osmolytes (i.e., glycerophosphorylcholine) and energetic substrates (i.e., succinate). The simultaneous increase of formate and decrease of glycerophosphorylcholine in the liver, or the decrease of glycerophosphorylcholine in muscle, may serve as sensitive sublethal biomarkers for WAF or CEWAF exposures, respectively. In conclusion, dispersant treatment significantly decreased the lethal potency of crude oil to salmon smolts, and the NMR-based metabolomics approach provided a sensitive means to characterize the sublethal metabolic actions.

Background: Pressure release continuous positive airway pressure (CPAP) is an evolution of CPAP that has been reported to improve patient comfort. We hypothesised the pressure release would lead to unloading of the inspiratory muscles and therefore conducted a prospective double-blind cross-over physiological study of autotitrating CPAP (APAP) against autotitrating pressure relief CPAP (PR-APAP)., Methods: Eleven patients with severe obstructive sleep apnoea (OSA; mean AHI 74.5+/-14.4/h) were studied. We assessed neural drive by recording the oesophageal pressure, gastric pressure, transdiaphragmatic pressure and the diaphragm EMG during overnight polysomnography., Results: Both APAP and PR-APAP significantly reduced neural respiratory drive. Transdiaphragmatic pressure swings during apnoea (30.2+/-11.5 cm H2O) before treatment decreased to 9.1+/-5.3 cm H2O for PR-APAP and 8.5+/-3.7 cm H2O for APAP. The transdiaphragmatic pressure and the diaphragm EMG did not differ significantly between APAP and PR-APAP. The gastric pressure swing at expiration phase disappeared during both APAP and PR-APAP when sleep respiratory events were eliminated., Conclusions: PR-APAP is not superior to APAP in terms of reducing neural respiratory drive. It is unnecessary to replace conventional APAP with PR-APAP for patients who have been successfully treated with traditional APAP.

Background/purpose: Accurate length-of-stay (LOS) estimates have an impact on medical costs for stroke patients. Most studies have reported only descriptive sample means or have provided linear-model-based estimates for LOS. This study calculated point and interval estimates by treating hospital discharge as an event, and utilizing the proportional hazards (PH) model to provide the estimation of hospital stay for first-ever stroke patients in a rehabilitation department of a clinical center., Methods: Pairwise analysis for correlations between age, sex, comorbidity status, modified Barthel index (MBI) and functional independence measure (FIM) was performed. These explanatory variables are used in the K-sample comparisons, the Chi-squared test for association, the PH regression analysis, and log-transformed linear (LTL) regression., Results: The PH model gave a prediction on estimated mean LOS, with an absolute bias of 0.85 days, by combining MBI and FIM into a single variable, or a bias of 1.15 days and 1.16 days with MBI and FIM variables, respectively. The LTL-based estimation generated a bias of 5.91 days. The PH model has relatively shorter confidence intervals than those obtained by sample-mean and LTL methods., Conclusion: We recommend using the PH model for predicting mean LOS when the PH assumption for patients with different clinical characteristics is satisfied. However, the proposed method only applies to rehabilitating stroke patients.

Atomic bomb survivors outside of Japan are few and often hard to follow-up. Spinal malignant lymphoma among these survivors is rare in established studies from Japan or the United States. Here, we report an 81-year-old woman, who experienced the atomic bomb explosion in Nagasaki when she was 19 years old, who presented with papillary thyroid carcinoma when she was 70 years old. Both follicular lymphoma over the right elbow region and vertebral malignant lymphoma were found when she turned 81 years old. Bone scan did not show any increased uptake of isotope. However, thoracolumbar spine magnetic resonance imaging showed multiple infiltrative soft tissue masses involving vertebral bodies at the T10-11 level. Computed tomography-guided biopsy further showed lymphocyte infiltration. Fortunately, the neurological deficit was improved after chemotherapy. The diagnosis of malignant lymphoma in atomic bomb survivors should be more careful and aggressive, even when their bone scan results show negative findings. In addition, the authors suggest that atomic bomb survivors should be followed-up carefully throughout their entire life.

Background: Congenital central hypoventilation syndrome (CCHS) is characterized by compromised chemoreflexes resulting in sleep hypoventilation. We report a Chinese family with paired-like homeobox 2B (PHOX2B) mutation-confirmed CCHS, with a clinical spectrum from newborn to adulthood, to increase awareness of its various manifestations., Methods: After identifying central hypoventilation in an adult man (index case), clinical evaluation was performed on the complete family, which consisted of the parents, five siblings, and five offspring. Pulmonary function tests, overnight polysomnography, arterial blood gas measurements, hypercapnia ventilatory response, and PHOX2B gene mutation screening were performed on living family members. Brain MRI, 24-h Holter monitoring, and echocardiography were performed on members with clinically diagnosed central hypoventilation., Results: The index patient and four offspring manifested clinical features of central hypoventilation. The index patients had hypoxia and hypercapnia while awake, polycythemia, and hematocrit levels of 70%. The first and fourth children had frequent cyanotic spells, and both died of respiratory failure. The second and third children remained asymptomatic until adulthood, when they experienced impaired hypercapnic ventilatory response. The third child had nocturnal hypoventilation with nadir pulse oximetric saturation of 59%. Adult-onset CCHS with PHOX2B gene mutation of the + 5 alanine expansions were confirmed in the index patient and the second and third children. The index patient and the third child received ventilator support system bilevel positive airway pressure treatment, which improved the hypoxemia, hypercapnia, and polycythemia without altering their chemosensitivity., Conclusions: Transmission of late-onset CCHS is autosomal-dominant. Genetic screening of family members of CCHS probands allows for early diagnosis and treatment.

Introduction: Myasthenic crisis is a great threat to patients with myasthenia gravis. Usage of non-invasive ventilation (NIV) to prevent intubation and timing of extubating of patients in myasthenic crisis are important issues though not well documented., Methods: To explore the factors predicting NIV success and extubation outcome in myasthenic crisis, we reviewed the records of 41 episodes of myasthenia crisis., Results: NIV was applied to 14 episodes of myasthenic crisis and eight (57.1%) of them were successfully prevented from intubation. An Acute Physiology and Chronic Health Evaluation (APACHE) II score of <6 and a serum bicarbonate level of <30 mmol/l were independent predictors of NIV success. For patients undergoing invasive mechanical ventilation, extubation failure was observed in 13 (39.4%) of 33 episodes, and the most common cause was sputum impaction due to a poor cough strength (61.5%). A maximal expiratory pressure (Pemax) of > or = 40 cmH(2)O was a good predictor of extubation success. Extubation failure led to poorer outcomes., Conclusions: NIV may be applied to those patients with a low APACHE II score and a lesser degree of metabolic compensation for respiratory acidosis. For patients undergoing invasive mechanical ventilation, extubation failure is associated with significant in-hospital morbidity in myasthenic crisis. Adequate levels of Pemax and cough strength correlate significantly with extubation success.

This study was conducted in Dachang, a small mining town in Gaungxi Zhuang Autonomous Region in southern China. A total of 23 farmland soil samples and two atmospheric samples of particulate matter less than 10 microns (PM(10)) were collected in this town. ICP-MS was used to analyze for 20 elements in each of the samples. All of the samples contained some level of heavy metals. The most commonly detected heavy metals detected in the soil samples were: Cd (up to 29.0 mg kg(-1)), As (up to 776 mg kg(-1)), Sb (up to 36.8 mg kg(-1)), Pb (up to 582 mg kg(-1)), Zn (up to 1379 mg kg(-1)) and Cu (up to 156 mg kg(-1)), Mn (up to 1476 mg kg(-1)). The PM(10) content in air samples exceeded the Chinese standard by nearly ten-fold. The most commonly detected heavy metals detected in the PM(10) atmospheric samples were Cd (up to 210 mg kg(-1)), As (up to 15239 mg.kg(-1)), Sb (up to 445 mg kg(-1)), Pb (up to 8053 mg kg(-1)), Zn (up to 13151 mg kg(-1)) and Cu (up to 673 mg kg(-1)), Mn (up to 2826 mg kg(-1)), Mo (up to 120 mg kg(-1)). All of these heavy metals are associated with significant human health effects ranging from reduced intelligent quotients (IQs) in children (cf. Pb) to cancer (e.g., Cd and As). Müller Geo-accumulation Index (Igeo) and enrichment factor (EF) were used to assess the findings. The results to the two assessments showed the same ranking: Cd > As > Sb > Pb > Zn > Cu > Mn, which would imply that the particulate matter in ambient air was the source of the contamination in the soil. The correlation analysis supported this inference. Upon further examination, ore transportation through the town was identified as the most likely source of contamination. Therefore, steps should be taken to improve the management of the ore transportation in order to protect the farmland and the health of the residents.

Objective: To investigate the changes of endocrine, cyclic nucleotide and immune systems in subjects of yang deficiency constitution, and to explore the relationship among characteristics and causes of yang deficiency constitution, the physiological and biochemical parameters., Methods: Based on the diagnostic criteria for the clinical epidemiological investigation, sixty subjects of yang deficiency constitution and fifty of normal constitution were selected. Eight milliliters venous blood were taken from overnight fasted subjects at 8:00-9:00. The sera were obtained by centrifugation of the blood at the speed of 3000 r/min for 5 minutes, and they were stored at -70 degrees C until use. The serum levels of corticosterone, cortisol, adrenocorticotrophic hormone (ACTH), cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), free triiodothyronine (FT3), free thyroxine (FT4), thyrotropic-stimulating hormone (TSH), interleukin-1beta and interleukin-2 were measured by enzyme-linked immunosorbent assay; the cAMP/cGMP ratio was also computed; and the differences of the above indexes were compared between the two types of subjects., Results: The serum levels of corticosterone, interleukin-1beta, TSH and cAMP/cGMP ratio of yang deficiency constitution significantly increased as compared with those of normal constitution, and the serum levels of cortisol, ACTH, cGMP and FT4 of yang deficiency constitution significantly decreased in comparison with those of normal constitution., Conclusion: Subjects of yang deficiency constitution may be not only related to hypothalamic-pituitary-adrenal axis and hypothalamic-pituitary-thyroid axis, but also related to the functional disorders of cyclic nucleotide and immune systems.

To explore the relationship of self-reported exposure to tobacco smoke and the cotinine levels in the urine and blood over the follow-up period for pregnant women. Three hundred ninety-eight pregnant women undergoing prenatal care were interviewed in different trimesters at three hospitals in central Taiwan using a structured questionnaire. Based on their self-reported smoking experience, the participants were classified into three groups (25 smokers, 191 passive smokers, and 182 non-smokers) and were tracked in this study up to the time of delivery. Cotinine levels were tested for the maternal blood and urine at the end of each trimester and for the umbilical cord-blood of the newborns. All specimens were measured using a sensitive high-performance liquid chromatographic (HPLC) technique. In general, urinary cotinine levels were higher in subjects who smoked (including current- and ex-smokers) than those who never smoked. The pattern of distribution of cotinine levels among smoking/ETS exposure group in the urine sample was similar to that in the blood sample. The umbilical cord-blood cotinine levels was found to be highest in the active smoking group, followed by the ETS group exposed to ETS both at home and in the workplace. Over the course of the pregnancies, there was an increase in cotinine levels in urine and maternal blood for each of 3 exposure groups. Exposure to smoking by self-reported information in pregnant women has been found to be directly related to the levels of cotinine in the umbilical cord-blood of the fetus. Cotinine is a sensitive measure of ETS exposure, but if biochemical analysis is not available or convenient for a pregnant woman, then self-reported exposure to ETS can provide a good estimate if the information is gathered by a well-trained interviewer in a structured way.

A previous study investigated metal contamination in farmland and the air in a typical mining town of Guangxi, South China. In this study, the health risks associated with exposure to this contamination that were evaluated for the following routes of exposure are reported: inhalation, dermal contact, ingestion of dust, and ingestion of homegrown vegetables. The findings demonstrated that the inhabitants were at high risk for noncancer effects posed by some of the metals. The total hazard index (THI) of all the pathways was 145 for adults and 560 for children, which were far higher than the normative level 1. The noncancer risk mainly came from air PM(10) pollution through inhalation and ingestion routes of exposure. However, vegetable ingestion also made a noticeable contribution to HI of about 7 for adults and 22 for children. The metals that posed the greatest noncancer risks were Mn for inhalation, and ingestion of dust and vegetables. The total cancer risks of the inhabitants were 1 x 10(-1) (adult) and 3 x 10(-1) (child), which far exceeded the acceptable carcinogen risk of 10(-4) approximately 10(-6) for regulatory purposes. The cancer risk in the village is mainly (97%) associated with As exposure by inhalation and ingestion of dust. However, consumption of vegetables is also associated with a significant cancer risk of up to 2 x 10(-3) for adults and 8 x 10(-3) for children. The cancers associated with this exposure are estimated to be lung cancer and skin cancer. Air particulate-matter pollution was the main source of noncancer risk and cancer risk and originated from vehicular transport of ore through the community. The risk could be tested by a specifically designed epidemiological study.

Background: Prolonged surgical workload and different starting times of laparoscopic-assisted vaginal hysterectomy (LAVH) might be factors influencing surgical and patient's outcomes., Aims: The aim of this study is to elucidate possible detrimental results of the schedule effect on LAVH., Methods: Retrospective cohort study based on patient charts and hospital's electronic database in a tertiary teaching hospital. A total of 217 consecutive women who underwent LAVH for gynecological diseases were enrolled. Among them, 159 LAVHs performed by four surgeons were divided into three groups according to three different starting times of the operation. Among 159 LAVHs, 110 performed by the same surgeon were divided into three groups in the same way. Variables related to operative and medical outcomes were compared and analysed by one-way anova and chi-squared test., Results: Data on both all women (159 cases) and subgroup women (110 cases) revealed that no statistical significant differences among the three groups including length of hospital stay, shift of serum haemoglobin, shift of serum haematocrit, flatulence-relief time, surgical blood loss, blood transfusion rate, rate of postoperative fluid injection over two days after surgery or complication rate. Interestingly, the first LAVH scheduled within the 08.30 to 10.29 hours time slot had the longest mean operation time. LAVHs starting within the 15.30 to 17.29 hours time slot had the shortest mean operation time., Conclusion: The time of day in which LAVH is performed does not have a detrimental effect on outcome. Successful LAVH is dependent on multidisciplinary team work to achieve good surgical and patient outcomes.

This study investigated whether mothers with prenatal environmental tobacco smoke (ETS) exposure increased the newborn genetic damage and adverse birth outcomes. Study participants were women receiving prenatal care at three hospitals in Central Taiwan and their newborns. Participants were divided into two groups (nonsmokers and ETS-exposed non-smokers) based on maternal ETS-exposed status. Comet assay were performed for cord blood samples. Infants born to mothers with prenatal ETS exposure had the highest mean cord blood DNA damage score (69.7 +/- 42.3) and poorer birth outcomes. No negative fetal growth effects appeared among newborns with low DNA damage levels. Among newborns with high DNA damage levels (comet scores >50), those born to prenatal ETS exposure had an average reduction of 252.7 g in birth weight, 1.10 cm shorter in length and a 0.92-cm decrease in head circumference, compared to newborns with no smoking exposure. This study shows that the DNA damage scores can be used as an effect-modifier on the relationships between ETS exposure and adverse birth outcome. The association appears more apparent for the ETS exposure in relation with more severe DNA damage.

Objectives: Comparisons of survival in patients on peritoneal dialysis (PD) and on hemodialysis (HD) have been conducted in many Western countries, but publications on this subject in Asian populations are scarce. The present study estimated the survival and the relative mortality hazard for HD and PD patients in Taiwan., Methods: Incident end-stage renal disease patients reported to the Taiwan Renal Registry during 1995 - 2002 were included in the study. Patients had to be 20 years of age or older and had to have survived for the first 90 days on dialysis. A total of 45,820 incident HD and 2,809 incident PD patients formed the study population. Patients on PD were treated mainly with traditional glucose-based solutions. Using an intent-to-treat analysis, the Cox proportional hazards (CPH) model was applied to identify the factors that predict survival by treatment modality. Subgroup analyses were conducted by stratifying patients according to sex, comorbidity, age, and diabetes status. Kaplan-Meier estimates were used to explore the survival of HD and PD patients. Adjustments were implemented using the CPH model., Results: The overall 1-year, 2-year, 3-year, 5-year and 10-year survival rates for PD patients were 89.8%, 77.6%, 67.6%, 55.5%, and 35% respectively. The equivalent survival rates for HD patients were 87.5%, 76.6%, 68.1%, 54.3%, and 33.8%. The differences were not statistically significant (p = 0.125). The CPH analysis stratified by diabetes status and age revealed that PD patients 55 years of age or younger and nondiabetic had a lower mortality ratio (MR) of 0.94. But the MR increased to 1.31 for nondiabetic patients older than 55. The MR for PD versus HD further increased to 1.72 for diabetic patients 55 years of age or younger, and to 1.99 for diabetic patients older than 55., Conclusions: After adjusting for both demographic and clinical case-mix differences, PD and HD patients were observed to have similar long-term survival. Subgroup analyses revealed that, among diabetic patients and patients older than 55, those on HD experienced better survival than did those on PD.

Assays of metabolised cotinine are considered to be an accurate measure of exposure to cigarette smoke among pregnant women. We investigated the association and differences between the cotinine levels in maternal urine and blood, and the umbilical cord blood of three tobacco exposure groups at different stages of pregnancy. A prospective study was conducted among 398 pregnant women undergoing prenatal care in different trimesters at two medical centres and one regional hospital in central Taiwan. All 398 subjects (including 25 smokers, 191 passive smokers and 182 non-smokers) remained in the study up to the time of delivery; 384 of them delivered singleton live births. Cotinine levels were assayed in the maternal plasma and urine of the mothers at each trimester and in the cord blood of the newborns. All specimens were measured using a sensitive high-performance liquid chromatography. Cotinine concentrations in plasma and urine showed a significant dose-dependent difference among the three groups (non-smoker, passive and active smoker) and a trend that increased with gestation among the pregnant women. Significant correlations between cotinine concentrations in plasma and urine among the pregnant women in each trimester were found. In addition, the level of cotinine in umbilical cord blood was significantly correlated with that in maternal blood at term (r = 0.89, P < 0.001). A pattern of elevated cotinine concentrations in the plasma and urine of pregnant women from the beginning to the end of pregnancy was found, and this correlated significantly with the cotinine levels in the umbilical cord blood.

For a given neural drive, oesophageal pressure during apnoeic episodes may differ from that during airflow, since inspiratory airflow and increased lung volume both reduce pressure generation. It was, therefore, hypothesised that diaphragm electromyography (EMG) may provide additional data to oesophageal pressure when used for the assessment of neural drive in patients with obstructive sleep apnoea, whose breathing is associated with variable airflow and changes in lung volume. Neural respiratory drive was assessed using diaphragm EMG recorded from multipair oesophageal electrodes in 12 patients with obstructive sleep apnoea. Oesophageal pressure was also recorded. The mean+/-sd inspiratory oesophageal pressure swing was 11.0+/-3.7 cmH(2)O during wakefulness, 38.2+/-15.7 cmH(2)O at the end of the apnoea and reduced to 28.5+/-10.4 cmH(2)O at the beginning of arousal. The mean peak inspiratory diaphragm EMG signal was 21.8+/-6.5 muV during wakefulness, 38.6+/-14.0 muV at the end of the apnoea and further increased to 59.6+/-32.0 muV at the beginning of arousal. It was concluded that the pattern of neural drive assessed by oesophageal pressure differs from that measured by diaphragm electromyography during apnoeic events and, therefore, that diaphragm electromyography may be a useful adjunct to measurement of oesophageal pressure for the assessment of neural drive in patients with obstructive sleep apnoea.

Purpose: The objective of this study was to differentiate the magnetic resonance (MR) imaging appearance of benign peripheral nerve sheath tumors (PNSTs) from that of malignant PNSTs., Materials and Methods: Twenty-six patients who underwent MR imaging and had a histologic diagnosis of benign (schwannoma, n=16; neurofibroma, n=1) or malignant (n=9) PNST were retrospectively reviewed. The size, location, shape, margin, and signal intensities of the tumors on precontrast and gadolinium-enhanced MR imaging were analyzed. In each patient, the presence or absence of split fat, target, and fascicular signs was determined., Results: The mean size of the benign PNSTs (3.4 cm, S.D.=2.5 cm) was significantly smaller than that of the malignant tumors (8.2 cm, S.D.=3.1 cm) (P<.001). Seventeen (65.4%) of the 26 tumors were spindle shaped or ovoid (12 benign and 5 malignant tumors). Contiguity with specific nerves was identified in 15 (88.2%) of the 17 benign PNSTs but in none of the malignant tumors (P<.05). Well-defined margins were noted in all 17 benign PNSTs but in only 3 (33.3%) of the 9 malignant tumors (P<.001). Five (55.6%) of the 9 malignant PNSTs but none of the benign tumors showed signal intensity change in adjacent soft tissue (P<.05). There was no significant difference in signal intensity between the benign and malignant tumors on T(1)-weighted, T(2)-weighted, and contrast-enhanced MR images. The split fat and target signs were present more frequently in the benign PNSTs than in the malignant PNSTs (P<.05)., Conclusions: Benign and malignant PNSTs are often spindle shaped. Recognition of contiguity with adjacent nerves, a well-defined margin, and the presence of the split fat sign may suggest benignity. Imaging features suggestive of malignancy can be a larger size and an infiltrative margin.

Cardiac magnetic resonance (CMR) has emerged as a versatile noninvasive tool for the comprehensive evaluation of patients with suspected or established coronary artery disease (CAD). In a single imaging session, CMR can assess left ventricular anatomy and function, myocardial perfusion, viability, and coronary luminal stenosis. Using specific pulse sequences, left ventricular global and regional function can be assessed by cine CMR at rest and in response to inotropic stress; first-pass perfusion quantified by vasodilator stress; myocardial viability evaluated by delayed enhancement imaging and also by functional reserve; and coronary artery stenosis assessed by angiography. All these modalities can be achieved with high spatial resolution and image contrast, without exposure to ionizing radiation, and within a reasonable time frame of about 1 hour of scan time. Also, the imaging planes can be programmed to provide identical views of the heart for each type of image, thereby facilitating intermodality comparisons. There is early but accumulating evidence that the accuracy and prognostic values of many of these modalities are comparable or superior to radionuclide scintigraphy and echocardiography in head-to-head studies. Current limitations unique to CMR include the inability to perform exercise stress testing inside the CMR suite and exclusion of patients with indwelling metallic devices such as defibrillators and pacemakers. Despite these limitations, CMR is unique in its multifaceted approach that can be specifically tailored to the clinical question at hand, making it arguably the best tool for the diagnosis and management of CAD. With the rapid pace of advancement in CMR hardware and pulse sequence technologies, the clinical use of this powerful technique is likely to grow even greater in this area.

This study determined the effects of environmental tobacco smoke (ETS) on fetal growth by measuring neonatal birth outcomes and the extent of maternal DNA damage, and investigating the relationships among gene polymorphisms, genotoxicity, and pregnancy outcomes of expectant mothers who had exposed to tobacco smoke. This prospective study enrolled 685 pregnant women who completed an initial questionnaire at three central Taiwan hospitals between 2003 and 2004. Genotype analyses of CYP1A1, GSTT1, GSTM1, and NAT2 were performed from 421 women. A total of 398 women completed the follow-up analysis and successfully delivered a live single baby (n=384). Comet assay was performed for 18 smokers, 143 ETS-exposed subjects and 130 non-smokers to measure DNA damage. Analytical findings indicated that the levels of DNA damage among smokers and ETS-exposed subjects were significantly higher than that of non-smokers. DNA damage score in the ETS-exposed group was 84.3+/-44.3 and 63.5+/35.0 [corrected] for the nonsmoking group (p<0.001). Risk of DNA damage (DNA strand breakage, sister chromatid exchange, cell transformation and escalation of cytotoxicity) for subjects exposed to ETS was 7.49 times (adjusted odds ratio; 95% CI, 1.27-44.20) [corrected] greater than that of non-exposed to tobacco smoke at home. Average birth weight of neonates born to subjects with extremely serious DNA damage (within the 90th percentile, DNA damage score >or =129.5) was 141 g lighter than that of those with DNA damage score <129.5 (p=0.068) [corrected] The degree of DNA lesion was not related to metabolic polymorphic genes. The results of this study suggest that comet assay are reliable biomarkers for monitoring pregnant women exposed to tobacco smoke and indicate fetal growth effects from environmental exposure to tobacco smoke.

Background: Injurious mechanical ventilation can cause a pro-inflammatory reaction in the lungs. Recent evidence suggests an association of the renin-angiotensin system (RAS) with lung inflammation. A study was undertaken to investigate the pathogenic role of the RAS in ventilator-induced lung injury (VILI) and to determine whether VILI can be attenuated by angiotensin converting enzyme (ACE) inhibition., Methods: Male Sprague-Dawley rats were mechanically ventilated for 4 h with low (7 ml/kg) or high (40 ml/kg) tidal volumes; non-ventilated rats were used as controls. Lung injury and inflammation were measured by the lung injury score, protein leakage, myeloperoxidase activity, pro-inflammatory cytokine levels and nuclear factor (NF)-kappaB activity. Expression of the RAS components was also assessed. Some rats were pretreated with the ACE inhibitor captopril (10 mg/kg) for 3 days or received a concomitant infusion with losartan or PD123319 (type 1 or type 2 angiotensin II receptor antagonist) during mechanical ventilation to assess possible protective effects on VILI., Results: In the high-volume group (n=6) the lung injury score, bronchoalveolar lavage fluid protein concentration, pro-inflammatory cytokines and NF-kappaB activities were significantly increased compared with controls (n=6). Lung tissue angiotensin II levels and mRNA levels of angiotensinogen and type 1 and type 2 angiotensin II receptors were also significantly increased in the high-volume group. Pretreatment with captopril or concomitant infusion with losartan or PD123319 in the high-volume group attenuated the lung injury and inflammation (n=6 for each group)., Conclusions: The RAS is involved in the pathogenesis of ventilator-induced lung injury. ACE inhibitor or angiotensin receptor antagonists can attenuate VILI in this rat model.

Valve lesions in degenerative calcific aortic stenosis (CAS), a disorder affecting 3% of those older than 75 years, are infiltrated by T lymphocytes. We sought to determine whether the alphabeta TCR repertoire of these valve-infiltrating lymphocytes exhibited features either of a polyclonal nonselective response to inflammation or contained expanded clones suggesting a more specific immune process. TCR beta-chain CDR3-length distribution analysis using PCR primers specific for 23 Vbeta families performed in eight individuals with CAS affecting tri- or bileaflet aortic valves revealed considerable oligoclonal T cell expansion. In five cases, beta-chain nucleotide sequencing in five selected Vbeta families showed that an average of 92% of the valve-infiltrating T cell repertoire consisted of expanded T cell clones, differing markedly in composition from the relatively more polyclonal peripheral CD8 or CD4 T cell subsets found even in this elderly population. Twenty-four of the valve-infiltrating T cell clones also had the same clone identified in blood, some of which were highly expanded. Interestingly, 22 of these 24 shared clones were CD8 in lineage (p = 1.5 x 10(-12)), suggesting a possible relationship to the expanded CD8(+)CD28(-) T cell clones frequently present in the elderly. Additionally, the sequences of several TCR beta-chain CDR3 regions were homologous to TCR beta-chains identified previously in allograft arteriosclerosis. We infer that these findings are inconsistent with a nonselective secondary response of T cells to inflammation and instead suggest that clonally expanded alphabeta T cells are implicated in mediating a component of the valvular injury responsible for CAS.

Objective: We analyzed data from the National Health Insurance Research (NHIR) database in the year 2000 to estimate the seasonal variation in the chickenpox rate in Taiwan., Patients and Methods: All chickenpox cases listed in the NHIR database were included (n = 165,719). A Lorenz curve was plotted and a chi-square test for equal proportions calculated for seasonal variation. To determine the effects of temperature and season on outcome values, generalized estimating equation methods were utilized to adjust the effects of other possible influencing factors and take into account the within-subject dependence over repeated assessments., Results: All four regions of the country had highest incidence rates in January, and three of them had lowest rates in September. Incidence was significantly higher in females aged 15-24 years than in males. An increment of 1 degrees C resulted in an incidence ratio of approximately 0.98 or, equivalently, a 10 degrees C increment gives an incidence ratio of approximately 0.78., Conclusion: The results suggest that season and temperature are significantly related to the incidence of chickenpox. Infectious diseases can be monitored. Prevention procedures can be taken by understanding its pattern and activity in order to decide the best policy for vaccination. Further studies are warranted, particularly for long-term trends, and in other nations with different seasonal temperatures from Taiwan.

Traditional wheezes detection methods are based on the frequency and durations of acoustic signal or the location of peaks from successive spectra. In these methods, the discriminative threshold used to identify peaks usually is fixed empirically. Therefore, accuracy of detected wheeze is affected by environment noise and artificial factors. The objective of this study is to classify normal and abnormal (wheezing) respiratory sounds using Cepstral analysis in Gaussian Mixture Models. The sound signal is divided in overlapped segments, which are characterized by a reduced dimension feature vectors using Mel-Frequency Cepstral Coefficients. In this study the ;speaker' is wheeze. During the test phase, an unknown sound is compared to all the GMM models and the classification decision is based on the Maximum Likelihood criterion. In these processes, identification is based on threshold value. If the threshold is bigger than zero, the sound is normal. Otherwise, the sound is wheeze. From experimental results, when the Gaussian mix number is 16, the accuracy of identification of wheeze is up to 90%.

The objective of this study was to determine which elements in serum best differentiated breast cancer in a case-control study. Concentrations of 13 elements in serum of 68 breast tumor patients (25 malignant and 43 benign) and 26 healthy controls were measured. Logistic regression with different variable-selection procedures was used to determine a possible configuration of elements. Sensitivity and specificity of the model were calculated to obtain the optimal cutoff point for discriminating malignant breast cancers vs other individuals (including benign breast disease and normal ones). Acombination of Cd, Mn, and Fe was found to have a specificity and sensitivity of 100% using forward-type logistic regression, when the cutoff value of the combination score was 52.71. Using stepwise-type logistic regression, a combination of Cr and Mn had a sensitivity of 100% and a specificity of 97.1% when the combination score of 17.4 was chosen as the cutoff. Similar analysis could be implemented to compare the malignant and control groups. Specificity and sensitivity were 100% for Mn (forward and stepwise type) with a cutoff point of 6.40. For the backward regression, specificity was 84.6% and sensitivity was 100% for Zn, with a cutoff point of 869.1. In conclusion, there was a significant difference in concentrations of all 13 elements in serum between breast cancer patients and controls. A combination among Cd, Mn, Fe, Cr, and Zn might be important to determine a differentiating reference for breast cancers if a long-term followed-up study is to be conducted.

Background and Purpose: Patients requiring prolonged mechanical ventilation (PMV) are frequently deconditioned because of respiratory failure precipitated by the underlying disease, the adverse effects of medications, and a period of prolonged immobilization. The effects of 6 weeks of physical training on the strength of respiratory and limb muscles, on ventilator-free time, and on functional status in patients requiring PMV were examined., Subjects: Thirty-nine patients with PMV were initially enrolled in the study and were assigned to either a treatment group (n=20) or a control group (n=19). Three subjects in the treatment group and 4 subjects in the control group died during the 6-week intervention period and thus their data were excluded from the final analysis., Methods: Subjects in the treatment group received physical training 5 days a week for 6 weeks. Strength of respiratory and limb muscles, ventilator-free time, and functional status, which was measured by the Barthel Index of Activities of Daily Living (BI) and Functional Independence Measure (FIM), were examined at baseline and at the third and sixth weeks of the study period., Results: Respiratory and limb muscle strength improved significantly at the third and sixth weeks in the treatment group compared with baseline measurements. Total BI and FIM scores increased significantly in the treatment group and remained unchanged in the control group. Effect sizes of the BI and FIM scores were 2.02 and 1.93, respectively, at the sixth week., Discussion and Conclusion: The results show that a 6-week physical training program may improve limb muscle strength and ventilator-free time and thus improve functional outcomes in patients requiring PMV.

Background: The emergence and rapid spread of multidrug-resistant isolates causing nosocomial infections, particularly pandrug-resistant Acinetobacter baumannii, pandrug-resistant Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and extended-spectrum beta-lactamase-producing Enterobacteriaceae are of great concern worldwide., Methods: This study investigated the efficacy of pasteurization against contamination of culture tubes and plastic bags by the above 4 important multidrug-resistant bacteria. A 5-mL bacterial suspension with approximately 10(5) and 10(9) cfu/mL of each organism was inoculated into 3 sets of plastic bags and culture tubes and subjected to pasteurization in a washer at 75 degrees C for 30 minutes., Results: A nearly total eradication was found after pasteurization of these 4 drug-resistant pathogens., Conclusion: Pasteurization was highly effective against drug-resistant bacteria. Strict adherence to appropriate infection control management for respiratory circuits is important for reducing the spread of drug-resistant bacteria among ventilator-assisted patients.

Background/purpose: The rapid shallow breathing index (RSBI) is a weaning parameter usually measured at the start of a spontaneous breathing trial (SBT). This study investigated the value of RSBI measured at the beginning and termination of SBT as a predictor of weaning outcome., Methods: RSBI was measured during the initial 1 minute (RSBI1) and at termination (RSBI2) of an SBT in 172 patients recovering from acute respiratory failure., Results: Weaning was successful in 106 patients and failed in 66 patients. Among the 66 patients with weaning failure, 12 required reintubation within 48 hours (extubation failure), and the remaining 54 patients could not be extubated after SBT (trial failure). There were no differences between RSBI1 in the three groups (69.4 +/- 27.5, 81.7 +/- 24.4 and 75.5 +/- 26.5, respectively), but RSBI2 was significantly higher in patients with extubation failure (95.9 +/- 20.6) and trial failure (98.0 +/- 50.0) than in patients with weaning success (64.6 +/- 26.3) (both p < 0.001). Logistic regression revealed that RSBI2 was superior to RSBI1 and various physiologic indices in predicting weaning outcome. For the 118 extubated patients, the mean area under the receiver operating characteristic curve for RSBI2 and RSBI1 was 0.83 and 0.63, respectively. Using a threshold value of 105, the sensitivity, specificity, accuracy and likelihood ratio for weaning outcome were 0.91, 0.25, 0.85 and 1.38 for RSBI2 and 0.89, 0.16, 0.60 and 1.06 for RSBI1, respectively., Conclusion: This study found that RSBI measured at the completion of SBT was superior to that measured at the start in predicting weaning outcome in critically ill patients.

The cuff-leak test was widely used for the prediction of post-extubation stridor, but controversial results limit its clinical application. The current study used real-time ultrasonography to evaluate the air-leak and hypothesised that the air-column width, measured by ultrasonography, may be correlated to the development of post-extubation stridor. From June 1, 2001 to March 1, 2002, a total of 51 planned extubations in 51 consecutively intubated patients were included. All of the patients received ultrasonographical examinations of their vocal cords and larynx in addition to an air-column width measurement within 24 h prior to extubation. The overall post-extubation stridor rate was 7.8%. The air-leak volume presented as median (interquartile range) were 300 (350) mL and 25 (20) mL, respectively, for the nonstridor and stridor groups. The air-column width during cuff deflation was 6.4 (2) mm and 4.5 (0.8) mm, respectively. They were found to be statistically significant. In conclusion, the authors demonstrated that laryngeal ultrasonography could be a reliable, noninvasive method, in the evaluation of vocal cords, laryngeal morphology and the ease of airflow, which passed through vocal cords or subglottic area due to laryngeal oedema. The air-column width during cuff deflation was a potential predictor of post-extubation stridor.

The influences of material properties on acoustic wave propagation modes in ZnO/Si bi-layered structures are studied. The transfer matrix method is used to calculate dispersion relations, wave field distributions, and electromechanical coupling coefficients of acoustic wave propagation modes in ZnO/Si bi-layered systems, in which the thickness of the substrate is of the same order of magnitude as the wavelength of the propagating wave modes. The influences of the thin film parameters on the acoustic wave propagation modes and their electromechanical coupling coefficients of the wave modes also are obtained. In addition, some experimental results for characterizing the wave propagation modes and their frequencies have also been obtained, which agree well with the theoretical predictions.

How emergency departments of different levels and types cope with a large-scale contagious infectious disease is unclear. We retrospectively analyzed the response of 100 emergency departments regarding use of personal protective equipment (PPE) and implementation of infection control measures (ICMs) during the severe acute respiratory syndrome outbreak in Taiwan. Emergency department workers in large hospitals were more severely affected by the epidemic. Large hospitals or public hospitals were more likely to use respirators. Small hospitals implemented more restrictive ICMs. Most emergency departments provided PPE (80%) and implemented ICMs (66%) at late stages of the outbreak. Instructions to use PPE or ICMs more frequently originated by emergency department administrators. The difficulty of implementing ICMs was significantly negatively correlated with their effectiveness. Because ability to prepare for and respond to emerging infectious diseases varies among hospitals, grouping infectious patients in a centralized location in an early stage of infection may reduce the extent of epidemics.

Background and Purpose: The negative expiratory pressure (NEP) method offers a simple and rapid assessment of expiratory flow limitation (EFL) during tidal respiration. This study compared the value of NEP in the assessment of the bronchodilator test (BDT) with those of spirometry and the interrupter method., Methods: Thirty two patients referred to the lung function laboratory for BDT were investigated. All patients underwent spirometry, interrupter airway resistance (Rint) and NEP measurements in the sitting position before and after inhalation of 500 microg of terbutaline. A positive BDT was defined as an increase in the forced expiratory volume in 1 second (FEV1) of > or = 12%., Results: The ratio of FEV1 to forced vital capacity (FVC) was less than 70% in 21 (65.6%) patients, but EFL as demonstrated by NEP (EFL-N) was present in only 10 patients (31.3%). The baseline EFL-N was only weakly correlated with FEV1 (r = -0.36, p = 0.04), but not with Rint or FEV1/FVC. Among the 14 patients with positive BDT results, the change in FEV1 was correlated with the change in Rint (r = -0.69, p < 0.01), but not with the change in EFL-N., Conclusions: These data suggest that, compared with spirometry and the interrupter method, NEP applied in the sitting position is not sensitive in the assessment of bronchodilator response in patients with obstructive airway disorders.

This paper presents results obtained for in vivo endogenous and exogenous 7-methylguanine (7-MG) analyzed using a method incorporating gas chromatography with electron-capture negative chemical ionization mass spectrometry and isotope dilution (GC/EC-ID-MS). 13C4-Labeled 7-MG was synthesized to serve as an internal standard to improve accuracy of quantitation, and was used to analyze 7-MG in livers of control mice and dacarbazine-treated mice. The results confirm that 7-MG in tissue DNA can be measured using this GC/EC-ID-MS method with excellent sensitivity and specificity. Administration of 0, 30, and 60 mg/kg dacarbazine to mice led to dose-dependent increases in the formation of 7-MG. The results indicate that this method could be applied to the analysis of endogenous and exogenous 7-MG in human tissues for future molecular epidemiology studies on potential health effects caused by methylating agents., (Copyright (c) 2005 John Wiley & Sons, Ltd.)

Respiratory sound is associated with many lung diseases. By observing respiratory sound symptoms, we can know more about lung conditions. In this research, we construct an efficient lung sound recording system according to CORSA, and develop a spectrogram process flow technique to object wheeze. It is a low cost and efficient system. In clinic test, we also can precisely objective wheeze up to about 89%.

The condition for high-yield suspension cell line and the precursors of volatile oil synthesis of Curcuma zedoaria (Berg.) Rosc were studied. The results showed that the light yellow particle callus was suitable for establishment of the high-yield suspension cell line. The optimum conditions for cell growth were MS medium added 15-30 g/L glucose and 15-30 g/L sucrose (1:1) as carbon source, the total concentration of 80 mmol/L nitrogen source combined NH4+ with NO3- (1:3), hormones of 3.0-5.0 mg/L 6-BA, 1.0 mg/L 2,4-D and dark culture after 10-15 days light culture. The 229 g/L cell (FW) and 2.11% content of volatile oil were obtained in vitro. The addition of precursors of calcium pantothenate, ammonium acetate and potassium acetate during the middle period of the cell suspension culture enhanced the volatile oil content respectively, and ammonium acetate was most effective among them. The highest yield of volatile oil obtained was 3.11% and 8.27 g/L respectively , which was 1.25 and 1.2 times of the control group.

Objectives: To compare the practicality, reliability, validity, and responsiveness of the timed up and go (TUG), one-leg stand (OLS), functional reach (FR), and Tinetti balance (TB) performance measures in people aged 65 and older., Design: A prospective study., Setting: Shin-Sher Township of Taichung County, west-central Taiwan., Participants: Twelve hundred community-dwelling older people., Measurements: During an initial assessment at their residences, participants were interviewed for demographics, cognition, fall history, use of a walking aid, and activities of daily living (ADLs), in addition to completing the four balance tests. Falls were ascertained by telephone every 3 months for a 1-year follow-up; the four balance measures and ADLs were also reassessed at the end of the follow-up year., Results: Of the four balance measures, the OLS had the lowest participation rate, and participation of people who were cognitively impaired had fallen in the previous year, used a walking aid, or suffered from an ADL disability was lower than for their counterparts. The time to complete the tests ranged from 58 seconds for OLS, to 160 seconds for the TB. All four balance measures exhibited excellent test-retest reliability and discriminant validity but poor responsiveness to fall status. The TB showed better discriminant, convergent, and predictive validities and responsiveness to ADL changes than the other three tests., Conclusion: According to psychometric properties, the most suitable performance measure for evaluating balance in community-dwelling older people was the TB, followed by the TUG.

Introduction: The diaphragm plays a pivotal role in weaning and successful extubation. We hypothesized that ultrasonographic evaluation of the movements of the diaphragm by measuring liver/spleen displacement during spontaneous breathing trials is a good predictor for extubation outcome., Patients and Methods: The studied subjects were intubated patients receiving mechanical ventilation who were scheduled to be extubated. The displacement of liver/spleen was measured by ultrasonography before extubation. The patients were classified into a success group (SG) or failure group according to the extubation outcome. The baseline data and organ displacements in these two groups were analyzed. The sensitivity and specificity for the mean organ displacements and weaning parameters to predict successful extubation were calculated., Results: We included 55 patients, 32 of whom (58%) were in the SG. The baseline data are similar for these two groups, but the mean values of liver and spleen displacements were higher in the SG. Using a cutoff value of 1.1 cm, the sensitivity and specificity to predict successful extubation were 84.4% and 82.6%, respectively, better than traditional weaning parameters in this study., Conclusion: The displacement of the liver/spleen, measured by ultrasonography, is a good predictor for extubation outcome.

Objectives: This study sought to determine the effect of lipoprotein(a), or Lp(a), levels and apolipoprotein(a), or apo(a), sizes on endothelial function and to explore ethnic differences in their effects., Background: Although high levels of Lp(a) have been shown to confer increased cardiovascular risk in Caucasians, its significance in non-Caucasian populations is uncertain. The pathogenic role of the apo(a) component of Lp(a) is also unclear., Methods: The relationship of Lp(a) levels and apo(a) sizes to endothelial function was examined in a multiethnic cohort of 89 healthy subjects (age 42 +/- 9 years; 50 men, 39 women) free of other cardiac risk factors. Endothelium-dependent, flow-mediated dilation (FMD) and endothelium-independent, nitrate-induced dilation (NTG) were assessed by ultrasound imaging of the brachial artery., Results: Plasma Lp(a) levels were lowest in Caucasians (18.3 +/- 21.1 mg/dl, n = 40); intermediate in Hispanics (30.2 +/- 30.5 mg/dl, n = 21); and highest in African Americans (68.8 +/- 46.0 mg/dl, n = 28). Lipoprotein(a) levels were found to correlate inversely to FMD (r = -0.33, p < 0.005) but not to NTG (r = 0.06, p = 0.60). This association remained significant after adjusting for gender (p = 0.002). In addition, subjects with small apo(a) size of

A 20-month prospective study was conducted to investigate the effect of motorcycle crash experience on changes in risk taking among 2514 urban and 2304 rural students in Taiwan. Risk taking was assessed using a 14-item self-administered questionnaire at the beginning and end of the study. A risk-taking score for each student at the initial and the last follow-up assessments was generated from adding up points across all 14 items. For exposure variables, the study documented past motorcycle crash history at the initial assessment and collected detailed information about any motorcycle crash involvement that occurred during the study period. A general linear mixed model was applied to assess the effects of prior and recent crash involvements on the path of risk-taking behavior. The results show that at the initial assessment, students with crash experience had higher risk-taking levels than those without crash experience. However, crash experience, irregardless of whether it was measured in terms of crash history prior to the study, crash frequency, time elapsed since the last crash, or crash severity, did not significantly change the risk-taking path among students, even though its effect differed between urban and rural areas.

Study Objectives: To examine the value of negative expiratory pressure (NEP) in the assessment of methacholine bronchoprovocation testing (BPT)., Design: Prospective, observational study., Setting: Pulmonary function laboratory in a university hospital., Participants: Fifty-nine patients with chronic cough referred from outpatient clinics for methacholine BPT., Methods: Each subject inhaled successive doubling concentrations of methacholine (from 0.049 to 25 mg/mL) until the FEV(1) decreased for > 20% or the maximum concentration of methacholine was inhaled. NEP was measured in the sitting position during tidal breathing before and after methacholine BPT. The FEV(1) and forced oscillation airway resistance (Rrs) and interrupter airway resistance (Rint) were also obtained simultaneously. A positive BPT result was defined as a fall in FEV(1) > or = 20%., Result: At baseline, only five patients had expiratory flow limitation as demonstrated by NEP (EFL-N). There were 39 patients with positive BPT results, and the other 20 patients had negative results. Among the BPT-positive patients, only 13 patients (33.3%) had EFL-N after methacholine challenge. The sensitivity indexes (absolute change/SD) of FEV(1), NEP, Rrs, and Rint were 16.0 +/- 9.6%, 1.1 +/- 1.6%, 3.8 +/- 4.5%, and 5.89 +/- 4.4% (mean +/- SD), respectively. The percentage changes in FEV(1) in BPT-positive patients correlated with the percentage changes in Rrs (r = 0.419, p = 0.008) and only marginally with the percentage changes in Rint (r = 0.307, p = 0.058), but not with the changes in EFL-N (r = 0.048, p = 0.77)., Conclusion: These data suggest that NEP at sitting position is not sensitive in the assessment of methacholine bronchoprovocation as compared to FEV(1) and airway resistance measurements.

Background: Adult human peripheral blood cells have been shown to differentiate into mature cells of nonhematopoietic tissues, such as hepatocytes and epithelial cells of the skin and gastrointestinal track. We investigated whether these cells could also transdifferentiate into human cardiomyocytes, mature endothelial cells, and smooth muscle cells in vivo., Methods and Results: Myocardial infarction was created in SCID mice by occluding the left anterior descending coronary artery, after which adult peripheral blood CD34+ cells were injected into the tail vein. Hearts were harvested 2 months after injection and stained for human leukocyte antigen (HLA) and markers for cardiomyocytes, endothelial cells, and smooth muscle cells. Cardiomyocytes, endothelial cells, and smooth muscle cells that bear HLA were identified in the infarct and peri-infarct regions of the mouse hearts. In a separate experiment, CD34+ cells were injected intraventricularly into mice without experimental myocardial infarction. HLA-positive myocytes and smooth muscle cells could only be identified in 1 of these mice killed at different time points., Conclusions: Adult peripheral blood CD34+ cells can transdifferentiate into cardiomyocytes, mature endothelial cells, and smooth muscle cells in vivo. However, transdifferentiation is augmented significantly by local tissue injury. The use of peripheral blood CD34+ cells for cell-based therapy should greatly simplify the procurement of cells for the regeneration of damaged myocardium.

Study Objectives: Despite the recognition that ventilator weaning is associated with a change in autonomic nervous system activity, there has not been any report concerning the change of heart rate variability (HRV), a reliable method to detect autonomic nervous system activity, in patients during weaning. The aim of this study was to investigate the change of autonomic nervous system activity during ventilator weaning by HRV analysis., Design: Prospective study., Setting: A 16-bed medical ICU of a tertiary university hospital., Patients: Twenty-four patients receiving mechanical ventilation were included. Twelve patients with successful extubation after a spontaneous breathing trial (SBT) [T-piece trial] were classified as the success group; otherwise, the patients were placed in the failure group., Interventions: None., Measurements and Results: Variables, including the total power (TP), and the high-frequency (HF) and low-frequency (LF) components of HRV, were measured in three phases: assist/control mandatory ventilation, pressure support ventilation (PSV), and SBT. While shifting from PSV to SBT, the HRV components decreased significantly in the failure group (TP, p = 0.025; LF, p = 0.007; HF, p = 0.031), but not in the success group., Conclusions: By HRV analysis, reduced HRV and vagal withdrawal of the autonomic nervous system activity are the main changes in patients with weaning failure.

Background and Purpose: Previous studies have provided little information about the comparative efficacy of treatment with pressure threshold and targeted resistive inspiratory muscle training devices. This study compared the efficacy of these two types of inspiratory muscle training (IMT) devices on inspiratory muscle function, exercise capacity, and quality of life in patients with chronic obstructive pulmonary disease (COPD)., Methods: Forty two patients with moderate to severe COPD were randomly assigned to either a control group, a group receiving pressure threshold inspiratory muscle training, or a group receiving targeted resistive inspiratory muscle training. The training intensity was 50% of patients' maximal inspiratory pressure (MIP). Home-based training comprised two 15-minute sessions a day, 5 days a week for 8 weeks. Inspiratory muscle function measurement included MIP and inspiratory muscle endurance., Results: Thirty patients completed the program, 10 from each group. Twelve patients were excluded because of changes in pharmacological regimen or admission to the hospital (n = 5), study withdrawal (n = 4), or poor compliance with the training program (n = 3). After training, a significant increase in endurance time was found for the threshold group and targeted resistive group (4.4 +/- 3.2 min and 3.0 +/- 2.9 min, respectively, both p < 0.05 vs control), with no significant difference between the 2 training groups. The 6-minute walking distance also increased significantly in both training groups (p < 0.05)., Conclusions: Targeted resistive IMT with a controlled training load has a similar efficacy to the more popularly used pressure threshold IMT and can be incorporated in the treatment of COPD patients. The targeted resistance device offers a less expensive and easily used treatment choice.

Patients are increasingly using the Internet to obtain medical information. Few practice Web sites provide services beyond information about the clinic and common medical diseases. We surveyed computer-using patients at 4 family medicine clinics in Denver, Colorado, by assessing their desire for Internet services from their providers. Patients were especially interested in getting e-mail reminders about appointments, online booking of appointments in real time, and receiving updates about new advances in treatment. Patients were also interested in virtual visits for simple and chronic medical problems and for following chronic conditions through virtual means. We concluded that computer-using patients desire Internet services to augment their medical care. As growth and communication via the Internet continue, primary care physicians should move more aggressively toward adding services to their practices' Internet Web sites beyond the simple provision of information.

A Cox-type regression model accommodating heteroscedasticity, with a power factor of the baseline cumulative hazard, is investigated for analyzing data with crossing hazards behavior. Since the approach of partial likelihood cannot eliminate the baseline hazard, an overidentified estimating equation (OEE) approach is introduced in the estimation procedure. It by-product, a model checking statistic, is presented to test for the overall adequacy of the heteroscedastic model. Further, under the heteroscedastic model setting, we propose two statistics to test the proportional hazards assumption. Implementation of this model is illustrated in a data analysis of a cancer clinical trial.

We report the successful application of high-frequency oscillatory ventilation in a patient with tension pneumatocele (TP). The proposed check-valve mechanism for the development of pneumatoceles predicts that positive-pressure ventilation could lead to distension of these airspaces and formation of TPs. Therefore, high-frequency ventilation could be more applicable in conditions, such as massive air leak due to bronchopleural fistula, that are difficult to manage by conventional ventilator modes.

Ultrasound (US) and magnetic resonance imaging (MRI) of 422 cases were evaluated to compare the feasibility in diagnosing full-thickness rotator cuff tears (FTRCTs). On the basis of different US performers, they were divided into two groups: Group 1 performed by a 5-year experience technician and Group 2 performed by a 10-year experience radiologist. Sensitivity, negative predictive value (NPV), accuracy of US, and correlation between the two modalities were better in Group 2. When an expert is available, US can be used for diagnosing FTRCTs; otherwise, MRI should be performed.