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Purpose: We studied geographic variation in age- and gender-specific prevalence and incidence of epilepsy in four different areas of Taiwan., Methods: By using large-scale, National Health Insurance (NHI)-based data from 2000-2003 in Taiwan, we identified 131,287 patients diagnosed with epilepsy (ICD code 345) receiving at least of one of 11 antiepileptic drugs (AEDs). Information on age, gender, and location were also collected. The multivariable Poisson regression analysis was used to assess the heterogeneity of the morbidity of epilepsy in different regions. External data validation was also performed to assess the accuracy of capturing epilepsy cases through our NHI data set., Key Findings: The age-adjusted prevalence and incidence of epilepsy were 5.85 (per 1,000) between 2000 and 2003 and 97 (per 100,000 person-years) during the follow-up time from 2001 to 2003 in Taiwan. The sensitivity and specificity of ICD-9 coding for epilepsy in the NHI data set were 83.91% and 99.83%, respectively, resulting in a slight overestimation. Male patients had a higher probability of having epilepsy than did females. East Taiwan had significantly higher prevalence and incidence than did other areas. The age-specific incidence pattern in east Taiwan was atypical in that it revealed clustering in young and middle-aged groups., Significance: Our study demonstrated geographic variation in epidemiologic patterns of epilepsy within Taiwan. The findings are informative and provide insight into the clinical management of epilepsy based on consideration of different target groups in different areas., (Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.)

Objective: To develop a population-based proband-oriented pedigree information system that can be easily applied to various diseases in genetic epidemiological studies, making allowance for the capture of theoretical family relationships. DESIGNS AND MEASUREMENTS: A population-based proband-oriented pedigree information system with ties of consanguinity based on both population-based household registry data and Keelung Community Integrated Screening data was proposed to build a comprehensive extended family pedigree structure to accommodate a series of genetic studies on different diseases. We also developed an algorithm to efficiently assess how well theoretical family relationships affecting the occurrence of diseases across three generations with respect to the relative relationship score, a quantitative indicator of genetic influence, were captured., Results: We applied this population-based proband-oriented pedigree information system to estimate the rate of hypertension with various relative relationships given the selection of probands. The degree of capturing complete familial relationships was assessed for three generations. The risk for early onset of hypertension was proportional to the proband-oriented relative relationship score with 2% increased risk and 1% correction for incomplete capture., Conclusions: The population-based proband-oriented pedigree information system is powerful and can support various genetic descriptive and analytic epidemiological studies.

Objective: This study aimed to reveal the relationships between histologic grade and other clinicopathologic parameters including intrinsic subtype in Taiwanese women with breast cancer., Methods: There were 1302 women diagnosed with breast cancer recruited for this study. Histologic grade was scored according to the Nottingham-modified Bloom-Richardson grading system., Results: Higher tumor grade was associated with larger tumor size (P = 0.021), a larger number of lymph node metastases (P = 0.001), advanced clinical stage (P = 0.010), higher human epithelial growth receptor-2 positivity (P < 0.001), negative estrogen receptor and progesterone receptor (P < 0.0001) status. Triple negative breast cancer (56.6%) and human epithelial growth receptor-2 (44.3%) subtypes were associated with more Grade III breast cancer in contrast to luminal A (22.3%) and B (29.9%) breast cancer. In multivariate Cox regression analysis for cancer-specific survival, histologic grade (hazard ratio = 1.78) was a significant prognostic factor., Conclusions: This study demonstrated that histologic grade is highly correlated with some valuable biomarkers and confirmed the significance of histologic grade in Taiwanese female breast cancers.

Background: Small hepatocellular carcinoma (HCC) affects millions of individuals worldwide. Surveillance of high-risk patients increases the early detection of small HCC., Objective: To identify prognostic factors affecting the overall survival (OS) and recurrence-free survival (RFS) of patients with small HCC., Methods: The present prospective study enrolled 140 Taiwanese patients with stage I or stage II small HCC. Clinical parameters of interest included operation type, tumour size, tumour histology, Child- Pugh class, presence of hepatitis B surface antigen and liver cirrhosis, hepatitis C status, alpha-fetoprotein, total bilirubin and serum albumin levels, and administration of antiviral and salvage therapies., Results: Tumour size correlated significantly with poorer OS in patients with stage I small HCC (P=0.014); however, patients with stage II small HCC experienced a significantly poorer RFS (P=0.033). OS rates did not differ significantly between patients with stage I and stage II small HCC. Tumour margins, tumour histology and cirrhosis did not significantly affect OS or RFS (P>0.05)., Discussion: Increasing tumour size has generally been associated with poorer prognoses in cases of HCC. The present study verified the relationship between small HCC tumour size and OS; however, a reduction in OS with increasing tumour size was demonstrated for patients with stage I - but not for stage II - small HCC., Conclusion: Patients with stage II small HCC may benefit from aggressive surveillance for tumour recurrence and appropriate salvage treatment. Further studies are needed for additional stratification of stage I patients to identify those at increased risk of death.

Background: Despite widespread use of the immunochemical faecal occult blood test (iFOBT), little is known about the subsequent risk of developing colorectal neoplasia for participants with negative iFOBT results. We investigated whether the concentration of faecal haemoglobin at the first screen is predictive of the subsequent incidence of colorectal neoplasia in those with a negative screening result., Methods: Between 2001 and 2007, we did a prospective cohort study within the Keelung community-based iFOBT screening programme for residents aged 40-69 years, using a cutoff faecal haemoglobin concentration of 100 ng/mL to classify attendees as negative and positive groups for further clinical investigations. 44,324 participants with negative findings and 1668 with a positive result at the first screen (854 non-referrals who refused colonoscopy and 814 with a false-positive result as assessed by colonoscopy) were followed up to ascertain cases of colorectal neoplasia. We investigated the association between baseline faecal haemoglobin concentration and risk of incident colorectal neoplasia, after adjusting for possible confounders., Findings: Median follow-up was 4·39 years (IQR 2·53-6·12) for all 45 992 participants, during which the incidence of colorectal neoplasia increased from 1·74 per 1000 person-years for those with baseline faecal haemoglobin concentration 1-19 ng/mL, to 7·08 per 1000 person-years for those with a baseline concentration of 80-99 ng/mL. The adjusted hazard ratios (HRs) increased from 1·43 (95% CI 1·08-1·88) for baseline faecal haemoglobin concentration of 20-39 ng/mL, to 3·41 (2·02-5·75) for a baseline concentration of 80-99 ng/mL (trend test p<0·0001), relative to 1-19 ng/mL. These results did not change when we included repeated iFOBT measurements. Non-referrals had the highest risk of incident colorectal neoplasia (adjusted HR 8·46 [6·08-11·76])., Interpretation: Quantitative faecal haemoglobin concentration at first screening predicts subsequent risk of incident colorectal neoplasia. During follow-up, risk stratification based on faecal haemoglobin could help clinicians, with particular attention being paid to those with higher initial faecal haemoglobin concentrations, especially those just under the threshold taken to indicate presence of colorectal neoplasia., Funding: None., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background and Aim: The widespread use of screening programs has resulted in an increase in detection of small hepatocellular carcinoma (HCC). Surgical resection generally leads to favorable outcomes in this group of patients; however, the prognostic significance of tumor size and the optimal cutoff point in resected specimens of small HCC have not been well defined. The aim of current study is to evaluate the prognostic significance of tumor size in small resected HCC., Methods: Patients who underwent surgical resection for small HCC at the Changhua Christian Hospital during January 2001 to June 2007 were enrolled. Small HCC was defined as a single HCC nodule with maximum diameter ≤ 5 cm. Cox regression hazard ratios for cancer-specific death were calculated to survey the prognostic significance of tumor size. We then determined the optimal cut-point for tumor size that could be used to stratify patients into 5-year disease-free survival (DFS) and cancer-specific survival (CSS) groups., Results: A total of 140 patients who underwent resection of small HCC were enrolled. The mean tumor size was 2.9 cm (range 0.9-5.0) and the mean follow-up period was 43.4 months. The 5-year DFS and CSS rates were 46.6% and 81.6%, respectively. Cox regression analysis revealed that tumor size (hazard ratio = 2.973, 95% confidence interval: 1.073-8.239, P = 0.036) was an independent prognostic factor. Our analysis showed that a tumor size of 3 cm was the cut-point that could dichotomize patients into statistically different 5-year DFS and CSS risk groups., Conclusions: Tumor size is an independent prognostic factor in resected small HCC and the prognostic significance of tumor size may vary according to different cut-off points., (© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.)

Background: We evaluated the heterogeneity of primary tumor volume (PTV) within tumors of the same pT4a-staged tongue carcinoma and to elucidate the effects of PTV on treatment outcomes in patients with pT4a-staged tongue carcinoma., Methods: Fifty-eight patients with newly diagnosed pT4a-staged tongue carcinoma who received surgery were enrolled onto this study. Magnetic resonance imaging-derived PTV was measured by the summation-of-area technique., Results: The mean PTV was 24.55 ml, with a range of 5.32 to 119.64 ml. The receiver operating characteristic curve was applied, and the optimal cutoff volume was 23 ml. Large PTV was associated with a significantly poor disease-specific survival (P = 0.010) by the log rank test. The Cox regression model also revealed that large PTV (P = 0.026) and positive lymphatic node metastasis (P = 0.004) were statistically significant in the prognosis of T4a-staged tongue carcinoma., Conclusions: A substantial variation of PTV was present within the same pT4a-staged tongue carcinoma, and PTV represented an important prognostic factor. In the light of these findings, we suggest that taking the PTV into account in pT4a-staged tongue carcinoma would better refine the newest revised T classification, and the treatment strategies may be different.

Objective: To incorporate clinical complications in the susceptible-infectious-recovered model to estimate parameters needed in dynamic changes of infectious diseases and to further evaluate the impact of disease-controlling methods., Methods: We developed a new extended epidemic model that incorporates of disease-related complications. This model was applied to empirical data on influenza during the epidemic season of 2001-2002 in Taipei County, Taiwan, to estimate the transmission parameters that were converted to the basic reproductive rate (R(0)). The proposed model, in conjunction with estimated parameters, was applied in quantifying the efficacy of different preventive strategies., Results: During the study period there were 5 outbreaks of influenza. The estimated transmission probability for outbreak 1 was 0.135, with corresponding estimate of R(0), 2.7; for outbreak 2, 0.165, with estimated R(0), 3.3; for outbreak 3, 0.15, with R(0), 4.5; for outbreak 4, 0.165, with R(0), 5; and for outbreak 5, 0.165, with R(0), 5. The efficacy of antiviral prophylaxis to reduce the total episodes was 18% (95% CI, 15%-21%) under the coverage rate of 30%, 31% (95% CI, 26%-36%) under the coverage rate of 50%, and 73% (95% CI, 59%-90%) under the coverage rate of 80%. The corresponding figures for the efficacy of vaccination were 17% (95% CI, 15%-20%), 41% (95% CI, 35%-48%), and 76% (95% CI, 61%-95%). Combination of both methods would yield efficacy of 32% (95% CI, 28%-38%), 59% (95% CI, 49%-71%), and 88% (95% CI, 66%-118%), respectively., Conclusions: We demonstrate how to apply a novel extended model to empirical surveillance data of an influenza study for estimating parameters pertaining to dynamic changes in the infection process. These parameters were further used to evaluate the impact of antiviral prophylaxis alone, vaccination alone, or the use of both methods.

Obesity and type 2 diabetes are associated with insulin resistance (IR), increased circulating proinflammatory cytokines, and hypertriglyceridemia, the latter being caused by overproduction of hepatic very low density lipoprotein (VLDL). One cytokine strongly linked with development of hepatic IR is interleukin-6 (IL-6). Our objective was to evaluate IL-6 effects on hepatic apolipoprotein B (apoB) and VLDL secretion and to examine possible linkages between cytokine signaling and insulin-suppressive effects on lipoprotein secretion. Of the cytokines examined, only IL-6 stimulated secretion of apoB-containing lipoproteins in a dose-dependent manner. Both B100 and B48 secretion were significantly increased in VLDL and in lipoproteins with a density >1.019 g/ml. The ability of insulin to suppress hepatic apoB secretion was maintained in hepatocytes treated with IL-6. Pulse-chase studies indicated that enhanced apoB synthesis was the primary mechanism for increased lipoprotein secretion, which corresponded with higher abundance of apoB mRNA. Because IL-6 did not alter the decay rate of apoB mRNA transcripts, results support that increased apoB mRNA levels are the result of enhanced apob gene transcription. Increased apoB-lipoprotein secretion was also detected with oncostatin M (OSM), supporting involvement of the signal-transducing protein, gp130. Increased suppressor of cytokine signaling (SOCS) 3 expression negated IL-6 and OSM effects and significantly reduced cellular apoB mRNA abundance. We conclude that IL-6 favors secretion of apoB-containing lipoproteins by increasing availability of apoB through changes in apob gene transcription. These changes may contribute to hypersecretion of VLDL associated with obesity, particularly under conditions where SOCS3 is not overexpressed to an extent capable of overcoming IL-6-stimulated apob gene transcription.

Purpose: Population-based routine service screening has gained popularity following an era of randomized controlled trials. The evaluation of these service screening programs is subject to study design, data availability, and the precise data analysis for adjusting bias. We developed a computer-aided system that allows the evaluation of population-based service screening to unify these aspects and facilitate and guide the program assessor to efficiently perform an evaluation., Methods: This system underpins two experimental designs: the posttest-only non-equivalent design and the one-group pretest-posttest design and demonstrates the type of data required at both the population and individual levels. Three major analyses were developed that included a cumulative mortality analysis, survival analysis with lead-time adjustment, and self-selection bias adjustment. We used SAS AF software to develop a graphic interface system with a pull-down menu style., Results: We demonstrate the application of this system with data obtained from a Swedish population-based service screen and a population-based randomized controlled trial for the screening of breast, colorectal, and prostate cancer, and one service screening program for cervical cancer with Pap smears. The system provided automated descriptive results based on the various sources of available data and cumulative mortality curves corresponding to the study designs. The comparison of cumulative survival between clinically and screen-detected cases without a lead-time adjustment are also demonstrated. The intention-to-treat and noncompliance analysis with self-selection bias adjustments are also shown to assess the effectiveness of the population-based service screening program. Model validation was composed of a comparison between our adjusted self-selection bias estimates and the empirical results on effectiveness reported in the literature., Conclusions: We demonstrate a computer-aided system allowing the evaluation of population-based service screening programs with an adjustment for self-selection and lead-time bias. This is achieved by providing a tutorial guide from the study design to the data analysis, with bias adjustment., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: It is controversial whether unilateral interruption of the arteria iliaca interna distal end affects penile hemodynamics and erectile function. The purpose of this study was to prospectively evaluate this influence by detecting the blood flow of the penile artery before and after renal transplantation., Methods: Thirty-three patients with chronic renal failure (CRF) on maintenance hemodialysis (MHD) received renal transplantation, the grafts revascularized by end-to-end anastomosis to the right internal iliac artery. Six months before and after the surgery, we obtained the IIEF scores of the patients, recorded their penile blood flow on color Doppler ultrasonography and the levels of serum creatinine, hemoglobin and serum cholesterol, and analyzed post-transplantation immunosuppressive medication., Results: The patients ranged in age from 21 to 55 years, of whom 36% had erectile dysfunction (ED) during MHD, and 33% after renal transplantation. A total of 67% of the renal transplant recipients (RTR) complained of unchanged and 15% deteriorated ED, while 18% admitted improved erectile function. The patients showed a significantly stronger sexual desire after the transplantation than before it (6.2 +/- 1.6 vs 8.9 +/- 0.9, P < 0.01). There was a significant decrease in peak systolic velocity (PSV) in the cavernous arteries after transplantation as compared with pre-transplantation (P < 0.01). Penile arterial blood flow insufficiency was found in none of the RTRs., Conclusion: Unilateral interruption of the internal iliac artery decreases penile arterial blood flow, but not to such a degree as to result in ED. Unilateral interruption of the arteria iliaca interna distal end does not affect the erectile function of RTRs.

Objective: To investigate the changes of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2) and testosterone (T) in male adolescents of different ages by determining their levels in 8-17 years old boys., Methods: We included in this study 627 male adolescents aged 8-17 years and qualified through physical examinations. All the subjects underwent determination of FSH, LH, PRL, E2 and T with an automatic ACCESS microparticle chemiluminescence immunoassay analyzer and detection of liquid quality control by immunoassay., Results: FSH remained at a low level in the 8-10 years old male adolescents and increased at 11 years; the levels of LH and T were low before the age of 12 years and began to increase at 13 years; and that of E2 was low before the age of 13 years and began to rise after that, all with statistically significant differences (P < 0.01)., Conclusion: In the male adolescents, FSH, LH and T significantly increased at 11, 12 and 13 years old, respectively, which marked the beginning of sexual development.

Background & Aims: The quantitative relationships between instruments and assays that measure clinical, endoscopic, and biologic disease activity in patients with Crohn's disease are poorly characterized. This study evaluated the correlations between the Crohn's Disease Activity Index (CDAI), the Simple Endoscopic Score for Crohn's Disease (SES-CD), serum high-sensitivity C-reactive protein (hsCRP) (both phenotype and genotype) and interleukin-6 (IL-6), and fecal calprotectin and lactoferrin., Methods: A total of 164 patients with Crohn's disease undergoing colonoscopy were enrolled. The CDAI and SES-CD scores, serum hsCRP and IL-6, CRP and IL-6 genotypes, and fecal calprotectin and lactoferrin were measured., Results: There were no significant associations between the CDAI and SES-CD scores (Spearman rank correlation coefficient, 0.15) or between the CDAI scores and the serum concentrations of hsCRP and IL-6, or the fecal concentrations of calprotectin and lactoferrin. In contrast, the serum hsCRP and IL-6 concentrations and the fecal calprotectin and lactoferrin concentrations were significantly higher in patients with more severe endoscopic disease activity (SES-CD score > 7 points) (P < .001 for all comparisons). The CRP 717 mutant homozygote and heterozygote status was associated with significantly lower concentrations of hsCRP (P = .02). There was a trend toward higher hsCRP concentrations in the CRP 286 heterozygous adenine mutant-type mutant genotype, but this did not reach statistical significance., Conclusions: Serum and fecal biomarker concentrations are associated with endoscopic but not clinical disease activity in patients with Crohn's disease. Stimulated hsCRP concentration is affected significantly by select genetic polymorphisms.

Background: Betel-quid chewing, a recognized risk factor for oral cancer, was shown to be a contributory cause of metabolic syndrome in humans, which implies a greater likelihood of developing cardiovascular disease (CVD) among those with the betel habit., Objective: This study investigated the effect of betel chewing on the risk of developing overt CVD., Design: We used the prospective cohort data derived from a community-population-registry-based integrated screening program to quantify the effect of betel-quid chewing on the incidence of newly diagnosed CVD by classifying the study population into either exposed or nonexposed groups according to chewing status at baseline. We then followed the group free of CVD at recruitment for 2.72 y (SD=1.52 y) to learn of new cardiovascular events. Proportional hazards regression modeling was used to estimate the magnitude of the effect of betel-quid chewing on CVD., Results: After control for age and education level, ever chewers had a 23% (95% CI: 11%, 37%) greater risk of developing CVD than did never chewers; ever chewers were still at greater risk of developing CVD by 24% (95% CI: 11%, 39%) after further adjustment for age, education, and other significant confounders. Significant dose-response relations were found for betel-quid chewing (P<0.05, trend test) after adjustment for other significant variables., Conclusion: The habit of chewing betel nut was shown to have independent dose effects to predict increases in the risk of CVD in men, with the use of a prospective community-population-registry-based cohort study.

The quality of sexual life is important for renal transplantation recipients. With the increase of survival rate of renal transplantation, the quality of the male recipients' sexual life, especially their erectile function, has been generally remarked. The prevalence of ED is 35.8%-78.3% in male allograft renal transplantation recipients. And it can be caused by various factors, such as age, dialysis time, modus operandi, hemoglobin level, deprementia, immunosuppressant, and diabetes. We give an overview of the therapeutic options for ED in this special population. Sildenafil is effective and safe. If the oral drug fails, we can choose intracavernosal injection and penile prosthesis implantation. Nevertheless, three-piece prostheses should be avoided.

Objective: To introduce the application of percutaneous epididymal sperm aspiration (PESA) in the differential diagnosis between obstructive and non-obstructive azoospermia, and to investigate the association of the results of PESA with testis volume and the level of serum follicle stimulating hormone (FSH)., Methods: A total of 118 patients with diagnosed azoospermia were included. Their testis volume was measured by model method, the serum gonadal hormone level examined by chemoluminescence assay, and the epididymal fluid obtained by puncturing the head of the epididymis with a size-7 butterfly needle., Results: Sperm was found in the epididymal fluid in 60 of the patients, 56 with normal and 4 with smaller testis volume, and 55 with normal and 5 with higher FSH level. No sperm was detected in the other 58 cases, 34 with normal and 24 with smaller testis volume, and 38 with normal and 20 with higher serum FSH level. The rate of successful PESA was significantly higher in patients with normal testis volume or normal serum FSH level than in those with smaller testis volume (P < 0.05) or higher serum FSH level (P < 0.05)., Conclusion: PESA is a quick, convenient and effective method for the differential diagnosis between obstructive and non-obstructive azoospermia.

Background: To evaluate morbidity, mortality, and long-term survival in patients undergoing partial or total cystectomy during en bloc resection for locally advanced colorectal cancer., Methods: This study retrospectively evaluated the outcome of combined bladder resection for colorectal cancer in our department., Results: Patients (n=33) with colorectal tumors adherent to the bladder were followed. Overall morbidity was 11/33 (33.3%). Histological staging demonstrated inflammatory adhesion in 54.5% (18/33) and invasion in 45.6% (15/33). Morbidity was significantly higher in those that had undergone total cystectomy than in those that had undergone partial cystectomy (4/5 vs 7/28, P=0.033). The local recurrence has no difference the between total cystectomy group and the partial cystectomy group (1/5 vs 8/28, P=1.000). Overall 5-year survival rate was 39.4% (13/33). Mean survival time was 46.6875 month. There was no difference in 5-year survival between patients with inflammatory adhesion vs those with tumorous infiltration between colorectal tumor and bladder (P=0.7389)., Conclusion: Survival after surgery for colorectal cancer is not influenced by the need to excise part or all of the urinary bladder in case it is contiguous to a colorectal tumor. Experienced surgeons in urology and colon and rectal surgery should be left to decide on the surgical options to be employed.

Multiple detection modalities have increasingly gained attention in population-based screening. However, the disease natural history and its efficacy have been barely addressed. We reviewed a series of articles addressing multiple detection modalities including mammography, ultrasound and magnetic resonance image between 1995 and 2005. A stochastic model was developed to estimate transition parameters pertaining to the disease natural history defined by multiple detection modalities. The effectiveness of the combination of ultrasound or magnetic resonance image (MRI) with mammography was projected using a series of computer simulation models. The results indicated that multiple detection modalities may lead to reduced mortality. However, the benefit and the selection of detection modalities are affected by biological factors including age, breast tissue type and histological type. In addition, other social factors may also affect the utilization of multiple detection modalities.

Premature ejaculation is a common but incompletely understood male sexual dysfunction. Recent years have witnessed fruitful researches on NO in the mechanism of male ejaculation and successful application of selective PDE5 inhibitor in the treatment of male sexual dysfunction. And now the researches on the etiopathogenesis, mechanism, diagnosis and therapy of premature ejaculation have achieved great development. Selective serotonin re-uptake inhibitors (SSRIs) have been widely applied to clinical practice, but with increasing adverse effects. The purpose of the review is to introduce the updated development of the epidemiology, definition, etiopathogenesis, mechanism and therapy of premature ejaculation, and to provide some reference for the diagnosis and management of the problem.

Background: Laparoscopic resection (LR) has become increasingly popular for the management of rectal cancer. Despite a decade of experience, the safety and efficacy of LR for rectal cancer remains to be established. This report performs a meta-analysis to compare LR with conventional open resection (CR) in patients with rectal cancer., Methods: Using a defined search strategy, studies directly comparing CR with LR for rectal cancer were identified. The data for patients with rectal cancer treated with both approaches were extracted and used in our meta-analysis. Open surgery and laparoscopic surgery were compared in terms of postoperative mortality, morbidity, complications, oncological clearance, operating time, and time before recovery to a normal diet., Results: Compared with CR, LR is associated with lower morbidity rates [OR 0.63 (0.41, 1.96) P=0.03], longer operating times [weighted mean difference 1.59 (1.20, 1.98) P<0.00001], similar mortality rates, wound healing disorder rates, urinary disorder rates, cardiopulmony disease rates, all leakage rates, all abscess rates and a positive rate of margin., Conclusion: LR is associated with less postoperative morbidity, but longer operation time. A prospective randomized controlled trial is warranted to fully investigate these and other outcome measures.

Objective: To explore the expressions of P33ING1, P53 and their relationships with apoptosis in anal canal carcinoma (ACC)., Methods: The expressions of P33ING1, P53 proteins were measured by immunohistochemistry method (SP method), and apoptosis was detected in 42 cases with ACC, 36 cases with anal canal adenoma (ACA) or anal canal papilloma (ACP), and 40 cases with paraanal inflammatory mass(PAIM)., Results: The positive expression rates of P33ING1 and P53 proteins were 40.5% (17/42), 97.2% (35/36) and 97.5% (39/40), 50.0% (21/42), 22.2% (8/36) and 27.5% (11/40) respectively, and the average apoptosis indexes(AI) were (10.27+/- 1.23) per thousand, (42.75+/- 0.98) per thousand and (42.67+/- 1.04) per thousand respectively in ACC, ACA or ACP and PAIM. There were significant differences in the positive expression rates of P33ING1, P53 and apoptosis index between ACC and the other two groups respectively (P< 0.05). Among 21 cases of ACC with positive expression of P53 protein,there were 18 cases with P33ING1 negative expression., Conclusions: P33ING1 expression decrease in ACC, which may play an important role in the carcinogenesis and progression of ACC. P33ING1 and P53 may have an synergistic effect of suppressing cell growth and accelerating cell apoptosis.

Background: Betel-quid chewing, an established risk factor for oropharyngeal malignancy, is associated with hyperglycemia and obesity. Associations with other characteristics of the metabolic syndrome have not been reported., Objective: This study examined associations between betel-quid chewing and the metabolic syndrome, allowing for recognized risk factors and exploring dose-response effects in a population-based study., Design: Age-specific prevalence rates of the metabolic syndrome were examined in betel-quid chewing and nonchewing men (n = 19,839) recruited into the Keelung Community-based Integrated Screening program in 2001-2003. The independent effect of betel-quid chewing on metabolic syndrome risk was examined by using multiple logistic regression with control for well-recognized risk factors (eg, education, physical activity, and dietary factors) and dose-response effects were examined by using trend tests., Results: The age-adjusted prevalence of the metabolic syndrome was highest in current chewers (25.13%), next highest in ex-chewers (22.04%), and lowest in nonchewers (15.73%) (P < 0.0001). Odds ratios (95% CIs) for the metabolic syndrome were 1.38 (1.19, 1.60) and 1.78 (1.53, 2.08) in ex-chewers and current chewers, respectively, adjusted for other significant correlates such as a family history of hypertension and diabetes mellitus. Meaningful odds ratios for the metabolic syndrome components ranged from 1.24 for hyperglycemia (95% CI: 1.09, 1.64) to 1.90 (95% CI: 1.66, 2.19) for hypertriacylglycerolemia. Increasing odds ratios for the metabolic syndrome with higher consumption of betel quid (whether by rate of use, duration of use, or cumulative exposure) suggest dose-response effects., Conclusions: After adjustment for well-established risk factors, our study showed independent predictive dose-response effects of betel-quid chewing for the metabolic syndrome and its components in a population-based study of men with a 15% prevalence of betel-nut chewing.

Background: Community-based multiple screening for common cancers and chronic diseases has increasingly gained attention. However, as infrastructure and evaluation system are more diversified and complicated compared with single screening, the development of a novel health information system is paramount., Methods: The main goal of our health information system was to support the multiple screening program not only from technical aspect but also from a broad range of perspectives including quality assurance system, organized features appertaining to screening, economic evaluation (cost-effectiveness or cost-utility analysis), epidemiological applications, behavior risk factor surveillance system, and social impact due to the introduction of the Keelung Community-Based Integrated Screening (KCIS) program., Results: Health information system was designed and programmed on the basis of the demand derived from KCIS within which five cancers and three chronic diseases were included. In addition to the detailed description of infrastructure and process, design, relevant database and security involved in health information system, an innovative and extensive evaluation system in accordance with the main goals was included in our health information system., Conclusion: Our information system proposed several aspects regarding organized screening system that has never been addressed in computerized system supporting for single screening. These included quality assurance system, organization features, co-morbidity profiles, epidemiological applications and social and economic considerations.

Objective: To investigate the clinical efficacy of integrative traditional Chinese and Western medicine on polycystic ovarian syndrome (PCOC)., Methods: Sixty-three patients with polycystic ovarian syndrome were randomly allocated into 2 groups, 31 patients orally administered with diane-35 in the Western medicine group (WMG) and 32 patients treated with conventional controlled medicine plus modified Yougui Pill in the integrative medicine group (IMG). Changes of relevant hormones and clinical syndromes in patients were detected before treatment, after 3 cyclic treatment and at the 6th cycle after treatment., Results: The levels of relevant hormones and the indexes of B-ultrasonic were obviously improved after treatment in the two groups. But 6 cycles after treatment, these changes restored to the baseline as those before treatment in WMG, while maintained in IMG (P < 0.01). What's more, the normalization of menstruation, ovulation and pregnancy rate in IMG were significantly higher than those in WMG (P < 0.01)., Conclusion: Diane-35 combined with modified yougui pill in treating polycystic ovarian syndrome not only shows marked short-term effect, but could consolidate the curative effect.

Objective: To summarize the clinicopathological characteristics of primary anorectal malignant melanoma (AMM)., Methods: Clinical data of nine patients with AMM were reviewed retrospectively from January 1999 to March 2005., Results: Anorectal malignant melanoma had a female predominance. The average age was 56 years old and average course of disease was 5.8 months. The onset of symptom was hematochezia, then anus prolapses. 94.7% of patients had AMM within 5 cm from anus margin; the average tumor size was (3.3+/- 2.1) cm. The polyp and ulcer were most common types. More than a half (54.5%) of the tumor was movable, 19.1% smooth surfaced, 6.6% soft textured. Synchronous metastasis was found in 14.0% of the patients, the first common metastasis was found in liver, the secondary was superficial inguinal lymph node metastasis. Half of the patients were misdiagnosed,and over 50% of patients were misdiagnosed as benign disease. Mile's operation was performed in most of patients (63%), while anal resection was performed in 30% of the patients., Conclusions: Anorectal malignant melanoma is often misdiagnosed,surgical procedure is the first choice for patients with AMM.

Background & Objective: Inhibitor of growth 1 (ING(1)) gene has been identified as a novel tumor suppressor gene. Its over-expression can inhibit cell growth, and induce cell apoptosis. This study was to explore the effect and significance of ING(1) gene in occurrence and progression of sporadic colorectal cancer., Methods: The expression, mutation, and loss of heterozygosity (LOH) of ING(1) gene in 46 specimens of sporadic colorectal cancer tissues and adjuvant normal mucous membrane tissues were detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), PCR-single strain conformation polymorphism (PCR-SSCP), and microsatellite markers, respectively., Results: (1)The average ratios of light density of p33/ING(1) mRNA, and p47/ING(1) mRNA in the cancerous tissues were significantly lower than those in normal tissues (0.52 vs. 1.28, P < 0.01; 0.51 vs. 1.21, P < 0.01). Difference between the 2 mRNA splices was not significant in the matched tissues (P > 0.05). (2) The average ratios of light density of p33/ING(1) mRNA, and p47/ING(1) mRNA in the cancerous tissues of Dukes' C, D stage were significantly lower than those in cancerous tissues of Dukes' A, B stage (0.38 vs. 0.65, P < 0.01; 0.40 vs. 0.63, P < 0.01). (3) Of the 46 cases, no mutation of ING(1) gene was detected, only 5 (10.9%)cases of LOH were found., Conclusions: Abnormal alteration of ING(1) gene is rare in sporadic colorectal cancer. Its down-regulation may happen in transcription or post-transcription, and correlates tightly with the occurrence and progression of sporadic colorectal cancer.

Disease screening is one of important activities in the domain of public health. However, traditional disease screening is based on solitary disease rather than multiple diseases. Although information accrued from multiple screening make contribution to health risk assessment as well as efficient management, data sources underpinning multiple screening are diversified and complicated including registration, primary data from questionnaire or biological measurement, referral system, confirmatory diagnosis, and case management. As our multiple screening integrates five types of cancers and four types of chronic disease at each out-reach and ambulatory setting, packages for attendants vary according to age, gender and risk factor (such as betel chewing, alcohol drink, smoking, family history, self-disease history, etc.). We took the initiative in design of health information system to support the complex processes of multiple screening. To enhance the efficiency of multiple screening and efficient disease management, health information system was therefore designed to support such a complicated infrastructure.

To investigate the DNA binding activity of the JC virus minor capsid protein, VP2, both wild-type and mutant VP2 were cloned and expressed in Escherichia coli. Southwestern blotting was employed for the DNA-binding assay. The results showed that VP2 was able to bind to DNA, except when either the last 13 or the last 29 amino acids were truncated. The results indicate that the DNA-binding domain of VP2 is located within the last 13 amino acids. Furthermore, we also demonstrated that Lys(332) and Lys(336) within the DNA-binding domain are crucial for DNA binding. The findings may provide further information for understanding the mechanism of virion assembly of the JC virus.

This review provides an overview of the pharmacology mechanism of sildenafil. The efficacy and safety of the medicine are briefly summarized. The special conclusion was made for the usage of sildenafil to the particular patients such as those with hypertension or those taking any antihypertensive agent, with cardiovascular disease, with diabetes, with spinal cord injury, after radical prostatectomy and on chronic dialysis. In general, sildenafil is effective and safe for various ED patients.