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The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Score (BAS-G) have been recommended for evaluating function and disability in patients with ankylosing spondylitis (AS). The aim of this study was to develop a Chinese version of the BASDAI, BASFI, and BAS-G and assess their reliability and validity. The Chinese version was obtained after a translation and back-translation process. A total of 447 patients with adult and juvenile AS were assessed using these three instruments. Reliability was tested by internal consistency and test–retest reliability. Internal consistency of the instrument was given as Cronbach’s alpha. Test–retest reliability was assessed by intraclass correlation coefficient. To assess the sensitivity to change, 153 patients were included in an 8-week follow-up study. In our analysis, the reliability of these three instruments—the BASDAI, BASFI, and BAS-G—for a 24-h test–retest showed acceptable intraclass correlation coefficients (0.92–0.94). Our Chinese versions of the BASDAI, BASFI, and BAS-G also showed 0.87, 0.94, and 0.90, respectively, with Cronbach’s alpha coefficient, indicating good reliability. For sensitivity to change in 8-week follow-up, all three instruments showed 5.0 to 5.4% changes. Our Chinese versions of the BASDAI, BASFI, and BAS-G showed adequate reliability, validity, and responsiveness to clinical change. Thus, disease activity and functional status in Chinese-speaking patients with AS may be adequately evaluated with these versions of the original instruments. [ABSTRACT FROM AUTHOR]

Aim: Chondrosarcoma is a malignant primary bone tumor that responds poorly to both chemotherapy and radiation therapy. The aim of the present study was to investigate the effect of alendronate, a bisphosphonate, on the invasion and migration of human chondrosarcoma cells (JJ012). Methods: JJ012 cells were treated with alendronate of various concentrations up to 100 μmol/L for a specified period, and then gelatin zymography and matrigel invasion assay was performed to study the effects of alendronate on matrix metalloproteinase (MMP)-2 activity and the invasion ability of JJ012 cells, respectively. Results: Our data showed that alendronate exerted a dose- and time-dependent inhibitory effect on the invasion and migration of JJ012 cells. Furthermore, gelatin zymography and RT-PCR showed that alendronate treatment decreased the activity and mRNA levels of MMP-2 in a concentration-dependent manner. Conclusion: Our findings suggest that alendronate may reduce MMP-2 secretion at the transcriptional and translational levels, and inhibit the invasion of chondrosarcoma cell. Therefore, alendronate may be a potential candidate for the systemic therapy of chondro-sarcomas, as well as other malignant diseases. [ABSTRACT FROM AUTHOR]

Fourteen serum samples obtained from hepatitis B virus (HBV) chronic carriers and patients recovered from hepatitis B infection were used with four sodium dodecyl sulfate‐treated enzyme‐linked immunosorbent assay (ELISA) plates available commercially, and one self‐prepared HBcAg analog for evaluation of anti‐HBe subclass pattern absorbance. The self‐prepared plates had the best performance and were thus used for samples obtained from 104 (60 male and 44 female) HBV chronic carriers and 439 (247 male and 192 female) recovered individuals. Tests for aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were also carried out in 21 of the subjects (>25 IU/ml). Statistical comparison of these patients with elevated ALT/AST levels with other ALT/AST‐normal chronic carriers revealed no significant differences in the anti‐HBe OD, although the mean optical density (OD) of patients with elevated ALT/AST levels was higher. The results suggest that the anti‐HBe IgG subclass profiles in the chronic carriers did not change with inflammation of the liver, and were independent of sex and age. In contrast to previous anti‐HBc findings, the distribution pattern of anti‐HBe subclasses in HBV chronic carriers was IgG1 > IgG4 > IgG3 while in the recovered individuals it was IgG1 > IgG3 > IgG4, for both males and females. Subclasses IgG1 and IgG2 were the most and least prevalent isotypes, respectively, in both study groups. The results of the study suggest that induction of IgG1 and/or IgG3 antibodies is important for effective virus neutralization, while IgG2 antibodies are of limited importance. Significantly higher OD values for anti‐HBe IgG4 were observed when comparing samples from the chronic carriers and recovered individuals, which may reflect the effects of persistence. Further, in contrast to previous anti‐HBs results, the concentrations of total IgG and IgG1 were higher in the samples from chronic carriers relative to those from recovered individuals. J. Med. Virol. 79:495–502, 2007. © 2007 Wiley‐Liss, Inc. [ABSTRACT FROM AUTHOR]

Homocysteine (Hcy), a sulfur-containing amino acid, is eliminated through B vitamins-dependent pathways. Hyperhomocysteinemia has been found to be an independent risk factor for atherosclerotic cardiovascular, cerebrovascular, and peripheral vascular diseases. Recently, psoriasis, lupus, and rheumatoid arthritis were reported to be associated with hyperhomocysteinemia. This study was aimed to evaluate the changes of plasma Hcy level before and after sulfasalazine and MTX therapy in patients with ankylosing spondylitis (AS). One hundred and two patients with AS and ten normal controls were enrolled in the cross-sectional case-control study. Fasting plasma Hcy levels were determined by ELISA kits (IMX, Abbott). Hcy levels were compared to their Bath AS disease activity index (BASDAI) and the usage of sulfasalazine and/or MTX. Active disease was defined by BASDAI as more than 3 in a 10-cm scale with ESR >20 mm/h. For those patients with plasma Hcy ≥15 μmol/l, a perspective trial of daily supplement of vitamin B-12 0.5 mg, B-6 50 mg, and folic acid 5 mg for 2 weeks were also tested for the efficacy. Plasma Hcy level increased significantly in AS patients under sulfasalazine (10.4±3.8 μmol/l, p<0.05), MTX (11.9±4.7, p<0.05) and sulfasalazine/MTX combination treatment (11.2±2.6, p<0.05) compared with normal controls (8.6±1.2 μmol/l) and AS patients without DMARD(9.4± 2.6μmol/l). No correlation between disease activity and plasma Hcy level was found. Daily supplement of vitamin B-12 0.5 mg, B-6 50 mg, and folic acid 5 mg can lower Hcy level in 2 weeks (32.3±24.0 vs 15.6±11.1 μmol/l, p=0.007). Plasma homocysteine level did significantly increase in AS patients under sulfasalazine or MTX treatment. B-vitamins should be considered as a routine supplementation for patients who underwent sulfasalazine and/or MTX treatment. Further longitudinal studies are required to confirm the conclusions. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the prevalence of nocturnal enuresis among children in elementary school in Taiwan and to evaluate its associated factors and severity. Materials and Methods: A randomly selected cross-sectional study was conducted from elementary schools in Changhua county, Taiwan in 2003. In all, 9228 questionnaires were sent to 46 schools in 26 districts. Results: A total of 92.1% (8496/9228) of questionnaires were completed. The overall prevalence of nocturnal enuresis was 6.8%. The ratio of male to female was about 1.5 (8.0% vs. 5.5%). The prevalence of enuresis according to age group declined from 12.5% at 6 years to 2.0% at 12 years. The prevalence of enuresis in the urban area did not show significant difference from that of rural area (6.2% vs. 6.9%). Of the factors associated with enuresis, gender, age, urinary frequency or urgency, heredity, drinking habit before sleep and difficulty in waking showed significant difference after multiple logistic regression analysis. After multivariate analysis, difficulty in waking and time of wetting were the only factors significantly associated with the severity of enuresis. Conclusion: Our investigation showed the prevalence of enuresis is similar to those reports from the north of Taiwan and most of other western countries, but higher than that of China and Hong-Kong. Difficulty in waking and time of wetting were the only factors significantly associated with the severity of enuresis. [ABSTRACT FROM AUTHOR]

PURPOSE The purpose of this study was to evaluate function of major salivary glands, subjective xerostomia, and correlation between subjective and objective xerostomia scoring after precision-oriented radiotherapy for nasopharyngeal carcinoma. MATERIALS AND METHODS From 2000 to 2002, 34 patients with histologically proven non-metastatic nasopharyngeal carcinoma received definitive therapy by parotid-sparing radiotherapy, which included intensity-modulated radiotherapy (33 patients > 60 Gy), 3D-conformal radiotherapy, and brachytherapy boost. Salivary function was assessed by sialoscintigraphy pre-irradiation and post-irradiation at 1, 6, 12, and 18 months. The salivary stimulated secretion ratio (SSR) was used to evaluate function of submandibular and parotid glands. Subjective and objective xerostomia was monitored by the LENT/SOMA system. RESULTS The median dose to parotid gland was 34.6 Gy (interquartile range, 32.9 36.5 Gy). The median dose to submandibular gland was 60.5 Gy (interquartile range, 58.1-61.5 Gy). Parotid-gland post-irradiation median SSR at 1 (0.01, P = 0.000) and 6 (0.08, P = 0.002) months showed significant reduction compared with pre-irradiation data (0.30). After 12 months, parotid-gland median SSR (12 months. 0.22, P = 0.734; 18 months, 0.16, P = 0.885) lost significance compared with pre-irradiation data. Submandibular-gland post-irradiation median SSR at 1 (P = 0.000), 6 (P = 0.000), 12 (P = 0.000), and 18 (P = 0.000) months all showed significant reduction compared with pre-irradiation data. There were significant correlations between LENT/SOMA subjective and objective xerostomia scores at 6 months (r = 0.657, P = 0.000), 12 months (r = 0.480, P = 0.013), and 18 months (r = 0.591, P = 0.002). CONCLUSIONS With parotid-sparing radiotherapy for nasopharyngeal carcinoma, gland function can recover significantly 12 months after radiotherapy. There were significant rank-order correlations between LENT/SOMA subjective and objective (analytic) grading scores at 6 to 18 months' follow up. [ABSTRACT FROM AUTHOR]

Although allergic asthma and allergic rhinitis have recently been considered to be a single disease, many questions remain unanswered. Why do some atopic patients develop asthma symptoms and others develop allergic rhinitis symptoms? Which factors play a role in the development of different allergic phenotypes? We hypothesized that angiotensin-converting enzyme (ACE) gene polymorphism might play a role in the development of asthma phenotypes in children with allergic rhinitis. The study sample included 106 children with allergic rhinitis, but no asthma, and 105 age- and gender-matched children with allergic rhinitis and asthma. Subjects of both groups exhibited the same systemic immunologic changes and allergen sensitivities. Controls consisted of 102 healthy children. The ACE genotype was determined by polymerase chain reaction. The serum total immunoglobulin E (IgE) level, allergen-specific IgE sensitivity, and eosinophil count were also measured. The frequencies of the DD genotype were significantly higher in the children with both allergic rhinitis and asthma than in the children with allergic rhinitis but no asthma [p = 0.018; odds ratio (OR) = 3.257; (1.222–8.680)]. Results of this study suggest that ACE gene polymorphism DD genotype might play a role in the development of the asthma phenotype in children with allergic rhinitis. [ABSTRACT FROM AUTHOR]

Immunotherapy through oral routes is thought to be a valuable therapeutic option for asthma. The clinical and immunologic effects of sublingual immunotherapy (SLIT) in children with asthma caused by mites were evaluated in a double-blind, placebo-controlled study for 6 months. Patients (aged 6–12 yr) with mild-to-moderate asthma, with single sensitization to mite allergen, received either SLIT or placebo with a standardized Dermatophagoides pteronyssinus ( D.p.)/ D. farinae ( D.f.) 50/50 extract. The cumulative dose was around 41824 IR, equivalent to 1.7 mg of D.p. and 3.0 mg of D.f. allergen. Symptom and medication scores were assessed throughout the study. Serum total immunoglobulin (Ig)E, eosinophil count, eosinophil cationic protein, specific IgE, specific IgG4, and skin sensitivity were evaluated before starting the treatment and after the treatment period. Twenty patients completed the study. At the beginning of the treatment, no differences were observed between the groups for symptom and medication scores, skin sensitivity, or immunologic parameters. After 6 months of treatment, there was a significant difference in nighttime asthma symptom scores and specific IgG4 (p < 0.05) in the SLIT group compared with the placebo group. Daytime symptom and medication scores, total IgE, eosinophil count, forced expiratory volume in 1 s, and mean evening peak expiratory flow rate reached significant differences in the SLIT group during the treatment period (p < 0.05). No severe adverse effects were reported. Our results revealed that treatment for 6 months with SLIT is clinically effective in decreasing asthmatic symptoms and medication use in children with mild-to-moderate asthma because of mite sensitivity. The clinical usefulness of this form of immunotherapy and the mechanism underlying its immunologic effects deserve further studies. [ABSTRACT FROM AUTHOR]

Background: Etanercept (Enbrel), was the first approved biologics in Taiwan for rheumatoid arthritis (RA), juvenile RA (JRA), psoriatic arthritis and ankylosing spondylitis. Approximately 500 patients with RA were under etanercept therapy by April 2006. Aim: We aimed to review the current status of biological agents use in the treatment of rheumatic diseases in Taiwan. Methods: MEDLINE database (January 1966 to February 2006) was searched by MeSH terms, limited to Taiwan by author affiliations. All known principal clinical investigators and pharmaceutical companies in Taiwan were contacted for unpublished information about this issue. Results: Six articles including two clinical trials, two case series and two preclinical studies were found in MEDLINE since January 1966. A 12-week double-blind placebo-controlled study of 58 patients with active adult RA in Taiwan revealed better efficacy than results in Western countries. For JRA, two studies reported good results in polyarticular type JRA but fair response in systemic type. Adalimumab (Humira, Abbott) and Alefacept (Ameviev, Biogen) had completed their local trials in RA and psoriasis but they are not yet available in Taiwan. Widespread usage of biologics has been limited due to restricted insurance coverage policy only to the refractory patients with RA. Some herbs demonstrating TNF-α inhibition properties are under exploratory clinical trials. Conclusions: Etanercept showed better efficacy in patients with adult RA in Taiwan than Western countries. Some herbs demonstrated TNF-α inhibition and are under laboratory and clinical investigations. [ABSTRACT FROM AUTHOR]

Background: Two-dimensional echocardiography (2DE) enhanced by combining with color Doppler technology has significant limitations in providing precise quantitative information, geometric assumptions to calculate chamber volume, mass, and ejection fraction. Reconstructed three-dimensional echocardiographic (3DE) systems (from multiple cross-sectional echocardiographic scans) are still cumbersome and time-consuming. Real time 3DE (RT-3DE) with shorter imaging time than with 3D reconstruction techniques can obtain qualitative and quantitative information on heart disorders. Our purpose was to investigate the feasibility and potential value of RT-3DE as a means of accurately and quantitatively estimating the size of VSD to correlate with the surgical findings. Materials and methods: 38 patients with VSD were examined with RT-3DE. 3D image database was postprocessed using TomTec echo 3D workstation. The results were compared with the results measured by 2 DE and surgical findings. RT-3DE produced novel views of VSD and improved quantification of the size of the defect. The sizes obtained from 3DE have equivalent correlation with surgical findings as diameter measured by 2DE (r = 0.89 vs r = 0.90). Good agreement between blinded observers was achieved by little interobserver variability. Conclusion: RT-3DE offers intraoperative visualization of VSD to generate a “virtual sense of depth” without extending examining time. From an LV en face projection, the positions, sizes, and shapes of VSDs can be accurately determined to permit quantitative recording of VSD dynamics. It is a potentially valuable clinical tool to provide precise imaging for surgical and catheter-based closure of difficult perimembranous and singular or multiple muscular VSD [ABSTRACT FROM AUTHOR]

Selecting an appropriate antimycotic targeting the pathogens are among the most important factors for successfully treating onychomycosis. The aim of this study was to investigate the pathogens of onychomycosis in southern Taiwan and analyse the association between various factors and the distribution of pathogens. A total of 375 patients with onychomycosis were enrolled. Histopathological examination and fungus culture of nail specimens were performed. The pathogens were dermatophytes in 227 patients (60.5%), Candida in 118 (31.5%) and moulds in 30 (8%). Compared to patients with toenail involvement, the odds ratio (OR) for those with fingernail involvement to have non-dermatophytic onychomycosis (NDO), i.e. onychomycosis caused by Candida and moulds, was 5.04 [95% confidence interval (CI): 2.21–11.15], and the OR for those with fingernail and toenail involvement to have NDO was 2.66 (95% CI: 1.61–4.34). The F/M OR to have NDO was 2.36 (95% CI: 1.51–3.61), and 9.80 for diabetics (95% CI: 1.01–106.85). The OR for patients with paronychia to have NDO was 10.33 (95% CI: 5.61–18.88) compared to those without paronychia. Compared to patients with a non-wet occupation, the OR for those with a wet occupation to have NDO was 4.76 (95% CI: 2.01–11.16). The distribution of pathogens significantly varies with the involved sites, patients’ gender and occupation, and presence of diabetes mellitus or paronychia. In contrast to temperate western countries, NDO is more prevalent in the tropics and subtropics including southern Taiwan. [ABSTRACT FROM AUTHOR]

Study objective: To review our experience in treatment of complicated parapneumonic effusion and pleural empyema by video-assisted thoracoscopic surgery (VATS). Design: Retrospective chart review. Setting: Taiwanese medical centers. Patients: A total of 234 patients (108 women, 126 men; median age, 51 years; range, 0.75 to 84 years) underwent procedures for parapneumonic effusion (145 patients) or pleural empyema (89 patients) between May 1995 and December 2003. All patients had chest radiographs, and 188 patients (80.3%) underwent preoperative CT or sonography. More than 85% (200 patients) received preoperative diagnostic or therapeutic thoracentesis, tube thoracostomy, or fibrinolytics. Indications for VATS included empyema refractory to medical control or peel or multiloculated exudate's per CT and chest tapping. Interventions: Septal lysis and debridement irrigation through one port (31 patients, 13.2%), decortication and debridement through two or three ports (179 patients, 76.5%), or rib resection or larger utility incision for decortication and drainage (24 patients, 10.3%). Results: Mean ± SD procedural time was 64.3 ± 22.5 min (range, 26 to 244 min). Sixteen patients (6.8%) needed further surgery for empyema (9 patients required open drainage or thoracoplasty, and 7 patients needed redecortication or repair of bronchopleural fistula). There were no intraoperative deaths and only eight (3.4%) perioperative deaths (< 30 days), which were mostly unrelated to surgery. Of the 234 patients, 202 patients (86.3%) achieved satisfactory results with VATS treatment. Patients requiring open decortication or repeat procedures (40 patients) had a longer mean duration of preoperative symptoms, longer mean duration of preoperative hospitalization, and a higher ratio of pleural empyema (vs complicated parapneumonic effusion) than patients undergoing simple VATS. Conclusions: VATS is safe and effective for treatment of complicated parapneumonic effusion and pleural empyema. Earlier intervention with VATS can produce better clinical results. A prospective study should be done to identify optimal timing and settings for VATS treatment for both complicated parapneumonic effusion and pleural empyema. [ABSTRACT FROM AUTHOR]

The Taiwan Association of Family Medicine (TAFM) was established in 1986. At the present time Taiwan has a total of 66 residency training programs with approximately 150 first-year residents accepted per year. The TAFM realizes and values the importance of outpatient teaching for family medicine residents. Following the guidelines of outpatient training for residents set in 1989, the first-year, second-year, and third-year residents should attend the outpatient teaching at least once, twice, and three times per week, respectively, at the designated Family Medicine Clinic. Residents also receive outpatient training from qualified preceptors during their community rotations, wherein services are provided to patients in the clinics, their homes or communities where they live. In this review article, guidelines on outpatient teaching in the family medicine residency training programs made by the Taiwan Association of Family Medicine will be described, followed by my personal experiences about teaching family medicine at an outpatient clinic. Family practice is characterized by its first-contact, office-based, patient-centred, family-as-a-unit, and prevention-oriented care. Obviously, the outpatient clinic is the proper place to demonstrate and practice the characteristics of family medicine. A family physician spends approximately 90% of his/her working time on outpatient services, followed by inpatient care, institutional care and home visits. Moreover, outpatient practice at the Family Practice Center has been the most important training curriculum for family medicine residents throughout the world. Quality ambulatory teaching requires the following: 1. Preliminary class: introduction to the practice, operating procedures for the practice, communication skills, use of computer, and evidence-based medicine. 2. Teaching primer: at least two partially connected examination rooms for each learner must be provided. 3. Teaching facilities: standardized outpatient facilities, documents, and computer systems. 4. Trainers: attending staff, chief residents, and allied professionals who have received adequate preparation for both first-time teachers and continuing professional development training. 5. Evaluation system: video-taping, one-way mirror, review of medical records, clinical performance examination with standardized patients for learners, and also evaluation of the learning experience by the learners. 6. Financial arrangements: rewards and credits to the trainers, funds to support the expenses, and maintenance of teacher enthusiasm. [ABSTRACT FROM AUTHOR]

In this study we quantified the levels of matrix metalloproteinase-2 and 9 (MMP-2 and 9) in effusions and serial synovial cultures of patients with arthritis of the knee in order to investigate the correlations between MMP and cell counts in effusions as well as the possible roles of the synovium. In 49 patients with arthritis of the knee (series I) we examined the cell counts and the amounts of MMP-2 and 9 in 51 effusions. In 20 knee samples of series I of patients who received arthroscopy (series II), we examined the amounts of MMP-2 and 9 in effusions and serial synovial organ cultures. We also compared the gene expressions of MMP-2 and 9 and MT1-MMP in serial synovial cultures using RT-PCR. In series I, significantly more proMMP-9 appeared in effusions from the inflammatory group than in the non-inflammatory and hemorrhagic group (p <0.001). The levels of proMMP-9 correlated with the neutrophil counts in the effusions (p <0.001). In series II synovial cultures, the activities of latent and activated forms of MMP-2 and 9 in lesional areas were all higher than that in paralesional ones (p <0.05). In RT-PCR analysis, MMP-2, -9 and membrane type 1 MMP mRNA levels of lesional areas also showed increased expression. Our data suggest that the analysis of MMP-9 indicates the inflammatory condition of the joints and that additional synovectomy may be beneficial for patients with inflammatory synovitis, compared with non-inflammatory and hemorrhagic arthritis. [ABSTRACT FROM AUTHOR]

BACKGROUND:Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Human WW domain-containing oxidoreductase (WWOX) gene has been identified as a tumor suppressor gene in multiple cancers. We hypothesize that genetic variations in WWOX are associated with HCC risk. METHODOLOGY/PRINCIPAL FINDINGS:Five single-nucleotide polymorphisms (SNPs) of the WWOX gene were evaluated from 708 normal controls and 354 patients with HCC. We identified a significant association between a WWOX single nucleotide polymorphism (SNP), rs73569323, and decreased risk of HCC. After adjustment for potential confounders, patients with at least one T allele at rs11545028 of WWOX may have a significantly smaller tumor size, reduced levels of α-fetoprotein and alanine aminotransferase (ALT). Moreover, the A allele at SNP rs12918952 in WWOX conferred higher risk of vascular invasion. Additional in silico analysis also suggests that WWOX rs12918952 polymorphism tends to affect WWOX expression, which in turn contributes to tumor vascular invasion. CONCLUSIONS:In conclusion, genetic variations in WWOX may be a significant predictor of early HCC occurrence and a reliable biomarker for disease progression.

Nuclear localization of β-catenin is known to associate with malignant transformation of many squamous cell carcinomas. The aim of this study was to compare β-catenin expression in normal human oral epithelium and areca quid chewing associated oral squamous cell carcinomas (OSCCs) and further to explore the potential mechanisms that may lead to induce β-catenin expression. Methods: A total of 40 areca quid chewing-associated OSCCs and 10 normal oral tissue biopsy samples without areca quid chewing were analyzed by immunohistochemistry. The oral epithelial cell line GNM cells were challenged with arecoline, a major areca nut alkaloid, by using Western blot analysis. Furthermore, extracellular signal-regulated protein kinase inhibitor PD98059, glutathione precursor N-acetyl-l-cysteine (NAC), tyrosine kinase inhibitor herbimycin-A, p38 inhibitor SB203580, and phosphatidylinositaol 3-kinase inhibitor LY294002 were added to find the possible regulatory mechanisms. Results: β-catenin expression was significantly higher in OSCC specimens than that in normal oral epithelial specimens (p

The fractional concentration of exhaled nitric oxide (FENO) has been reported to be elevated in asthma and many other lung diseases. The present study investigated reference values and determinants of FENO in a Taiwanese non-smoking, healthy adult population. Methods: We used a chemiluminescence analyzer according to American Thoracic Society/European Respiratory Society recommendations to measure FENO values in 356 adults who received a health check-up and a detailed respiratory questionnaire at Taichung Veterans General Hospital, Taiwan. Among the volunteers, 249 fulfilled our definition of healthy adults: no history of smoking or physician-diagnosed asthma; no recent upper airway infection; no chronic respiratory symptoms; and no allergic rhinitis and urticaria. Results: Among the 249 non-smoking and non-asthmatic adults, the mean (5th to 95th percentile reference range) FENO was 27.9 (12.5–58.0) parts per billion. In multivariate regression analyses, age and lung function (forced vital capacity or forced expiratory volume in 1 second) were associated positively with FENO values. Sex, height, weight, and ambient NO values were not associated significantly with FENO values. Conclusion: Age and lung function were predictors of FENO in this population, and these factors should be considered for clinical applications of FENO measurements.

This study evaluates the proliferative effects of danshen and its monomer extract, tanshinone IIA, on Schwann cell proliferation. A piece of silicone rubber was guided across a 15-mm gap in the sciatic nerve of a rat. This nerve gap was then filled with different concentrations of danshen (0-100 mg/mL). The results showed that danshen increased the expressions of uPA, cyclin D1, E and ERK, JNK, and P38 MAP kinases via the FGF-2 signaling pathway in a dose-dependent manner. RSC96, Schwann cells were also administered with danshen (0, 20, 40, 60, 80, and 100 μg/mL) and tanshinone IIA (0, 2, 4, 6, 8, and 10 μg/mL). In lower concentrations, danshen and tanshinone IIA exhibited an apparent effect on Schwann cells. Similar effects were also demonstrated in the FGF-2-uPA regulating cascade and cell cycle proliferative protein results. Schwann cell migration was elevated as well. We used MAPK-signaling chemical inhibitors and identified the proliferative effects of danshen and tanshinone IIA asMAPK-signaling dependent. The results from the in vitro systems indicate that danshen and tanshinone IIA can be used to induce Schwann cell proliferation, and in vivo results potentially suggest that danshen and tanshinone IIA might enhance neuron regeneration. [ABSTRACT FROM AUTHOR]

Accurate death certification is essential to high-quality mortality statistics. Physicians who certify disproportionately large numbers of deaths can significantly affect the validity of the resultant mortality data. In Taiwan in 1994, 110 death certifiers issued more than 100 death certificates each; and nine of these high-frequency certifiers issued more than 500 death certificates. We explore the cultural, political, economic, historical, and social contexts of high-frequency death certification in Taiwan. Because of the traditional belief in Taiwan that one must die at home for the soul to be incorporated into the collective ancestral tablet of the household, many families bring their loved ones home from the hospital just before death. Hospital physicians cannot legally issue a death certificate in these cases because they did not witness the dying process. Although the government introduced an administrative certification system to handle these outside-hospital deaths, the great demands of this system have attracted many `special exam' doctors (doctors with no formal medical degree) to adopt death certification as a full-time business. In this context, it is not surprising that `routinization' of death certification (J. Health Soc. Behav. 32 (1991) 273) has led to low-quality reporting among these certifiers. We argue that attempts to improve the quality of mortality statistics should take into account the unique sociocultural contexts of different countries. [ABSTRACT FROM AUTHOR]