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Cerebral white matter undergoes various changes with normal aging. This study investigated the association between age, gender, and the global and regional fractional anisotropy (FA) and mean diffusivity (MD) in 145 adults (30 to 80 years old) using diffusion tensor magnetic resonance imaging. We studied sixteen regions of interest in both hemispheres to search for regions that display age- and gender-related white matter changes and also performed a complementary voxel-based analysis without any hypothesis a priori. On a global scale, our results indicate that the full brain FA was negatively correlated with age. The regional analysis showed that the anterior corpus callosum, the bilateral anterior and posterior internal capsule, and the posterior periventricular regions had the most significant age-related FA decrease. On the other hand, the FA in the temporal and occipital regions was not correlated with age. However, in contrast to males, females overall had a significantly lower FA in the right deep temporal regions. More gender differences in precentral, cingulate, and anterior temporal white matter areas were also found, suggesting that microstructural white matter organization in these regions may have a sexual dimorphism. Such differences were mainly due to the increase in diffusion perpendicular to fiber tracts.

To evaluate the relationship of antibody clearance and clinical improvement for myasthenia gravis (MG) patients with MuSK antibody (MuSKAb) receiving one course of double-filtration plasmapheresis (DFP) treatment, we prospectively recorded their MG scores and measured MuSKAb concentrations before and after each DFP treatment session in two MuSKAb-positive patients. The clinical improvement trends roughly paralleled the reductions of MG score, except for the late rebound of MuSKAb in the 6th DFP treatment session, without concomitant clinical worsening in one patient. Longitudinal analysis on the serological changes during the serial sessions revealed that the levels of MuSKAb fell by 44%, 59%, 79%, 82%, 92%, and 71% in patient 1 and 52%, 70%, 78%, 87%, and 90% in patient 2. The titers of MuSKAb decreased constantly during the first 5 DFP treatment sessions. MuSKAb clearance per session for the 11 sessions ranged from 19% to 56%, with a mean of 45%. In conclusion, DFP was effective for MuSKAb removal and amelioration of clinical weakness for our two patients with MuSKAb. A 5-session protocol cleared 90% of serum MuSKAb.

Objectives/hypothesis: Among the airway mucin genes, the MUC4 gene is an important gene in its response to inflammatory diseases of the upper airway. However, the expression and regulation of the MUC4 gene in the nasal polyps remains unclear., Study Design: The purpose of this study was to evaluate the expression of MUC4 mRNA and synthesis of mucin glycoprotein in the nasal polyps before and after treatment with a topical steroid in vivo and in vitro., Methods: Nasal polyps were obtained from 20 patients with chronic rhinosinusitis and were subsequently cultured. The level of MUC4 mRNA was measured by reverse-transcription polymerase chain reaction, and the amount of the MUC4 mucin glycoprotein was estimated by the enzyme-linked immunosorbent assay method., Results: The expression of MUC4 mRNA was found to be significantly higher in the nasal polyps than in the inferior turbinate (P < .05). The addition of interleukin (IL)-1 beta and lipopolysaccharide (LPS) increased the expression of MUC4 mRNA and mucin glycoprotein synthesis in cultured nasal polyp epithelial cells. Treatment with glucocorticoid inhibited the expression of MUC4 mRNA in the nasal polyps; it also inhibited the expression of IL-1 beta and LPS-induced MUC4 mRNA and mucin glycoprotein synthesis in cultured nasal polyp epithelial cells. The inhibitory effects of glucocorticoid were restored by treatment with a glucocorticoid receptor antagonist (RU-486)., Conclusions: These results suggest that the MUC4 gene is expressed in the nasal polyps and that glucocorticoid can control the expression of the MUC4 gene and mucin glycoprotein synthesis.

Purpose: To investigate the association between diameter and flow velocity of the carotid arteries and ischemic stroke., Methods: Peak systolic velocity, end diastolic velocity, Pourcelot resistance index, blood flow volume, luminal diameter, and carotid plaque burden were measured and compared in 240 ischemic stroke (IS) patients without history of stroke, 163 chronic stable IS patients, and 236 nonstroke controls (age, >or=40 years). Data were also compared between stroke subtypes (large artery atherosclerosis, lacunar, cardioembolic, or undetermined origin)., Results: Acute as well as chronic stable IS patients had significantly lower flow velocities and flow volume, higher resistance index than nonstroke controls in the common carotid artery (CCA), internal carotid artery and external carotid artery, and larger common carotid artery diameter. The differences were found across all IS subtypes and in stroke patients with as well as without carotid plaque. Comparisons between these subgroups showed significant differences in end diastolic velocity, resistance index, flow velocity, and diameter that were more prominent in the CCA. After adjusting for carotid plaque and cardiovascular risk factors, the associations between the above-mentioned parameter and stroke remained significant., Conclusions: Stroke patients in acute as well as chronic stable phase appeared to have larger CCA diameters, lower carotid flow velocities and volume, and higher resistance index than nonstroke patients independently of extracranial carotid atherosclerosis. These findings need to be confirmed by a prospective study., ((c) 2007 Wiley Periodicals, Inc.)

Objectives: Mucin gene expression and mucin production are markedly increased in inflammatory airway disorders such as asthma, chronic bronchitis and rhinosinusitis. Cytokines, lipopolysaccharides and other inflammatory mediators such as prostaglandin and leukotriene are related to the secretion and production of mucin. However, the relationship of leukotrienes with mucin genes expression is not clear. The aim of this study is to evaluate MUC2/5AC gene expression and mucin secretion by the leukotriene receptor in human airway epithelial cells., Methods: The effect of leukotriene D(4) and the leukotriene receptor antagonist, pranlukast hydrate (ONO-1078) on the regulation of MUC2/5AC gene expression and mucin secretion were observed in human airway NCI-H292 epithelial cells. The mRNA levels of MUC2/5AC and the amount of mucin were determined by reverse transcription-polymerase chain reaction (RT-PCR) and immunoassay., Results: Leukotriene D(4) upregulated MUC2/5AC gene expression and mucin secretion in a dose dependent pattern. Pranlukast hydrate (ONO-1078, 100 microM) downregulated the leukotriene D(4)-induced MUC2/5AC gene expression and mucin secretion., Conclusion: These results suggest that the leukotriene receptor system is one of the mechanisms related to MUC2/5AC gene expression and mucin secretion in the human airway epithelium.

Background: Large hemispheric infarcts cause high mortality and morbidity. Understanding the clinical course and prognostic factors in patients with LHI, thereby enabling the identification of patients who will benefit from early aggressive intervention, is important. This study describes the clinical course of patients who had LHI and identifies the predictors for mortality., Methods: A retrospective collection of clinical and laboratory data in patients admitted to a neurologic intensive care unit of a medical center was examined. Large hemispheric infarct was defined as an infarct that involved at least 2 of the 3 (deep, superior, and posterior) MCA territories. Patients who received a hemicraniectomy were not included., Results: Fifty patients with radiologically confirmed LHI were analyzed. The 30-day mortality rate was 22%. Only patients who had massive infarcts (complete MCA territory infarcts and beyond) died, whereas none with i-MCAs died (P < .001). For the 26 patients with massive infarcts, the 30-day mortality was 42.3%. Early deterioration, ipsilateral pupil dilation, and a low GCS were associated with mortality. Further analysis revealed that an age less than 70 years (OR 24.5, 95% CI 2.3-262.6) and a GCS less than 10 at the second day of stroke (OR 15, 95% CI 1.5-149.5) predicted a fatal outcome among patients with massive infarcts. A GCS less than 12 at the first day of stroke and early CT findings of hypodensity more than one half of the MCA territory were associated with massive infarct., Conclusions: The extent of infarction is a crucial factor for mortality. The consciousness level may identify patients at risk for massive infarct at the first day of stroke and predict a fatal outcome as early as the second day. Early identification of the extent of infarction and close monitoring of the consciousness level help predict outcome.

Little is known regarding the development of metabolic syndrome. This study examining gender difference in the characteristics of metabolic components aimed to estimate the development of metabolic syndrome in both genders. This nation-wide, population-based survey included 5,880 men and women aged 20-79 years in Taiwan. Metabolic syndrome was defined by the revised National Cholesterol Education Program Adult Treatment Panel III, with adoption of the Asian criteria for abdominal obesity. The results indicate that metabolic syndrome was prevalent in 20.4% of the men and 15.3% of the women. Lipid components occurred the earliest in both genders. The appearance of the first isolated component was earlier in women than in men (mean age 43.4 vs. 45.6 years, P < 0.05). In contrast, the mean prevalent age of metabolic syndrome appeared earlier in men than in women by 4.9 years (mean age 51.3 vs. 56.2 years, P < 0.05). The differences in prevalent age from the appearance of any isolated component to metabolic syndrome were 12.8 years in women and 5.7 years in men, respectively. If men had a body mass index less than 23 kg/m(2) and exercise habits, the difference in the prevalent age from the isolated component to metabolic syndrome was 15.4 years, longer than for all women subjects. We conclude lipid components appeared the earliest. Women had the first isolated component earlier, presenting as metabolic syndrome later than men. The development of metabolic syndrome was slower in subjects without overweight characteristics and with exercise habits.

To evaluate the occurrence of hemolysis during double-filtration plasmapheresis (DFP) treatment and its causes, we prospectively treated 113 myasthenic patients and monitored transmembrane pressure (TMP), arterial line pressure (Pa), and venous line pressure (Pv) at 30-minute intervals (M30, M60, M90, and M120) during treatment. Laboratory and clinical parameters related to the development of hemolysis were also analyzed. The overall frequency of hemolysis was 35.4%. Peripheral venous access was associated with a higher rate of hemolysis (45.3%) The mean TMP increased significantly after M30 for the hemolysis group compared with the no hemolysis group. A similar trend was present for Pa. Pv did not differ between the 2 groups during treatments until M90 and M120. Pa and TMP changed significantly with time (both P < .0001). Vascular access through large veins and stable TMP during the procedure may help avoid hemolysis.

Several types of nonhematopoietic stem cells, including bone marrow mesenchymal stem cells (BMMSCs) and embryonic stem cells, have been shown to have immunosuppressive properties. We show that human placenta-derived multipotent cells (PDMCs), which are isolated from a source without ethical concern and harbor multilineage differentiation potential, have strong immunosuppressive properties. PDMCs suppress both mitogen-induced and allogeneic lymphocyte proliferation in both CD4 and CD8 populations. The immunosuppression seen with PDMCs was significantly stronger than that with BMMSCs. Both PDMCs and BMMSCs express indoleamine 2,3-dioxygenase, but only PDMCs are positive for intracellular human leukocyte antigen-G (HLA). Mechanistically, suppression of lymphocyte reactivity by PDMCs is not due to cell death but to decreased cell proliferation and increased numbers of regulatory T cells. Addition of neutralizing antibodies to interleukin-10 and transforming growth factor (TGF)-beta partially restored lymphocyte proliferation. Unlike BMMSCs, PDMCs treated with interferon-gamma for 3 days only very minimally upregulated HLA-DR. On the contrary, PD-L1, a cell surface marker that plays an inhibitory role in T-cell activation, was upregulated and TGF-beta expression was seen. The immunosuppressive properties of PDMCs, along with their multilineage differentiation potential, ease of accessibility, and abundant cell numbers, may render these cells as good potential sources for future therapeutic applications.

Background/purpose: Obesity and metabolic syndrome (MS) are major risk factors for the development of type 2 diabetes and cardiovascular diseases (CVD). This study estimated the prevalence of obesity and MS in Taiwan., Methods: Data from a nationwide cross-sectional population-based survey of 5936 participants (2815 men, 3121 women; age range, 20-79.9 years) in 2002 were analyzed. Obesity was defined as a body mass index (BMI) > or = 27 kg/m(2) according to the criteria of the Department of Health in Taiwan. The prevalence of MS was estimated using the definitions of the modified Adult Treatment Panel III (ATP III), the International Diabetes Federation for Chinese (MS-IDF(C)) and the MS criteria for Taiwanese (MS-TW)., Results: The overall prevalence of obesity in men was significantly greater than in women (19.2% vs. 13.4%, p < 0.0001). The age-standardized prevalence of MS was 15.7% by the modified ATP III criteria, 14.3% by the MS-IDF(C) criteria and 16.4% by the MS-TW criteria. The prevalence of obesity and MS significantly increased with age (trend test, p < 0.0001) in men and women. The risk of MS and its components increased significantly with BMI, and showed a marked increase with BMI > or = 24 kg/m(2). MS as classified by the MS-IDF(C) criteria failed to identify subjects at high risk of CVD who did not have abdominal obesity, including those with hypertension, type 2 diabetes and dyslipidemia., Conclusion: This study found a high prevalence of obesity and MS in Taiwan. The definitions of MS by the modified ATP III and MS-TW criteria were better able to detect high CVD risk than the MS-IDF(C) criteria.

Altered cytokine secretion as a mechanism in the etiology of depression is still obscure. The serotonin transporter (5-HTT) may play an important role in the termination of serotonergic neurotransmission by serotonin (5-HT) uptaking into presynaptic neurons and representing as an initial action site for selective 5-HTT reuptake inhibitors (SSRI). In our study, we evaluated whether cytokines and 5-HTT acted as biological markers for depression. Blood samples were collected from 42 participants. The differences in cytokine and 5-HTT mRNA expressions of leukocytes were assessed between the patients with major depression (n=20) and the healthy controls (n=22), along with the measurements prior and after treatment with a SSRI, fluoxetine, for 3 months in the follow-up patient group (n=8). The results revealed that the mRNA expressions of IL-1beta, IL-6, IFNgamma, TNFalpha, and 5-HTT were higher in the depressed patients than those of the healthy controls. The higher level of mRNA expressions of IFNgamma and 5-HTT diminished after fluoxetine treatment. Furthermore, we found a positive correlation between 5-HTT and cytokines mRNA expressions in total participants, which suggested that pro-inflammatory cytokines and 5-HTT might play critical roles in the pathogenesis of major depression and that their levels were affected by chronic treatment with 5-HTT inhibitors.

Background: Epidemiologic data regarding the role of inflammation in atherosclerosis have been based mainly on Caucasian populations. Thus, we analyzed the cross-sectional relationships of inflammatory biomarkers to cardiovascular risk factors (CVRF) and related variables in a large group of healthy Chinese men, a population with a markedly lower heart disease mortality rate compared with Western populations., Methods: The study consisted of 8374 men aged 20-80 who attended a voluntary health examination at a metropolitan university center between 1997 and 2002. The relationships between serum high sensitivity C-reactive protein (hsCRP), total white blood cell (WBC), neutrophil, and monocyte counts to CVRF were analyzed using multivariate linear and logistic regression analyses. Whether a dose-response effect existed between elevated levels of each marker and increasing numbers of CVRF was also evaluated., Results: The distribution of hsCRP was similar to Western studies. Both multivariate regression analyses showed all four markers to have significant correlations with body mass index, triglycerides, and adverse high density lipoprotein/low density lipoprotein ratio. Smoking was associated with increased levels of all four markers. Elevated neutrophil count had the most markedly progressive dose-response effect with increasing numbers of CVRF, whereas elevated monocyte count showed a drop in risk with CVRF of five and above., Conclusion: We show in our study that with increasing numbers of standard CVRF, healthy Chinese men have progressive and increasing risks of having elevated levels of hsCRP, total WBC, and neutrophil counts. While the inflammatory markers surveyed were largely correlated with CVRF, the similar values of CRP between populations with divergent mortality rates suggest that a more complex relationship may exist between CRP and disease outcome. The possible utility of neutrophil count as a marker for cardiovascular disease risk in healthy men awaits further evaluation in prospective studies.

Background and Purpose: In 2005, the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guideline lowered the fasting glucose cut point used to define metabolic syndrome (MS). This study investigated the influence of MS on ischemic stroke (IS) risk using both the original and revised definitions. In addition, because abdominal obesity is the measure of obesity used in the guideline to define MS, we also investigated whether general obesity (GOB) should be considered in the definition of MS., Methods: Baseline data from 3453 adults (> or =20 years of age) in the Cardiovascular Diseases Risk Factor Two-Township Study were linked to insurance claim and death certificate records. The 2001 and 2005 NCEP-ATP III definitions were used with Asian and Taiwanese specific cut-off values for waist circumference and body mass index. Hazard ratios of MS and GOB on IS were calculated using Cox models, and the Kaplan-Meier method was used to derive free-of-IS survival curves., Results: During 10.4 years of follow-up, 132 persons developed IS. Hazard ratios of subjects with 1 to 2 and > or =3 MS component disorders were 2.69 and 4.30, respectively, under the 2001 definition, and 3.16 and 5.15, respectively, under the 2005 definition (all P values <0.05). MS subjects with GOB had reduced survival at a borderline significance level. Adding GOB in the MS definition did not significantly alter the number of subjects with MS nor the ability to predict stroke risk. Replacing abdominal obesity with GOB in MS definition reduced the number slightly and increased the hazard ratio., Conclusions: MS predicted IS and the 2005 NCEP definition showed a stronger dose-response relationship with IS. Adding GOB to the existing MS definition had limited benefit.

To evaluate the optimal session of double filtration plasmapheresis (DFP) in terms of the maximal clearance rates for various serum substances, the laboratory parameters of 152 consecutive patients treated with different sessions of DFP following a standard protocol on an alternate-day basis was studied. Immunoglobulin M (IgM) and lipoprotein cholesterol had the most effective clearance by a minimum of two sessions of DFP treatment, and the clearance rates remained relatively constant despite the increase in the number of treatment sessions, while the clearance rates for other serum proteins increased steadily with further treatments. Using the clearance rate of the 2-session group as reference, the highest slopes for clearance of albumin, globulin, and triglyceride were found in the 4-session group, while the slopes for IgA and IgG were highest in the 5-session group. In conclusion, for the clearance of IgM and lipoprotein cholesterol, two sessions of DFP treatment are adequate. However, the best clearance of IgG and other globulins cannot be achieved until the fourth session of DFP treatment. Therefore, a minimum of 4 sessions of DFP treatment at 2-day intervals is needed for most immunological diseases.

Background and Purpose: The association between anticardiolipin antibody (aCL) and ischemic stroke is controversial, and there are few case-control studies of Asian populations. The aim of this study, therefore, was to determine whether aCL is an independent risk factor for ischemic stroke in Taiwanese patients over the age of 40 years., Methods: Both the IgG and IgM isotypes of aCL were measured in 273 patients (> 40 years of age) hospitalized for first-ever ischemic stroke and in 181 non-stroke controls. Results were defined as: negative (< 10 IgG phospholipid units [GPL] or < 7.5 IgM phospholipid units [MPL]); low positive (10-20 GPL or 7.5-15 MPL); or, high positive (> 20 GPL or > 15 MPL). Odds ratios (OR) were estimated by logistic regression with adjustment for potential confounders., Results: A high positive IgG aCL was present in 4.4% of the stroke patients and 1.2% of the controls. Age- and sex-adjusted analysis showed a borderline association between a high positive level for aCL IgG titer and stroke, with an OR of 4.01 (95% CI 0.87-18.37; p = 0.0739). Final analysis, with adjustments for age, sex, hypertension, diabetes, tobacco smoking, atrial fibrillation, left ventricular hypertrophy and hyperlipidemia, revealed an OR of 5.25 (95% CI 1.06-25.89; p = 0.0419)., Conclusions: The results of this study suggest that elevated titer of aCL IgG (> 20 GPL) is associated with first-ever ischemic stroke in Taiwanese patients aged over 40 years. High positive aCL titer is related to ischemic stroke after adjustment for conventional cerebrovascular risk factors, indicating that it is probably an independent risk factor for ischemic stroke., (Copyright 2006 S. Karger AG, Basel.)

Unlabelled: The aim of this study was to evaluate the potential role of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in patients with unexplained rising serum alpha-fetoprotein (AFP) levels after the treatment of hepatocellular carcinoma (HCC)., Patients and Methods: Thirty-one FDG-PET studies were performed in 26 patients (age range, 45-83; 21 men and 5 women), who had undergone either surgical resection or interventional therapy for HCC, but were subsequently noted to have high AFP serum levels on routine follow-up examinations, although imaging studies and physical examinations were normal. The FDG-PET results were correlated with histological findings, as well as long-term radiological and clinical follow-up (shortest follow-up period after FDG-PET was 6 months)., Results: FDG-PET was abnormal in 22 of the 31 studies (71.0%) among the 26 patients. Intrahepatic lesions were detected in 20 of a total 30 lesions (66.7%) in 18 studies of FDG-PET among 26 patients. Ten FDG-PET studies among 9 patients identified one intrahepatic lesion, while 3 studies among 3 patients identified more than one intrahepatic lesion. Extrahepatic metastases were found in 9/31 studies of FDG-PET (29.0%) among 8 patients. These metastatic foci, composed of increased FDG accumulation, were identified in several locations; lung (4 studies among 4 patients), bone (2 studies among 2 patients) and the peritoneum (4 studies among 3 patients). Overall, FDG-PET for detecting HCC recurrence demonstrated 22 true-positives, 8 false-negatives, 1 true-negative and 0 false-positive results., The sensitivity, specificity and accuracy of FDG-PET for detecting HCC recurrence was 73.3%, 100% and 74.2%, respectively., Conclusion: When conventional examinations are normal, FDG-PET is a valuable imaging tool in patients who have rising AFP levels after HCC treatment. FDG-PET whole-body scan also provides an important and valuable imaging study for detecting extrahepatic metastasis.

Objective: Accuracy of diagnostic methods for detecting Helicobacter pylori (H. pylori) infection among patients with bleeding peptic ulcers has not been thoroughly investigated. The aim of this study was to compare the diagnostic tests and their combined usage in detection of H. pylori infection in patients with bleeding gastric ulcers and without the use of nonsteroidal anti-inflammatory drugs., Methods: A total of 57 patients who presented with bleeding gastric ulcers by endoscopy were enrolled. The status of H. pylori was identified by performing the rapid urease test (RUT), histology and (13)C-labeled urea breath test (UBT). The criteria for having H. pylori infection was a minimum of two positive tests., Results: The prevalence of H. pylori infection in our patient group was 80.7%. Among the three tests used: RUT, histology, and UBT, sensitivities were 56.5%, 97.8% and 100%, while specificities were 100%, 45.5% and 81.8%, respectively. The overall accuracies of the tests were 78.3%, 71.6% and 90.9%, respectively. Although UBT obtained significantly higher accuracy than histology (P = 0.02) as opposed to RUT (P = 0.11), UBT had significantly higher sensitivity than RUT (P < 0.001). In terms of combining any two of the three tests, more accuracy (98.9%) was achieved when both UBT and histology were used to confirm the diagnosis of the other. Conversely, failure to use combined tests generated the potential of missing a proper H. pylori diagnosis., Conclusions: UBT is superior to the other two tests in bleeding gastric ulcers. RUT lacks sensitivity for detection of H. pylori infection. However, the concomitant use of UBT and histology seems to be more accurate when gastric ulcers present with bleeding.

Objective: We conducted a case-control study to identify risk factors for ovarian cancer in Taiwan, a low-incidence population where the incidence has been on the rise., Methods: Cases were 86 women (age range 20-75, median 47) drawn from patients with primary, invasive epithelial ovarian cancer diagnosed between 1993 and 1998 in the Taipei metropolitan area, with the following histologic subtypes: 35% serous, 27% mucinous, 21% endometrioid, 15% clear cell, and 2% unspecified adenocarcinoma. Controls were 369 women (age range 20-75, median 44) selected from patients who were hospitalized at the same time for treatment of unrelated diseases. Subjects were interviewed in person regarding sociodemographic and reproductive characteristics, family and medical history, and diet., Results: A strong inverse relationship of ovarian cancer to each live birth was observed (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.20-0.89; OR = 0.30, 95% CI = 0.13-0.69; and OR = 0.18, 95% CI = 0.05-0.62 for parity of 1 or 2, 3-5, and >5, respectively). Menopause was associated with increased risk of disease (OR = 2.15, 95% CI = 1.21-3.83). A trend toward protection was seen with breastfeeding for more than 1 year (OR = 0.55, 95% CI = 0.29-1.01). No dietary factor was associated with an increased disease risk. Milk intake was associated with a decreased disease risk (OR = 0.45, 95% CI = 0.28-0.74)., Conclusion: The strong protective effect of parity was supported by this study, and the decline in parity is likely an important reason for the rising incidence of ovarian cancer in Taiwan. A decreased disease risk was also seen with milk intake. In addition, the difference in the distribution of histologic subtypes in this population compared with high-incidence populations may point to further differences in risk factors.

Neurofibroma may occur in any parts of myelinated nerves having Schwann cells. However, it is extremely rare in the nasal septum. We have had experience with an isolated neurofibroma of the nasal septum which was successfully removed by transnasal endoscopic excision, and describe the clinical, endoscopic surgical and pathological features.

Background and Purpose: A subsample of 147 Chinese subjects from a population-based study of cardiovascular diseases (Cardiovascular Disease Risk Factor Two-Township Study) participated in an ancillary study on extracranial carotid color duplex ultrasonography that aimed to assess the relations of coagulation factors to stroke and carotid atherosclerosis., Methods: Logistic models were used to study the associations between cardiovascular disease risk factors and stroke/carotid atherosclerosis, controlling for the effects of age and sex., Results: Stroke was significantly associated with hypertension and high values of plasma glucose but not with fibrinogen, factor VIIc, or factor VIIIc. Carotid plaques identified in this study were mostly mild and moderate. The presence of these mild and moderate carotid plaques was significantly associated with high values of factor VIII activity, hypercholesterolemia, hypertriglyceridemia, and hypertension. The highest tertile of factor VIIIc (> 1.53) was associated with an odds ratio of 3.35 for carotid atherosclerosis when compared with the lowest tertile (< 1.20). A multiple logistic regression including all significant risk factors showed that the degree of association between factor VIIIc and atherosclerosis was attenuated to an odds ratio of 2.65 (P = .061)., Conclusions: In the present study, the roles of hypertension, hypercholesterolemia, and hypertriglyceridemia have been implicated in the pathogenesis of carotid atherosclerosis, and roles for hypertension and hyperglycemia in stroke were indicated. A positive association between factor VIIIc and carotid atherosclerosis in this Chinese population was found. Whether this association is independent of the effect of other cardiovascular risk factors awaits further study.

The role of hemostatic factors in the pathogenesis of cardiovascular disease has gained much attention recently. Information about hemostatic factors, and their age patterns is sparse for orientals. With the data collected in the Cardiovascular Disease Risk Factor Two-township Study in Taiwan, this study shows that, in general, the older the age, the stronger the tendency toward thrombosis. With advancing age, prothrombin time, activated partial thromboplastin time, and antithrombin-III level decreased steadily; but mean values of fibrinogen, factor VIIc, and factor VIIIc increased. Gender differences in the age patterns of the above factors are carefully described. Curvilinear relations between hemostatic factors and age were demonstrated for adults aged 18 and above for all hemostatic factors studied. This curvilinearity should be taken into consideration when adjusting for the effect of age in data analysis to avoid residual confounding, particularly when the age range of the study subjects is wide.