Genetic interaction is associated with lower metabolic connectivity and memory impairment in clinically mild Alzheimer's disease.

Metabolic connectivity as showed by [18F] fluorodeoxyglucose (FDG) positron emission tomography (FDG-PET) reflects neuronal connectivity. The aim of this study was to investigate the genetic impact on metabolic connectivity in default mode subnetworks and its clinical-pathological relationships in patients with Alzheimer's disease (AD). We separately investigated the modulation of 2 default mode subnetworks, as identified with independent component analysis, by comparing APOE-ε4 carriers to noncarriers with AD. We further analyzed the interaction effects of APOE (APOE-ε4 carriers vs noncarriers) with PICALM (rs3851179-GG vs rs3851179-A-allele carriers) on episodic memory (EM) deficits, reduction in cerebral metabolic rate for glucose (CMRgl) and decreased metabolic connectivity in default mode subnetworks. The metabolic connectivity in the ventral default mode network (vDMN) was positively correlated with EM scores (ß =0.441, P < .001). The APOE-ε4 carriers had significantly lower metabolic connectivity in the vDMN than the APOE-ε4 carriers (t(96) = -2.233, P = .028). There was an effect of the APOE-PICALM (rs3851179) interactions on reduced CMRgl in regions of vDMN (P < .001), and on memory deficits (F3,93 =5.568, P = .020). This study identified that PICALM may modulates memory deficits, reduced CMRgl and decreased metabolic connectivity in the vDMN in APOE-ε4 carriers. [18F] FDG-PET-based metabolic connectivity may serve a useful tool to elucidate the neural networks underlying clinical-pathological relationships in AD.

Longitudinal analysis of inpatient care utilization among people with intellectual disabilities: 1999-2002.

BACKGROUND: There has been no longitudinal study in Taiwan to identify the nature and the scale of medical care utilization of people with intellectual disabilities (IDs) up to the present. The aim of this study is to describe inpatient utilization among people under ID care in institutions in order to identify the pattern of medical care needs and the factors affecting utilization in Taiwan. METHOD: The subject cohort was 168 individuals with ID who were cared for by a large public disability institution from 1999 to 2002 in Taipei, Taiwan. RESULTS: On the examination of the inpatient care that these persons underwent, it was found that these individuals had a heightened need (inpatient rate: 10.1-14.9%) for inpatient care compared with the general population with disabilities (9.37%) in Taiwan. The main reasons for hospitalization were pneumonia, gastrointestinal disorders, cellulites, orthopaedic problems, epilepsy and bronchitis. Using the full model of Generalized Estimating Equations for inpatient care utilization, the factors including low income family, living in an institution, being a subject with cerebral palsy and being a high outpatient user all influenced the use of inpatient care. CONCLUSIONS: This study highlights that health authorities need to promote health planning more in order to ensure an excellent quality of health monitoring and health promotion among people with ID cared for by institutions.

A pollen-specific polygalacturonase from lily is related to major grass pollen allergens.

A pollen-specific gene from lily (Lilium longiflorum Thunb. cv. Snow Queen), designated LLP-PG, was characterized. Southern blots of lily genomic DNA indicated that LLP-PG is a member of a small gene family. A thorough sequence analysis revealed that the LLP-PG gene is interrupted by two introns and encodes a protein of 413 amino acids, with a calculated molecular mass of 44 kDa, and a pI of 8.1. Evaluation of the hydropathy profile showed that the protein has a hydrophobic segment at the N-terminus, indicating the presence of a putative signal peptide. A sequence similarity search showed a significant homology of the encoded protein to pollen polygalacturonases (PGs) from various plant species and to an important group (group 13) of grass pollen allergens. The LLP-PG transcript is pollen-specific and it accumulates only at the latest stage during pollen development, in the mature pollen. In contrast to other "late genes" LLP-PG transcript can neither be induced by abscisic acid (ABA) nor by dehydration. Immunoblot analyses of pollen protein extracts from lily, timothy grass and tobacco with IgG antibodies directed against LLP-PG and against the timothy grass pollen allergen, Phl p 13, indicated that lily LLP-PG shares surface-exposed epitopes with pollen PGs from monocotyledonous and dicotyledonous plants. Enzyme-linked immunosorbent assay (ELISA) analyses and inhibition ELISA assays with patients' IgE demonstrated a very low IgE reactivity of lily rLLP-PG and a lack of cross-reactivity between rLLP-PG and the timothy grass pollen allergen, rPhl p 13. These data demonstrated that despite the significant sequence homology and the conserved surface-exposed epitopes LLP-PG represents a low-allergenic member of pollen PGs.

In vitro studies of the neuroform microstent using transparent human intracranial arteries.

For better understanding of relevant morphology and mechanics, direct visualization of a Neuroform microstent (NFM) within an actual human intracranial artery is essential. Twelve NFM were deployed into 8 various segments of formaldehyde-fixed cadaver intracranial arteries. The arteries were then dehydrated and cleared in methyl salicylate to create transparency. The morphology of NFM was studied by digital macro-photography with a back illumination system. The possible limitations and important findings of the NFM were discussed.

Rapidly progressive fatal bihemispheric infarction secondary to Moyamoya syndrome in association with Graves thyrotoxicosis.

Moyamoya syndrome is the secondary form of intracranial arterial occlusive diseases that produces collateral vessels from the base of brain. We report a case of Moyamoya syndrome developing in association with Graves thyrotoxicosis; as a result of its rapid progression and severe global ischemia, it was ultimately fatal. Because of the rarity of this association, we reviewed the literature in an attempt to establish possible demographic and clinical characteristics that may suggest putative mechanisms of pathogenesis.

Concomitant conus medullaris arteriovenous malformation and sacral dural arteriovenous fistula of the filum terminale.

SUMMARY: A patient with a spinal intradural arteriovenous malformation (AVM) at the conus medullaris concomitant with a sacral dural arteriovenous fistula (AVF) of the filum terminale is reported. A 44-year-old-male presentied with bilateral leg weakness and urinary incontinence for several months. Spinal angiography demonstrated two lesions: one was spinal intradural AVM at the conus medullaris supplied by the anterior spinal artery; the other was sacral dural AVF of the filum terminale supplied by the middle sacral artery. Although multifocal spinal cord AVMs have been reported, this is the first case report of two different types of vascular malformations coexisting in one patient. The arterial supply of the dural AVF of the filum by the middle sacral artery is also first demonstrated in the literature. The patient was treated successfully by surgical approach for both lesions in the same operation.

Tuberculous arthritis mimic arthritis of the Sjögren's syndrome: findings from sonography, computed tomography and magnetic resonance images.

A patient with a history of Sjögren's syndrome developed chronic arthritis of left ankle. It was diagnosed as arthritis of the Sjögren's syndrome initially. However, joint pain persisted despite corticosteroid therapy. Sonography disclosed a multiloculated cystic lesion with peripheral hyperechoic enhancement around left ankle and extended to Achilles tendon and subcutaneous region. Computed tomography (CT) confirmed the findings. Magnetic resonance imaging (MRI) revealed increased signal intensity of the lesion after gadonillium enhancement on T1-weighted images. These abnormalities showed inhomogenous high signal intensities on T2-weighted images. Tuberculous arthritis was diagnosed by positive synovial tuberculous culture. Sonography is a valuable tool that offers significant advantages for the initial evaluation of arthritis of the Sjögren's syndrome and help early suspicious of tuberculous arthritis, because of its cost-effectiveness, superior differentiation between the cyst and solid lesions, convenience for guiding biopsy and drainage.

Electrolytic A12O3 coating on co-cr-mo implant alloys of hip prosthesis.

The ceramic films over metallic implant surfaces have the potential to improve implant performance with respect to implant fixation, wear, or corrosion. In this study, the electrolytic Al2O3 coatings on F-1537 Co-Cr-Mo alloy were conducted in an aqueous solution of Al(NO3)3. Through the cycle polarization test in Hank's solution, it was found that the corrosion potential and protection potential of the alumina-coated were higher than that of the uncoated, and the corrosion current density was lower. The phase transformation of A12O3 film on Co-Cr-Mo alloy annealed at 800 K revealed todlite (5Al2O3 . H2O) and thetaAl2O3 (113) preferred orientation for 20 min, and thetaAl2O3 (200) preferred orientation with eta phase for 80 min. Scanning electron microscopy/energy dispersive spectroscopy observations after the scratch tests showed that the adhesion of the alumina films on Co-Cr-Mo alloy can load a stress over the yield strength (450 MPa) of Co-Cr-Mo alloy. The wear loss of ultra-high molecular-weight polyethylene to the Al2O3-coated specimen was eight times less than that to the uncoated. It is concluded that such Al2O3-coated films on Co-Cr-Mo implant alloy exhibit excellent quality in corrosion, adhesion, and wear for the application of hip prosthesis.

Spontaneous healing and complete disappearance of a giant basilar tip aneurysm in a child.

SUMMARY: We report a rare case of spontaneous total thrombosis of a giant basilar tip aneurysm resulting in compression of the brainstem, diagnosed in a two-year-old child who presented with neurological deficits and third cranial nerve impairment. After conservative treatment, the giant aneurysm was completely thrombosed and the clinical symptoms were remarkably improved. MRI demonstrated dramatic shrinkage and ultimately complete disappearance of the giant aneurysm at seven month follow-up.

Tuberous sclerosis complex with an unruptured intracranial aneurysm: manifestations of contiguous gene syndrome.

SUMMARY: With the advancement of molecular genetics, the deletion of the TSC2/PKD1 gene at chromosome 16p13.3 has been discovered to be responsible for the tuberous sclerosis complex sharing some of the clinical manifestations of autosomal dominant adult polycystic kidney disease such as multiple renal cysts and intracranial aneurysms. The unruptured aneurysm in tuberous sclerosis complex is far beyond the meaning it has in general population. The risk of aneurysmal hemorrhage in tuberous sclerosis complex may be higher than that in autosomal dominant adult polycystic kidney disease due to the synergistic effect of gene deletion and certainly much higher than that in the general population. For such high-risk patients with intracranial aneurysms doomed to subarachnoid hemorrh age, magnetic resonance angiography plays an important role in screening and follow-up, especially more critically for patients with contiguous gene syndrome. Endovascular coil embolization should be the first choice of treatment for un ruptured intracranial aneurysms.

Spray-drying of air-liquid interface sensitive recombinant human growth hormone.

Spray-drying is an attractive method for preparing fine recombinant human growth hormone (rhGH) powders if the detrimental effect of protein degradation at the air-liquid interface on the protein can be minimized. In this study, we demonstrated that rhGH degradation (insoluble and soluble aggregate formation), as the consequence of air-liquid interfacial degradation, could be prevented using the appropriate formulation. Adding polysorbate-20 surfactant into the liquid feed (with no presence of sugar protectant) significantly reduced the formation of insoluble protein aggregates, while adding the divalent metal zinc ion effectively suppressed the formation of soluble protein aggregates. The combination of the two yielded a spray-dried rhGH powder having insignificant protein degradation. Our data suggest that the two components might protect the protein through different mechanisms. Polysorbate molecules occupy the air-liquid interface of spray droplets, thereby reducing the chance for rhGH to form insoluble aggregates by surface denaturation. Two zinc ions associate with two rhGH molecules to form a dimer complex that can resist the formation of soluble protein aggregates. Characterization of spray-dried powders by scanning electron microscopy suggests that both formulation and drying conditions have a strong influence on particle morphology and shape. Overall, spherical rhGH powders of smooth surface and good biochemical quality can be prepared by spray-drying using this formulation with no addition of sugar protectant.

Pulmonary edema induced by upper airway obstruction--report of 3 cases.

Pulmonary edema is a well-recognized complication of upper airway obstruction, and has been reported sporadically both in children and adults since 1977. Although the pathogenesis of pulmonary edema associated with upper airway obstruction is multifactorial, attention is primarily focused on excessive negative intrapleural and transpulmonary pressure produced by forceful inspiration against a closed glottis that results in transudation of fluid from the pulmonary capillary into the interstitial and alveolar spaces. We report 3 cases of pulmonary edema induced by upper airway obstruction after extubation following general anesthesia.

[Surgical patients' attitude towards anesthesia].

There are few studies assessing the degree of understanding of anesthesia among surgical patients in Taiwan. So we designed a questionnaire to explore patients' attitude toward anesthesia. 505 patients scheduled for routine surgery were included in this study. We found there were great differences between the patients in their attitude toward and understanding of anesthesia. It is clear that we must give much more attention to communicating clearly with our patients in this regard. Further detailed studies may be useful in revealing particular area of misunderstanding.

Urinary aflatoxin levels, hepatitis-B virus infection and hepatocellular carcinoma in Taiwan.

Using a urinary immunoassay to measure aflatoxin metabolites, we examined the associations between exposure to aflatoxin, chronic infection with the hepatitis-B virus (HBV) and background rates of hepatocellular carcinoma (HCC) mortality in a cross-sectional survey of 250 residents from 8 areas of Taiwan with a 4-fold variation in age-adjusted HCC mortality. Specimens of fasting blood and overnight urines were used to determine HBV carrier status and excretion of aflatoxin in the subjects surveyed. While the prevalence of hepatitis-B virus carriers showed moderate variability, there was a 500-fold range in urinary aflatoxin levels. Mean log-transformed levels of aflatoxin metabolites were similar in males and females and in HBV carriers and non-carriers. In the 8 townships, HCC mortality correlated positively with both area HBV carrier prevalence and mean aflatoxin levels. The primary analyses, however, were conducted at the individual level. Each subject's aflatoxin level was treated as the response variable in a multiple regression model, and the corresponding sex-specific area HCC rate was included as a predictor along with the individual's carrier status, age and sex; alcohol consumption and cigarette smoking were also considered. In these analyses, a significant association was again observed between the marker of aflatoxin exposure and the background rate of HCC mortality. In females, the slope of the regression line was somewhat steeper in HBV carriers, but this pattern was not seen in males and formal testing yielded no statistically significant evidence of an interaction. Our findings are consistent with the hypothesis that aflatoxin plays an independent role in hepatocellular carcinoma in Taiwan.

[Intrathecal meperidine attenuates shivering induced by spinal anesthesia].

Shivering is a common and complex phenomenon that occurs in many patients during spinal anesthesia. Shivering can increase oxygen consumption up to 500 per cent which may be detrimental to patients with decreased myocardial reserve. The metabolic costs and cardiorespiratory consequences of shivering are important particularly for patients with anemia, coronary arterial disease, cardiopulmonary insufficient, debilitated status or are elderly. We studied whether intrathecal meperidine could prevent shivering after spinal anesthesia. 60 patients with ASA class I-II were divided into intrathecal meperidine group (Group I) (n = 30) and control group (Group II) (n = 30). Group I received spinal tetracaine 12-16 mg with meperidine 0.2 mg/kg and Group II received spinal tetracaine 12-16 mg without meperidine. During operation the highest level of spinal anesthesia, ambient and rectal temperatures, blood pressure (BP) and heart rate (HR), presence or absence of shivering, intensity of shivering in both groups were recorded. Close observation for side effects was given post-operatively. There was a significant reduction (p < .005) in incidence of shivering in group I patients (16.7%) when compared with group II (56.7%). There was no or less side effects observed with other neuraxial opioids except nausea. We concluded that intrathecal meperidine could suppress shivering induced by spinal anesthesia.

Growth estimation of solid-state koji by covering a cellophane membrane on the mash.

In a solid-substrate fermentation system, fungal growth within a solid mash is an important index for the efficiency of the saccharification and production of metabolites. Estimation of fungal mass in such a heterogeneous solid-substrate systems is difficult and tedious. In this work, the comparison of Aspergillus oryzae which is a common strain for the wine-brewing process cultured on a cellophane membrane placed on a koji juice agar medium and a small scale of steamed rice koji culture was conduted. Experimental results showed that the cellophane membrane technique resembled the steamed rice koji culture and is considered as a convenient and effective way for investigating the growth characteristics and cytology for solid-substrate koji system.

Testing a zone plate with a grating interferometer.

The physical theory, of testing optics by the Ronchi sine grating interferometer is developed. In the experiment a sine grating splits the third-order wavefront of the zone plate under test into three displaced wavefronts, which then interfere with one another to form interference fringes. The intensity distribution of the interference pattern can be recorded for various positions of the sine grating. By subtracting the contribution of the inherent diffractive aberration of the sine grating, the value of the spherical aberration associated with the third-order wavefront of the zone plate under test can be determined. Theory and experiment are compared.

Immunological detection of aflatoxin B1-DNA adducts formed in vivo.

Two monoclonal antibodies (6A10 and 12F5) were obtained after fusion of mouse P3X63-AG.8.653 myeloma cells with spleen cells isolated from BALB/c mice immunized with imidazole ring-opened aflatoxin B1 (AFB1)-DNA and characterized by competitive enzyme-linked immunosorbent assays. Both antibodies are highly specific for imidazole ring opened AFB1-DNA and show some cross-reactivity with AFB1-DNA and no cross-reactivity with 8,9-dihydro-8-(7-guanyl)-9-hydroxy-AFB1, AFB1 conjugated with bovine serum albumin, aflatoxin M1 conjugated with bovine serum albumin, AFB1, or aflatoxin G1. Antibody 6A10 was further characterized and showed no cross-reactivity with DNA modified by several other carcinogens. It could detect adducts with 4-fold higher sensitivity in highly modified DNA (2.5 adducts/100 nucleotides) than in low modified DNA (4 adducts/10(5) nucleotides). With low modified DNA the limit of sensitivity is 5 adducts/10(7) nucleotides. Antibody 6A10 reliably detected adducts formed in vivo in rats and mice treated with AFB1. In a pilot study, AFB1 adducts were detected in liver tissues from individuals living in areas with suspected exposure to AFB1. Monitoring adduct levels in human tissue may provide information not only on carcinogen exposure but also on the relationship among infection with hepatitis B virus, dietary exposure to aflatoxin B1, and liver cancer.