Factors associated with osteoporosis in patients with chronic obstructive pulmonary disease-a nationwide retrospective study.

The present study aimed to identify the factors associated with osteoporosis in patients with chronic obstructive pulmonary disease in Taiwan. The study found that female sex, old age, and use of a high dose of oral corticosteroids were significantly associated with osteoporosis in these patients. INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is becoming an increasingly serious and prevalent issue worldwide. The treatment of COPD with long-term steroid use may cause osteoporosis and have significant influences on disability and mortality. However, few studies have evaluated the association between steroid use and osteoporosis in patients with COPD. The present study aimed to identify the factors, including demographic characteristics and steroid use (oral corticosteroids [OCSs], inhaled corticosteroids, and injected steroids), associated with osteoporosis in patients with COPD in Taiwan. METHODS: This was a retrospective case-control study. Data were obtained from the National Health Insurance Research Database from 1997 to 2009. Cox proportional hazard regression models were used to identify the factors associated with osteoporosis. RESULTS: The incidence of osteoporosis in the patients with COPD was 1343.0 per 100,000 person-years, the majority of patients were women (63.6 %), and the mean age of the patients was 72.5 years. In multivariate regression analysis, female sex, old age, and use of a high OCS dose with a defined daily dose (DDD) >56 (hazard ratio 1.85, 95 % confidence interval 1.52-2.26, P < .0001) exhibited significant independent associations with osteoporosis. CONCLUSIONS: Female sex, old age, and use of a high OCS dose with a cumulative DDD >56 are associated with osteoporosis in patients with COPD. Additionally, female patients >50 years old and male patients >70 years old have a higher risk of osteoporosis. Medical personnel should actively provide health education for the prevention of osteoporosis in these patients.

Six-minute walk test among heart transplant recipients.

OBJECTIVE: Six-minute walk test (6MWT) is an important measure to assess the exercise capacity of cardiac patients. This study aimed to evaluate the correlations of 6MWT with findings of cardiopulmonary exercise testing (CPET), health-related quality of life (HRQoL), and obesity among heart transplantation recipients (HTR) at least 1 year after transplantation. METHOD: Clinically stable HTR were recruited for this study from the National Taiwan University Hospital, Taipei, Taiwan. The 6MWT was performed by a physical therapist following the American Thoracic Society standard. Each subject underwent a symptom-limited CPET to evaluate cardiorespiratory fitness and bioelectrical impendence analysis for determination of body composition. The HRQoL of study subjects was evaluated by the Medical Outcomes Trust 36-item health survey (SF-36). RESULTS: The study subjects included 43 HTR (age: 47.8±11.1 years; 37 men, 6 women) at 4.8±3.2 years after transplantation. The 6MWT distance was 539±108 m (89.9±18.2% of the predicted value). The peak oxygen uptake was 19.3±4.7 mL/kg/min. The body composition analysis showed body fat percentage 25.2±7.9%, body mass index 26.5±4.8, and waist circumference 94.8±13.3 cm. The 6MWT distance was significantly positively correlated with peak oxygen uptake, peak heart rate, peak work rate, and peak systolic blood pressure during CPET, and significantly negatively correlated with body fat percentage, body mass index, and waist circumference. The 6MWT distance was also significantly positively correlated with SF-36 HRQoL parameters including general health perception and standardized physical component scale. The peak HR during CPET and standardized physical component scale was significantly correlated with 6MWT distance in multivariate analysis. CONCLUSIONS: Our findings indicate that 6MWT is a simple and useful measure to assess the exercise capacity of clinically stable HTR. The 6MWT distance is positively correlated with HRQoL and negatively correlated with obesity among HTR. The prognostic significance of 6MWT for HTR requires further investigation.

Horizontal and vertical resistance strength of infrazygomatic mini-implants.

This study assessed the adequacy of anchorage strength of infrazygomatic mini-implants in vertical and horizontal directions. Each brand of infrazygomatic mini-implant tested provided acceptable skeletal anchorage.

Computer-assisted automatic peak recognition and result evaluation for analysis of chlorinated hydrocarbons in environmental samples.

A data manipulation method has been developed for automatic peak recognition and result evaluation in the analysis of organic chlorinated hydrocarbons with dual-column gas chromatography. Based on the retention times of two internal standards, pentachlorotoluene and decachlorobiphenyl, the retention times of chlorinated hydrocarbons can be calibrated automatically and accurately. It is very convenient to identify the peaks by comparing the retention times of samples with the calibrated retention times calculated from the relative retention indices of standards. Meanwhile, with a suggested two-step evaluation method the evaluation coefficients and the suitable quantitative results of each component can be automatically achieved for practical samples in an analytical system using two columns with different polarities and two internal standards.

A reevaluation and discussion on the threshold limit for hemolysis in a turbulent shear flow.

One major factor of red blood cell damage induced by artificial heart valves is the magnitude of turbulent shear stresses in the flow field. An often-cited threshold for hemolysis is 400 N/m(2) (Sallam and Hwang, Biorheology 21 (1984) 783). This value, however, was measured with a one-component laser Doppler anemometer and was not calculated from the major principal Reynolds shear stress, therefore underestimating the threshold. This study performed flow field measurements under similar conditions, using a two-component laser Doppler anemometer and determining major principal Reynolds shear stress, to reevaluate the hemolytic threshold as 800 N/m(2) with an exposure time of 1 ms. The Kolmogorov length scales, approximately 9 microm, are capable of inflicting direct damage to the red blood cells. These results will serve as a more accurate reference in future heart valve design and testing.

Posterior corneal surface changes after refractive surgery.

OBJECTIVE: To determine the frequency of changes in posterior corneal surface after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). DESIGN: Nonrandomized, comparative trial. PARTICIPANTS: Ninety-five eyes (71 patients) that underwent PRK (n = 45) or LASIK (n = 50). CONTROLS: Twenty nonsurgery eyes were used to validate the method of analysis of the posterior corneal curvature (PCC). Seventy nonsurgery eyes were used for comparisons. METHODS: Float, apex-fixed best fit corneal curvature (ABC), and posterior elevation difference were evaluated in 20 elevation topography maps at 6 zone diameters (3-7 and 10 mm) and at two time points. Corneal elevation maps before and after PRK or LASIK were analyzed by the ABC and float methods and compared with a nonsurgery group. MAIN OUTCOME MEASURES: Posterior corneal curvature change (mm) was classified as flattening, steepening, or no change. RESULTS: Flattening of more than 0.12 mm was found in 22.2% of eyes (n = 10) in the PRK group, a change of +/-0.12 mm was found in 53.3% of eyes (n = 24), and steepening of more than 0.12 mm was found in 24.4% of eyes (n = 11) using the float method and in 28.9% of eyes (n = 13), 35.6% of eyes (n = 16), and 35.6% eyes (n = 16), respectively, using the ABC method. In the LASIK group, the float method registered flattening in 20% of eyes (n = 10), no change in 52% of eyes (n = 26), and steepening in 28% of eyes (n = 14), whereas the ABC method registered flattening in 30% of eyes (n = 15), no change in 40% of eyes (n = 20), and steepening in 30% of eyes (n = 15). The nonsurgery group showed a similar change in PCC at two different time points similar to that of the PRK and the LASIK groups. CONCLUSIONS: The differences observed in the PCC after PRK or LASIK were not statistically significantly different from those observed over time in the nonsurgery control group.

Turbulence characteristics downstream of bileaflet aortic valve prostheses.

This study was focused on a series of in vitro tests on the turbulent flow characteristics of three bileaflet aortic valves: St. Jude Medical (SJM), CarboMedics (CM), and Edwards Tekna (modified Duromedics, DM). The flow fields of the valves were measured in a pulsatile flow model with a laser-Doppler anemometer (LDA) at the aortic sinus area downstream of the valves. The heart rate was set at 70 beats per minute, the cardiac output was maintained at 5 liters per minute, and the aortic pressure wave forms were kept within the physiological range. Cycle-resolved analysis was applied to obtain turbulence data, including mean velocity, Reynolds stresses, autocorrelation coefficients, energy spectral density functions, and turbulence scales. The Reynolds shear stresses of all three valves induced only minor damage to red blood cells, but directly damaged the platelets, increasing the possibility of thrombosis. The smallest turbulence length scale, which offers a more reliable estimate of the effects of turbulence on blood cell damage, was three times the size of red blood cells and five times the size of platelets. This suggests that there is more direct interaction with the blood cells, thus causing more damage.

Prevalence of pre-eruptive intracoronal dentin defects from panoramic radiographs.

PURPOSE: This investigation stemmed from preliminary clinical observations from a school dental clinic, which suggested that a proportion of clinically undetected, radiolucent lesions on radiographs may originate as pre-eruptive intracoronal dentin defects. This study investigated the prevalence of such defects in orthopantomograms from a group of children and young adults. METHODS: A total of 1281 orthopantomograms with 11,767 unerupted permanent teeth were examined. RESULTS: The prevalence of intracoronal dentin defects was 3% by subjects, and 0.5% by teeth; the highest prevalence being noted in the maxillary and mandibular first permanent molars. Most of the lesions occurred singly, and nearly half had extended to greater than two-thirds the width of dentin thickness. Ectopic positioning was significantly associated with this lesion. CONCLUSIONS: Pre-eruptive intracoronal dentin defects occur at a significant prevalence rate. Increased awareness of this entity may improve diagnosis and allow early treatment.

Immunolocalization and gene expression of matrilysin during corneal wound healing.

PURPOSE: To investigate the protein level of matrilysin and stromelysin-1 and the gene expression of matrilysin in rat corneas after excimer keratectomy using immunofluorescence staining, reverse transcriptase-polymerase Chain Reaction (RT-PCR), and in situ hybridization. METHODS: Rat corneas were treated with 3-mm excimer laser keratectomy (193-nm ArF). Unwounded corneas served as controls. Confocal microscopy was used to immunolocalize matrilysin protein at 6 hours, 1 day, 3 days, 1 week, 4 weeks, and 8 weeks after surgery. RT-PCR was performed to analyze matrilysin mRNA in unwounded controls and in 3-day wounded corneas. In situ hybridization was performed to localize matrilysin mRNA. RESULTS: Matrilysin was immunolocalized to the epithelial layers of unwounded and wounded corneas, predominantly to the leading edge at 6 hours and 1 day after wounding and to the epithelial layer at 3 to 7 days after surgery. Stromelysin-1 was expressed in the deep stromal layer in the first 3 days after wounding and in the area of newly synthesized stromal matrix 1 week after surgery. Upregulation of matrilysin expression 3 days after wounding was confirmed by RT-PCR. In situ hybridization revealed that the gene expression of matrilysin in rat corneas was upregulated during the migration phase (6 hours, 1 day) and that matrilysin mRNA was predominantly localized to the basal cell layers during the subsequent cell proliferation phase (7 and 14 days). CONCLUSIONS: Basal epithelial cells express matrilysin during the migration proliferation phase of corneal wound healing after excimer keratectomy.

Immunoconfocal localization of gelatinase B expressed by migrating intrastromal epithelial cells after deep annular excimer keratectomy.

PURPOSE: Intrastromal epithelial migration occurs following deep excimer annular keratectomy. Our purpose is to determine the localization of gelatinase B expression and its relationship to migrating intrastromal epithelial cells following deep annular excimer keratectomy. METHODS: Rabbit corneas were treated with deep annular ablation and harvested 3, 5, 7 and 14 days following surgery. Histological examination was performed. Confocal microscopy was used to determine the time and the pattern of gelatinase B expression. This was compared to AE-5, vimentin, and alpha-smooth muscle actin immunolocalization. RESULTS: Histologic examination revealed islands of epithelial cells within the corneal stroma after deep annular excimer ablation, whereas eyes treated with superficial annular keratectomy did not show intrastromal epithelial migration. Immunoconfocal microscopy using monoclonal anti-matrix metalloproteinase-9 (MMP-9) antibody demonstrated the presence of gelatinase B at the outer borders of the intrastromal epithelial islands following deep annular excimer keratectomy. CONCLUSION: Gelatinase B may be involved in the process of intrastromal epithelial migration following deep annular excimer keratectomy.

Flavobacterium indologenes keratitis.

Flavobacterium indologenes has recently been implicated in nosocomial or opportunistic infection. It has been isolated from lids, conjunctiva, and lacrimal system, and is resistant to most antibiotics. No previous cases of F. indologenes corneal ulcer have been reported in the literature. The natural habitat of Flavobacteria is soil, water, plants, and foodstuffs. In the hospital environment, these bacteria exist in water systems and on wet surfaces. They are not part of the normal ocular flora.

Computer-assisted peak recognition for polychlorinated dibenzo-p-dioxins (PCDD) and polychlorinated dibenzofurans (PCDF) in environmental samples.

A software has been developed for the peak recognition of 136 polychlorinated dibenzo-p-dioxins (PCDD) and polychlorinated dibenzofurans (PCDF) after high resolution gas chromatography coupled with mass spectrometry (HRGC/HRMS). Based on the retention times of (13)C labelled 2,3,7,8-substituted PCDD/F internal standards, the retention times of all PCDD and PCDF can be calibrated automatically and accurately. Therefore, it is very convenient to identify the peaks by comparing the retention of samples and the calibrated retention times of their chromatograms. Hence, this approach is very significant because it is impossible to obtain always a standard chromatogram and PCDD/F analysis are very expensive and time consuming. The calibration results can be transferred to Excel for calculation. The approach is a first step to store costly and environmentally relevant data for future application.

High performance liquid chromatographic determination of individual bile acids in serum for automatic diagnosis of various liver and biliary diseases.

A reversed phase high performance liquid chromatographic method for the high sensitivity determination of individual bile acids in serum using a C18 column with a ternary solvent system combined with fluorometric techniques using immobilized enzymes is described. A computer-assisted diagnosis system using pattern recognition was developed to assist the clinical diagnosis of various liver and biliary diseases. A total consistency rate of 95% can be reached using this system.

The retention behaviour of conjugated bile acids in reversed phase high performance liquid chromatography.

The retention behaviour of conjugated bile acids has been studied in a reversed phase high performance liquid chromatographic (RP-HPLC) system by using the mixture of methanol and aqueous phosphate buffer as the mobile phase. The retentions of the conjugates in RP-HPLC have been found to be mainly controlled by the glycine and taurine groups. The selectivity between five different glycine and taurine conjugated bile acids is a constant in RP-HPLC. This selectivity has been used for peak identification in the practical separation of conjugated bile acids.

A health hazard assessment in school arts and crafts.

Unlike the cautious attitude being exercised toward generic chemicals, an off-guard behavior is often observed toward the same chemicals once they are recognized as a "common daily item." Students and instructors of arts and crafts classes alike are often unaware of the potential risks from exposure to some of the arts and crafts materials they use due to either the false security of "common daily item" or the lack of specific knowledge of the hazardous ingredients in those products. This unawareness of potential health hazards could lead to improper handling of these materials and result in unnecessary health risk during their use. A three-year study of college arts and crafts class students indicates a high incidence of allergic reactions among attending students for exposure of less than 70 hours within a period of 7 weeks. A self-evaluation method is developed to identify and minimize these health hazards associated with arts and crafts classes. This checklist of 15 pertinent parameters covers identifiable hazardous areas and situations in arts and crafts classrooms. Record keeping and promotion of student awareness are also addressed, so that instructors and students in an arts and crafts class can more readily recognize actual or potential hazards and act to prevent them.

[Experimental studies on immunostimulatory effects of the Isatis indigotica polysaccharide].

Polysaccharides extracted from the root of Isatis indigotica (IIP, 50 mg/kg.d, ipx8d) significantly increased the weight of spleen and number of white blood cell and lymphocyte in peripheral blood in normal ICR mice, and antagonized the immunosuppressive actions of hydrocortisone. There were marked potentiating effects on delayed hypersensitivity reaction induced by 2, 4-dinitrochlorobenzene in normal NIH mice treated with IIP as well as in immunodepressed mice induced by cyclophosphamide. By administration of IIP, the percentage of ANAE+ lymphocytes stained with acid alpha-naphthyl acetate esterase method were significantly increased in peripheral blood of normal ICR mice, and the decreases in number of ANAE+ lymphocytes in mice induced by hydrocortisone were prevented to a certain extent. But IIP could not enhance Con A-induced lymphocyte proliferation of C57BL mouse spleen cells in vitro measured with MTT colorimetric assay. In addition, the plaque forming cells in 5 x 10(6) splenocytes of NIH mice treated with IIP were higher than that of the control group (P less than 0.01). IIP could also elevate the clearance rate of intra-venous charcoal particles in normal mice, i.e., stimulated the phagocytic activity of macrophages. The result indicates that IIP is capable of increasing humoral and cellular immune functions and enhancing the functions of reticuloendothelial system, and might be a good immunopotentiator.

[Pharmacological localization of Horner's syndrome. Case report].

Horner's syndrome is derived from an interruption of the sympathetic pathway at any point along its course between the hypothalamus and the orbit. This pathway is generally considered to consist of three neurons. It had been suggested that the pupillary response to various pharmacologic agents will aid in localizing the lesioned neuron in the sympathetic pathway. We had the opportunity to observe a patient who developed Horner's syndrome as a consequence of pulmonary apex adenocarcinoma. Clinical, radiologic and pharmacologic studies are presented. The methods of pharmacologic localization are discussed.