Magnesium exposure increases hip fracture risks in patients with chronic kidney disease: a population-based nested case-control study.

This population-based study demonstrates a strong link between Mg-containing antacid exposure and hip fracture risk in nondialysis CKD and dialysis patients. As an Mg-containing antacid, MgO is also commonly used as a stool softener, which can be effortlessly replaced by other laxatives in CKD patients to maintain bone health. PURPOSE: Bone fracture is a severe complication in chronic kidney disease (CKD) patients, leading to disability and reduced survival. In CKD patients, blood magnesium (Mg) concentrations are usually above the normal range due to reduced kidney excretion of Mg. The present study examines the association between Mg-containing antacid exposure and the risk of hip fracture of CKD patients. METHODS: In this nationwide nested case-control study, we enrolled 44,062 CKD patients with hip fracture and 44,062 CKD matched controls, among which the mean age was 77.1 years old, and 87.9% was nondialysis CKD. RESULTS: As compared to non-users, Mg-containing antacid users were significantly more likely to experience hip fracture (adjusted odds ratio (OR) 1.36, 95% CI, 1.32 to 1.41; p < 0.001). Subgroup analysis showed that such risk exists in both nondialysis CKD patients and long-term dialysis patients. In contrast, aluminum or calcium-containing-antacid use did not reveal such association. Next, we examined the influence of Mg-containing antacid dosage on hip fracture risk, the adjusted ORs in the first quartile (Q1), Q2, Q3, and Q4 were 1.20 (95% CI, 1.15 to 1.25; p < 0.001), 1.35 (95% CI, 1.30 to 1.41; p < 0.001), 1.49 (95% CI, 1.43 to 1.56; p < 0.001), and 1.54 (95% CI, 1.47 to 1.61; p < 0.001), respectively, showing that such risk exists regardless of the antacid dosage. A receiver operating characteristic curve analysis demonstrated that the best cutoff value of the exposed Mg dose to discriminate the hip fracture is 532 mEq during the follow-up period. CONCLUSION: This population-based study demonstrates a strong link between Mg-containing antacid exposure and the hip fracture risk in both nondialysis CKD and dialysis patients.

Carcinogenesis of Male Oral Submucous Fibrosis Alters Salivary Microbiomes.

Most oral squamous cell carcinoma (OSCC) tumors arise from oral premalignant lesions. Oral submucous fibrosis (OSF), usually occurring in male chewers of betel quid, is a premalignant stromal disease characterized by a high malignant transformation rate and high prevalence. Although a relationship between the inhabited microbiome and carcinogenesis has been proposed, no detailed information regarding the oral microbiome of patients with OSF exists; the changes of the salivary microbiome during cancer formation remain unclear. This study compared the salivary microbiomes of male patients with OSCC and a predisposing OSF background (OSCC-OSF group) and those with OSF only (OSF group). The results of high-throughput sequencing of the bacterial 16S rRNA gene indicated that OSF-related carcinogenesis and smoking status significantly contributed to phylogenetic composition variations in the salivary microbiome, leading to considerable reductions in species richness and phylogenetic diversity. The microbiome profile of OSF-related malignancy was associated with increased microbial stochastic fluctuation, which dominated the salivary microbiome assembly and caused species co-occurrence network collapse. Artificial intelligence selection algorithms consistently identified 5 key species in the OSCC-OSF group: Porphyromonas catoniae, Prevotella multisaccharivorax, Prevotella sp. HMT-300, Mitsuokella sp. HMT-131, and Treponema sp. HMT-927. Robust accuracy in predicting oral carcinogenesis was obtained with our exploratory and validation data sets. In functional analysis, the microbiome of the OSCC-OSF group had greater potential for S-adenosyl-l-methionine and norspermidine synthesis but lower potential for l-ornithine and pyrimidine deoxyribonucleotide synthesis and formaldehyde metabolism. These findings indicated that the salivary microbiome plays important roles in modulating microbial metabolites during oral carcinogenesis. In conclusion, our results provided new insights into salivary microbiome alterations during the malignant transformation of OSF.

Increased risk of bone fracture among patients with urinary calculi: a nationwide longitudinal population-based study.

UNLABELLED: Urinary calculi were associated with higher risk of vertebral and upper limb fracture. Therefore, patients with urinary calculi should be evaluated carefully because they may have a higher risk of subsequent fracture later in life. INTRODUCTION: The contribution of urinary calculi to reduced bone mineral density has been recognized. However, the association of urinary calculi with the risk of fracture remains inconclusive. The aim of the study was to determine the risk of overall fracture and fractures at different anatomic sites in patients with urinary calculi. METHODS: The records of inpatients and outpatients with urinary calculi were retrieved from the Taiwan National Health Insurance Database from 2000 to 2010. Among patients with urinary calculi at the cohort entry, controls were matched using propensity scores on a 1:1 ratio. All subjects were followed up from the date of enrollment until fracture occurrence, death, or December 31, 2010. There were 46,243 Medicare beneficiaries with a diagnosis of urinary calculi and 46,243 controls without calculi enrolled. RESULTS: Among these patients, 6005 patients with a diagnosis of urinary calculi and 5339 controls developed fractures during a median follow-up period of 5.3 years. Patients with urinary calculi had a higher incidence of fracture compared with controls (23.9 versus 22.1 per 1000 person-years) and a greater risk of overall fractures (adjusted hazard ratio [aHR] 1.08, 95 % confidence interval [CI], 1.04-1.12), mainly located at the vertebrae (aHR 1.15, 95 % CI, 1.06-1.25) and upper limb (aHR 1.07, 95 % CI, 1.01-1.14), but the risk for hip fracture was not increased (aHR 1.09, 95 % CI, 0.96-1.22). CONCLUSIONS: Urinary calculus is independently associated with higher risk of subsequent fracture. Patients with urinary calculi should pay attention to the future vertebral and upper limb fractures.

Heavy metal removal from wastewater using zero-valent iron nanoparticles.

Because of having a high reduction potential, the zero-valent iron (ZVI) is often applied for the remediation of wastewater or groundwater with heavy metals. The purpose of this study was aimed to investigate the reaction behavior of heavy metals with ZVI nanoparticles in the wastewater. The affecting factors, such as initial pH, dosage of nanoscale ZVI and initial concentration of heavy metal, on the removal efficiency of heavy metals by ZVI in the wastewater were examined by the batch experiments in this study. It was found that the removal of heavy metals was affected by initial pH. The rate and efficiency of metal removal increased with decreasing initial pH. Greater than 90% of the heavy metals were removed when the initial pH was controlled at 2. In addition, the rate and efficiency of metal removal increased as the dosage of nanoscale ZVI increased. The removal efficiency of heavy metal was higher than 80% when 2.0 g/L of ZVI was added in the wastewater. On the other hand, the slow rate and low efficiency of metal removal from the wastewater treated by nanoscale ZVI was found in the wastewater with high concentration of heavy metal.

Efficient phase field simulation of a binary dendritic growth in a forced flow.

Efficient quantitative phase field simulation using an adaptive finite volume method with an antisolutal trapping scheme is presented for a binary dendritic growth in a forced flow. For the case of no convection, the calculated results with different interface thickness are examined. It is found that with a proper antisolutal trapping flux, a thick interface, but smaller than the diffusion boundary layer, could be used and the solution could approach to the sharp-interface Gibbs-Thompson equation limit in almost all aspects quantitatively. Based on the concentration driving force obtained from the sharp-interface limit of the Wheeler-Boettinger-McFadden (WBM) model, the calculated results are in good agreement with the classic Oseen-Ivantsov solution for the concentration-driven growth in a forced flow. And the selection scaling factor also increases with the external flow as the theoretical prediction.

Characterization of Methanococcus voltaei strain P2F9701a: a new methanogen isolated from estuarine environment.

A new methanogen, designated as strain P2F9701a (= OCM 745), was isolated from a water sample of estuarine environment in Elrin Shi, Taiwan. Cells of strain P2F9701a were motile coccus (0.7 approximately 1.1 micron) with tufts of flagella. Gas vacuoles were observed, and the protein cell wall was composed of S-layer protein subunit with Mr of 74,700. Cells catabolized formate and H2+CO2 to produce methane, but not acetate, methanol, and trimethylamine. Strain P2F9701a grew in the range of 30-42 degrees C, with optimal growth temperature at 37 degrees C, but did not grow below 28 degrees C or above 42 degrees C. This estuarine isolate P2F9701a tolerated well the NaCl concentration between 0.02 and 1.03 m, and the optimal salt for growth was 0.17 m. Although phylogenetic analytic results indicated that P2F9701a belongs to the mesophilic, hydrogenotrophic marine methanogen of Methanococcus voltaei, the occurrence of gas vacuoles, tufts of flagella, eury-halotolerant and steno-thermotolerant characters of strain P2F9701a are different from mesophilic Methanococcus spp. that had been reported.

Acute and chronic phase platelet aggregability studies in Chinese patients after implantation of a permanent transvenous pacemaker.

It has been suggested that the incidence of thromboembolic events always increases in patients after insertion of a transvenous pacemaker. Blood samples from twenty consecutive patients (fifteen males and five females) before and after pacemaker implantation was retained for platelet aggregability studies which were analyzed separately with ADP, collagen, epinephrine and arachidonic acid. The maximal amplitude of platelet aggregatory curve was detected by an aggregometer. The samples collected the day before pacemaker implantation (day 0) were used as self-control. Day 1 and day 3 after pacemaker implantation were defined as the acute phase, while day 30 was defined as the chronic phase. The maximal amplitude of platelet aggregatory curve was observed to be lowest on day 1 and then return to normal on day 3 and day 30. The results of platelet aggregability, however, showed no significant difference (P>0.05) between self-control and post-implantation samples. In conclusion, there was no significant change in platelet aggregability for either acute or chronic phases after pacemaker implantation. Antiplatelet medications may not be necessary for the prevention of thromboembolic events after the implantation of a pacemaker.

Distinct biochemical and topological properties of the 31- and 27-kilodalton plasma membrane intrinsic protein subgroups from red beet.

Plasma membrane vesicles from red beet (Beta vulgaris L.) storage tissue contain two prominent major intrinsic protein species of 31 and 27 kD (X. Qi, C.Y Tai, B.P. Wasserman [1995] Plant Physiol 108: 387-392). In this study affinity-purified antibodies were used to investigate their localization and biochemical properties. Both plasma membrane intrinsic protein (PMIP) subgroups partitioned identically in sucrose gradients; however, each exhibited distinct properties when probed for multimer formation, and by limited proteolysis. The tendency of each PMIP species to form disulfide-linked aggregates was studied by inclusion of various sulfhydryl agents during tissue homogenization and vesicle isolation. In the absence of dithiothreitol and sulfhydryl reagents, PMIP27 yielded a mixture of monomeric and aggregated species. In contrast, generation of a monomeric species of PMIP31 required the addition of dithiothreitol, iodoacetic acid, or N-ethylmaleimide. Mixed disulfide-linked heterodimers between the PMIP31 and PMIP27 subgroups were not detected. Based on vectorial proteolysis of right-side-out vesicles with trypsin and hydropathy analysis of the predicted amino acid sequence derived from the gene encoding PMIP27, a topological model for a PMIP27 was established. Two exposed tryptic cleavage sites were identified from proteolysis of PMIP27, and each was distinct from the single exposed site previously identified in surface loop C of a PMIP31. Although the PMIP31 and PMIP27 species both contain integral proteins that appear to occur within a single vesicle population, these results demonstrate that each PMIP subgroup responds differently to perturbations of the membrane.

Epidemiological study of moyamoya disease in Taiwan.

From January 1978 to December 1995, 92 cases of Moyamoya disease were collected from seven major medical centers in Taiwan. The data gave an annual incidence rate of 0.048 per 100,000 population. There were 40 males and 52 females and the ages ranged from 2 to 62 years with the peak incidence in the 31-40 year age group (23 cases). Cerebral infarction occurred in 20 out of 24 juvenile patients (83%), and in 24 out of 68 adult patients (35%). The difference was statistically significant. Haemorrhagic stroke was more frequent in adult patients. Computed tomographic scans following stroke showed cerebral infarction in 44 cases, ventricular haemorrhage in 26 cases, intracerebral haemorrhage in 14 cases and pure subarachnoid haemorrhage in eight. The most frequent initial symptom was motor disturbance (59%), followed by headache (49%) and impaired consciousness (35%). This survey showed an incidence rate much lower than that in Japan, but comparable with those in other Oriental countries and higher than those in Western countries. The male-to-female ratio once differed considerably from that of the Japanese series, but from the present study is now quite similar.

Establishment of a cell line from Spodoptera litura (Lepidoptera: Noctuidae) and replication of S. litura nuclear polyhedrosis virus in vitro.

A new cell line, designated IBL-SLO1A, was established from pupal ovaries of the tobacco cutworm Spodoptera litura. Cells were grown in the TNM-FH insect cell culture medium supplemented with 10% fetal bovine serum. The subculture of cells was initiated with 1-3 x 10(5) cells/ml, a split ratio about 1:10. The growth curve of the cells fit the model of exponential growth (Y = e-0.6750 + 0.0317X R2 = 0. 98), the population doubling time during logarithmic growth at 28 degrees C was 21.9 hr. The number of chromosomes was about 140. Cytopathology characteristics of baculovirus infection were observed when the culture cells were infected with SINPV derived from alkali dissolution of occlusion bodies at 24 hr postinfection (pi). The cells lysed and released occlusion bodies into culture medium at 120 hr pi.

Contralateral temperature changes of the finger surface during video endoscopic sympathectomy for palmar hyperhidrosis.

One hundred and eight consecutive patients with primary palmar hyperhidrosis were surgically managed by coagulation of bilateral T2 sympathetic ganglia using video thoracoscopic techniques. Patients were divided into two groups. In the first group (N = 46), finger surface temperature of the ipsilateral index finger was recorded before and after T2 ganglionectomy. The average increase of post-operative temperature was 2.74 +/- 0.27 degrees C (mean +/- SE) on the right side and 2.67 +/- 0.33 degrees C on the left (P < 0.05). The significant rise of temperature resulting from sympatholytic vasodilatation was only noted in cases of exact ablation of the T2 ganglion. In the second group (N = 62), surface temperatures of both index fingers were monitored and recorded simultaneously. These patients were arbitrarily subdivided into Group 2-A (N = 29) when right side ganglionectomy was performed first and Group 2-B (N = 33) when left side ganglionectomy was done initially. After the first ganglionectomy was completed, an ipsilateral increase with a contralateral decrease of temperature was observed; the average increase of temperature was 1.92 +/- 0.35 degrees C and 2.19 +/- 0.30 degrees C, and the average decrease was 1.50 +/- 0.51 degrees C and 1.67 +/- 0.39 degrees C for Group 2-A and 2-B respectively (P < 0.05). The authors postulate that a cross-inhibitory effect by the post-ganglionic neurons innervating blood vessels of the upper extremities may exists in humans and this effect is released after ganglionectomy, resulting in contralateral vasoconstriction and decrease of finger surface temperature.

Risk factors predicting surgically significant intracranial hematomas in patients with head injuries.

This population-based study was designed to determine the risk of patients with head injuries to develop surgically significant intracranial hematomas (SSIHs). A total of 28,500 cases of head injury were reviewed in Taipei City and Hualien County from 1988 to 1992. The Glasgow Coma Scale (GCS) was used to determine the severity of head injury. The presence of skull fracture and intracranial hematoma was determined by x-ray and computed tomographic (CT) scan, respectively. Those patients suffering from both loss of consciousness and skull fracture had a significantly greater risk of developing SSIHs than those having none or only one of these conditions. The relationship between skull fracture and severity of head injury revealed that the presence of a skull fracture in mildly head-injured patients could be used as an indicator to investigate the development of SSIHs before the occurrence of irreversible damage. The distribution of hematomas by location showed that a higher rate of SSIH resulting in parenchymal damage occurred when consciousness was lost. It also showed that epidural hematomas occurred more frequently with skull fractures. Skull fracture and impaired consciousness are important indices in determining the risk of developing SSIH.

Epidemiology of head injury in rural Taiwan -a four year survey.

An epidemiological study of head injury in Hualien County, Taiwan, was undertaken from January 1, 1988 to December31, 1991. The age-adjusted incidence rate of head injury was 382/100 000, 499/100 000 for males and 244/100 000 for females. The highest incidence rate was observed in the elderly group 70 years or older. It is notable that 79% of head injuries were associated with traffic accidents, 75% of which directly involved motocycle use. The age-adjusted mortality rate was 89/100 000 per year, 125/100 000 for males and 47/100 000 for females. As to the severity of head injury, the elderly group presented the highest percentage of moderate to severe degrees of injury as well as mortality. The victims of motorcycle accidents and pedestrians had the highest percentage of relatively severe head injury. Hospitalised patients showed an outcome worse than that ever reported in the literature.

[Moyamoya disease in Taiwan].

From January 1978 to December 1993, 73 patients with moyamoya disease were collected from seven neurological centers in Taiwan. The annual incidence of this disease in Taiwan is 0.024 per 100,000 population. There were 33 males and 40 females. The ages ranged from 2 to 62 years with a peak incidence in the 31 to 40 year age group (18 cases). Cerebral infarction occurred in 16 out of 19 juvenile patients (84.2%); by contrast, only 19 out of 54 adult patients (35.2%) presented with infarction. Hemorrhagic strokes were more frequent in adult patients. Computed tomographic scans following stroke showed cerebral infarction in 35 cases, ventricular hemorrhage in 21 cases, intracerebral hemorrhage in 11 cases and pure subarachnoidal hemorrhage in 6 cases. The most frequent initial symptom was motor disturbance (58.9%), followed by headaches (49.3%), and impaired consciousness (34.2%). Compared with reports from Japan, this survey showed a lower incidence of moyamoya disease in Taiwan.

[Intracranial arteriovenous malformations in Taiwan].

This paper analyzes the available literature on intracranial arteriovenous malformations (AVM) in Taiwan. The incidence and symptoms of the disease are studied with a view to assisting practitioners in its recognition. The incidence of intracranial AVM in patients who have suffered hemorrhagic stroke in Taiwan is 2.5% to 4.8%, with the male to female ratio being 1.5:1. The peak age at which bleeding from intracranial AVM occurred ranged from 10 to 40 years; bleeding showed no seasonal variation. Sudden headaches, vomiting, and disturbance of consciousness were the commonest presenting symptoms of AVM, similar to the rupture of intracranial aneurysms. However, the possibility of focal neurological deficit among patients with intracranial AVM was higher than in patients with intracranial aneurysms. Risk factors, such as hypertension, diabetes mellitus, heart disease, smoking and alcohol intake showed no close relationship to bleeding in intracranial AVM. Pregnancy is not a risk factor in female patients with intracranial AVM with no history of hemorrhage. Small intracranial AVM are more likely to bleed. Since 1961 the majority of Taiwan's intracranial AVM patients have been treated surgically, while before that date general medicine was the treatment of choice. In recent years, several developments such as operation microscope, microsurgical instruments and microsurgical techniques have enhanced the efficacy of surgical intervention in the treatment of AVM. When the mortality and morbidity rates resulting from the two forms of treatment are compared, surgical treatment shows a better prognosis for the treatment of intracranial AVM.

Neurobehavioral manifestations following closed head injury.

This study was designed to examine neurobehavioral sequelae following closed head injuries. It adapted the Neurobehavioral Rating Scale (NRS) which was designed by Harvey S. Levin in 1987. The scale has been proven to be valid and reliable in previous Western studies and was translated by the authors into Mandarin with the consent of its designer. A total of 335 cases of closed head injury in eight major hospitals in Taipei were studied. The main findings obtained from this preliminary study were: 1) the correlation coefficients between raters ranged from 0.749 to 0.956, manifesting satisfactory reliability; 2) seven factors were obtained through factorial analysis of NRS, explaining 65.5% of the variance; and 3) significant differences in neurobehavioral change were found in patients with various degrees of severity and various types of head injuries. The results demonstrate that NRS is applicable to Chinese patients. Possible modification as well as elaboration of this scale is suggested.

[Epidemiologic study of head injuries in Taipei City, Taiwan].

This study was designed to examine the descriptive epidemiology of head injuries in an urban population in the Taiwan area, Taipei City, during the period from July 1, 1987 to June 30, 1988. Clinical records reviewed included emergency room (ER) charts, inpatient charts of 19 major hospitals, death registration forms and medical examiners' reports in this city. A formulated definition was used to identify patients with head injuries. A total of 4,692 cases were collected, which included 4,319 hospital inpatients and 373 non-hospital deaths. The average incidence rate for head injury was 180/100,000 per year, 246/100,000 for males and 111/100,000 for females. The highest incidence rate was observed in the elderly group followed by the age group of 20-29 years. Sixty eight percent of the head injuries were caused by traffic accidents, 59.7 percent of which were involved in motorcycle rides. This rate was higher than those in any western reports. Among the 10-39 age group, the head injuries caused by traffic accidents were mainly due to motorcycle accidents. However, most of the children and the elderly who were injured were either pedestrians or bicycle riders. The average mortality rate was 23/100,000 per year, 34/100,000 for males and 12/100,000 for females. Initially the Glasgow Coma Scale was used in assessing the severity of head injuries. Seventy-two percent of the cases were considered mild, and 28 percent moderate to severe in degree, including 609 deaths.(ABSTRACT TRUNCATED AT 250 WORDS)

[An epidemiological study of head injury in Hualien County, Taiwan].

An epidemiological study of head injuries in Hualien County, Taiwan, was undertaken from July 1, 1987 to June 30, 1988. Clinical records, including emergency room (ER) charts, inpatient charts from the four major hospitals and coroner or medical examiner reports in this county, were reviewed. A formulated definition was used in identifying patients with head injury. A total of 1,183 cases were identified. They included 975 hospital inpatients and 208 nonhospital deaths. The age-adjusted incidence rate for head injuries was 333/100,000 for all, 450/100,000 for males and 194/100,000 for females, with a male-to-female ratio of 2.32. The cumulative incidence rate from 0 to 69 years of age was 27.6% for males and 13.7% for females. The highest incidence rate was observed in the elderly group, whereas in other published reports the highest occurrence has been noted in the young adult group. An extraordinary 82% of the head injuries were associated with traffic accidents, 71% of which directly involved motorcycle riders. The age-adjusted mortality rate was 89/100,000 per year, 127/100,000 for males and 44/100,000 for females. The cumulative mortality rate was 8.7% for males and 3.2% for females. These are the highest rates ever reported. Sixty percent of the 1,183 patients had a moderate to severe injury or were dead. In the remaining 40%, the injury was considered mild. The elderly group presented with the highest percentage of moderate to severe degrees of injury, as well as mortality. Among traffic accident victims, those from motorcycle accidents and pedestrians had the highest percentage of severe head injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of thermal stress and various agents on the brain edema formation in rats following a cryogenic brain lesion.

The influence of cold stress, heat stress, or various agents on the development of brain edema were assessed in rats following a cryogenic brain lesion. Brain edema was induced by local cold injury to the cortex. Cerebral edema was assessed 0.5, 3.0 or 24 h after a cryogenic brain lesion by measuring the water content of two hemispheres. Pretreatment of animals with sodium pentobarbital (15 or 30 mg/kg, i.p.) or lidocaine (15 mg/kg, i.p.) did not influence the development of brain edema. In addition, pretreatment with an external heat stress (heat exposure of 32 degrees C for 6 h) exaggerated significantly the development of brain edema in the rat following a cryogenic brain lesion. On the other hand, pretreatment of animals with either external cold stress (cold exposure of 8 degrees C for 6 h), glycerol (10% 10 ml, i.p.), mannitol (15% 10 ml, i.p.), gamma-hydroxybutyric acid (300 mg/kg, i.p.), metiamide (5 mg/kg, i.p.), dexamethasone (4 mg/kg, i.p.), aminophylline (100 mg/kg, i.p.), or ketamine (30 mg/kg, i.p.) inhibited significantly the brain edema formation.

Sympathetic postganglionic innervation of the cardiac coronary artery in cats.

The localization of the sympathetic postganglionic neurons innervating the cardiac coronary arteries of the cat was investigated using retrograde axonal transport with horseradish peroxidase. We found after the enzyme was applied to the main trunk of the right coronary artery, and to the main trunk and the terminal branch of the ventral descending vessels of the left coronary artery, the peroxidase-labeled sympathetic neurons were localized predominantly in the right stellate ganglia, with a few cells in the left stellate ganglia. There were very few labeled cells in the middle cervical, superior cervical, and T4-7 ganglia on both sides. After peroxidase application to the terminal branch of the dorsal descending vessels of the right coronary artery, labeled cells were mainly in the left stellate ganglia, with only a few cells in the right stellate ganglia.