Seasonal variation of chemical characteristics of fine particulate matter at a high-elevation subtropical forest in East Asia.

The aim of this study was to chemically characterize the fine particulate matter (PM2.5) at a subtropical forest in East Asia under the influences of anthropogenic and biogenic sources and a complex topographic setting. Four seasonal campaigns were conducted at the Xitou Experimental Forest in central Taiwan from the winter of 2013 to the autumn of 2014. The results indicated that the ambient levels and chemical features of PM2.5 exhibited pronounced seasonal variations. Non-sea-salt sulfate (nss-SO42-) constituted the major component of PM2.5, followed by ammonium (NH4+) and nitrate (NO3-) during winter, summer and autumn. However, it was revealed that the mass fraction of NO3- increased to be comparable with that of nss-SO42- in springtime. The mass contribution of secondary organic carbon (SOC) to PM2.5 peaked in summer (13.2%), inferring the importance of enhanced photo-oxidation reactions in SOC formation. Diurnal variations of O3 and SO2 coincided with each other, suggesting the transport of aged pollutants from distant sources, whereas CO and NOx were shown to be under the influences of both local and regional sources. Notably high sulfur oxidation ratio (SOR) and nitrogen oxidation ratio (NOR) were observed, which were 0.93 ±â€¯0.05 and 0.39 ±â€¯0.20, respectively. Precursor gases (i.e. SO2 and NOx) could be converted to sulfate and nitrate during the transport by the uphill winds. Furthermore, due to the high relative humidity at Xitou, enhanced aqueous-phase and/or heterogeneous reactions could further contribute to the formation of sulfate and nitrate at the site. This study demonstrated the significant transport of urban pollutants to a subtropical forest by the mountain-valley circulations as well as the long-range transport from regional sources, whereas the implications of which for regional climate change necessitated further investigation.

Negative association between acrylamide exposure and body composition in adults: NHANES, 2003-2004.

BACKGROUND/OBJECTIVES: Acrylamide is present in mainstream cigarette smoke and in some food prepared at high temperature. Animal studies have shown that acrylamide exposure reduces body weight. Prenatal exposure to acrylamide also has been linked to reduced birth weight in human. Whether acrylamide exposure is associated with altered body compositions in adults is not clear. SUBJECTS/METHODS: We selected 3623 subjects (aged ⩾20 years) from a National Health and Nutrition Examination Survey (NHANES) in 2003-2004 to determine the relationship among hemoglobin adducts of acrylamide (HbAA), hemoglobin adducts of glycidamide (HbGA) and body composition (body measures, bioelectrical impedance analysis (BIA), dual energy x-ray absorptiometry (DXA)). Data were adjusted for potential confounding variables. RESULTS: The geometric means and 95% CI concentrations of HbAA and HbGA were 60.48 (59.32-61.65) pmol/g Hb and 55.64 (54.40-56.92) pmol/g Hb, respectively. After weighting for sampling strategy, we identified that one-unit increase in natural log-HbAA, but not HbGA, was associated with reduction in body measures (body weight, body mass index (BMI), subscapular/triceps skinfold), parameters of BIA (fat-free mass, fat mass, percent body fat, total body water) and parameters of DXA (android fat mass, android percent fat, gynoid fat/lean mass, gynoid percent mass, android to gynoid ratio). Subgroup analysis showed that these associations were more evident in subjects at younger age, male gender, whites, lower education level, active smokers and those with lower BMI. CONCLUSIONS: Higher concentrations of HbAA are associated with a decrease in body composition in the US general population. Further studies are warranted to clarify this association.

Trends of hypertension prevalence, awareness, treatment and control in rural areas of northern China during 1991-2011.

This study aims to investigate the trends in prevalence, awareness, treatment and control of hypertension among rural residents aged 35-74 years in northern China during the country's rapid economic development from 1991 to 2011. Two surveys, conducted in 1991 and 2011, included 2196 and 1939 participants aged 35-74 years from same villages in Ji County, Tianjin of China, respectively. The prevalence of hypertension, adjusted by age and gender using the world standard population in 2000, increased 30% (39.9% vs 51.7%) between 1991 and 2011. The increase was greatest (68%) in women aged 35-44 years. Meanwhile, the prevalence of stage II hypertension increased by 75% overall, with a 4-fold increase in men aged 45-54 years. Although the awareness, treatment and control of hypertension increased significantly during the same period, they remained unacceptably poor. In conclusion, the community-based surveys showed that the prevalence of hypertension in rural residents of northern China aged 35-74 years increased rapidly over the past 20 years, and most dramatically in young women. Efforts in the primary prevention of hypertension, particularly for young women, and promoting education for hypertension awareness, treatment and control are of paramount importance in rural China.

Prediction models for the risk of new-onset hypertension in ethnic Chinese in Taiwan.

Prediction model for hypertension risk in Chinese is still lacking. We aimed to propose prediction models for new-onset hypertension for ethnic Chinese based on a prospective cohort design on community, which recruited 2506 individuals (50.8% women) who were not hypertensive at the baseline (1990-91). Total 1029 cases of new-onset hypertension developed during a median of 6.15 (interquartile range, 4.04-9.02) years of follow-up. In the clinical model, gender (2 points), age (8 points), body mass index (10 points), systolic blood pressure (19 points) and diastolic blood pressure (7 points) were assigned. The biochemical measures, including white blood count (3 points), fasting glucose (1 point), uric acid (3 points), additional to above clinical variables, were constructed. The areas under the receiver operative characteristic curves (AUCs) were 0.732 (95% confidence interval (CI), 0.712-0.752) for the point-based clinical model and 0.735 (95% CI, 0.715-0.755) for the point-based biochemical model. The coefficient-based models had a good performance (AUC, 0.737-0.741). The point-based clinical model had a similar net reclassification improvement as the coefficient-based clinical model (P=0.30), and had a higher improvement than the point-based biochemical model (P=0.015). We concluded that the point-based clinical model could be considered as the first step to identify high-risk populations for hypertension among Chinese.

Ethnic variation in hypertension prevalence of women in Taiwan.

The prevalence and risk factors of hypertension vary in ethnic groups. This study aimed to estimate the hypertension prevalence and to compare risk factors associated with hypertension in women of four ethnic groups in Taiwan. The study subjects were participants in the Taiwanese Survey on Hypertension, Hyperglycemia and Hyperlipidemia (TwSHHH) enrolled in 2002. In this analysis, only 2810 women who were at age of 20-80 years old and whose father and mother had same ethnic background (Minnan, Hakka, Aborigines or Mainland Chinese) were included. Results showed that there were significant ethnic differences in the prevalence of hypertension, obesity indices, fasting glucose, dyslipidaemia, hyperuricaemia, history of alcohol drinking and tobacco smoking and socioeconomic status. Aborigines had the highest prevalence of hypertension (28.6%) and diabetes mellitus (8.9%), whereas the Minnan group had the second highest prevalence of hypertension (19.2%) and diabetes mellitus (7.9%). Both age and central obesity were associated with an increased prevalence of hypertension except central obesity in Mainland Chinese in all four ethnic groups. Compared with the Mainland Chinese as the referent, the multivariate-adjusted odds ratio (OR) (95% CI) was 1.19 (0.63-2.26), 1.92 (1.15-3.21) and 2.03 (1.00-4.12) for Hakka, Minnan and Aborigines, respectively. Elevated body mass index (>or=27.0 vs <24.0 kg m(-2)) and central obesity were significantly associated with hypertension showing multivariate-adjusted OR (95% CI) of 1.68 (1.18-2.38) and 1.95 (1.48-2.57), respectively. In addition, dyslipidaemia, hyperuricaemia and diabetes associated with higher OR for hypertension in Minnan women. In conclusion, there were ethnic variations in hypertension prevalence and determinants in Taiwanese women.

Xanthelasma is not associated with increased risk of carotid atherosclerosis in normolipidaemia.

OBJECTIVES: Extracranial carotid artery (ECCA) atherosclerosis is well known to be associated with cardiovascular diseases. This study aims to investigate the difference of ECCA atherosclerosis between patients with xanthelasma and control subjects in normolipidaemia. METHODS: Carotid atherosclerosis (CA) of 41 (8 males and 33 females) patients with xanthelasma and normolipidaemia, defined as levels of cholesterol below 6.21 mmol/l and triglyceride below 2.26 mmol/l, recruited from Department of Dermatology was compared with that of 85 age- and gender-matched control subjects. The extent and severity of CA were measured by high-resolution B-mode ultrasound and expressed as the mean intima-media thickness (IMT) of the common carotid artery (CCA) and ECCA plaque score. Mixed-effects model and multivariate logistic regression analyses were used to estimate the association between xanthelasma and CA. RESULTS: Patients with xanthelasma showed significantly higher levels of low-density lipoprotein cholesterol (LDL-C) levels and higher body mass index (BMI) compared with the control group. Mixed models identified age, male gender, smoking and subjects of hypertension with medication, but not the presence of xanthelasma, were associated with an increase of CCA IMT. Multivariate logistic regression analysis revealed subjects of male gender, and hypertension with medication, but not the presence of xanthelasma, associated with thicker IMT, defined as IMT >or= 75th percentile, or ECCA plaque score >or= 3. CONCLUSIONS: Normolipidaemia with xanthelasma is not significantly associated with CA, but did relate with adverse cardiovascular profiles, such as higher BMI, waist circumference and LDL-C levels.

Lower plasma adiponectin is correlated to higher alanine aminotransferase independent of metabolic factors and hepatitis B virus carrier status.

BACKGROUND: Adiponectin has been linked to the metabolic syndrome and coronary artery disease in recent years. The animal and human data also suggest that adiponectin may be beneficial for liver functions. The aim of this study was to investigate the correlation between plasma adiponectin level and liver function tests in adults with or without chronic hepatitis B virus (HBV) infection. METHODS: We analysed the blood levels of liver enzymes and adiponectin in 140 apparently healthy adults, including 21 HBV carriers. RESULTS: We found that the plasma adiponectin levels were inversely correlated to aspartate aminotransferase (r = -0.314, P = 0.000) and alanine aminotransferase (ALT) (r = -0.430, P = 0.000). Among the HBV carriers, the ALT correlated with the plasma adiponectin levels (r = -0.521, P = 0.015). In linear regression models adjusting for age, sex and the other metabolic variables, the ALT was independently related to the plasma adiponectin levels (beta = -0.371 +/- 0.134, P = 0.007), even in HBV carriers (beta = -1.143 +/- 0.482, P = 0.034). The ALT was also independently correlated to the plasma adiponectin levels (beta = 0.552 +/- 0.132, P < 0.001) with adjustment for age, sex and insulin-resistance index by homeostasis model assessment, even in HBV carriers (beta = -1.202 +/- 0.562, P = 0.048). The subjects with normal ALT had a significantly higher least square mean of plasma adiponectin than those with abnormal ALT (4.01 +/- 0.19 vs 3.30 +/- 0.30, P = 0.014) with adjustment for age, sex, homeostasis model assessment insulin resistance and HBV status. CONCLUSION: ALT was inversely related to adiponectin levels, independent of the metabolic factors and HBV status. Whether there is any potential prognostic and therapeutic value of adiponectin in human liver diseases remains to be investigated.

Postchallenge hyperglycaemic spike associate with arterial stiffness.

Several large-scale epidemiological and intervention studies strongly indicate that postchallenge hyperglycaemia is the main factor associated with increasing the risk of morbidity and mortality in type 2 diabetes. However, the mechanisms that increase the risk of cardiovascular disease remain unclear. We aimed to study the relationship between postchallenge hyperglycaemia and arterial stiffness. We recruited 40 healthy subjects from a physical examination in 2005. Cardio-ankle vascular index (CAVI) was automatically calculated by VaSera VS-1000. For the reliability study, we performed the baseline study in the first 20 subjects who were returned to receive repeated measurements of CAVI 2 weeks later. The determinants of mean CAVI at different timings of oral glucose tolerance test (OGTT) study were analysed by constructing multivariate linear regression models. In reliability test, the inter-observer correlation coefficient was 0.82 for right CAVI, 0.87 for left CAVI and 0.85 for mean CAVI. Age, systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose levels at 60 min (Glu60) and glucose area under the curve of OGTT (GluAUC) are found to be significantly and positively correlated to right CAVI, left CAVI and mean CAVI (p < 0.05). After adjustment for age, gender and SBP, Glu60 and GluAUC are still independent determinants of CAVI. In subjects without clinical diagnosis of type 2 diabetes, postchallenge hyperglycaemic spike is highly associated with CAVI, a good parameter of aortic stiffness, independent of age, gender and blood pressure.

Familial aggregation of metabolic syndrome among the Chinese: report from the Chin-Shan community family study.

Genetic study on metabolic syndrome is a great challenge, due to its complex traits and the pleiotropic manifestation of atherosclerosis. Familial aggregation and recurrence risk ratio can provide the insight of possible genetic mechanism. The Chin-Shan community family study was based on adolescent probands and their relatives (1356 subjects) who were recruited from one junior high school in the community. Structured questionnaires and biochemical measures were obtained in standard procedures. Definition of metabolic syndrome was followed using the criteria defined by the third adult treatment panel, with a modification of the criteria for adolescent and Asian population. Grandmothers had the highest frequencies (70%) in metabolic syndrome and various atherosclerotic risks. Three factors were found and thus explained 68% of the overall variance. Estimated heritability was the highest in LDL and cholesterol factor (0.36 and 0.40), then blood pressure/obesity factor (0.27), and insulin resistance/dyslipidemia (0.27). Recurrence risk ratio among siblings was 2.95 (95% confidence interval [CI]: 1.39-6.26). The adjusted odds ratio (OR) of proband's metabolic syndrome status was 1.99 (95% CI: 1.08-3.66). The adjusted odds ratios for the three factors for predicting metabolic syndrome were all significant, with highest risk in blood pressure/obesity factor (OR: 1.27, CI: 1.22-1.33), then insulin resistance/dyslipidemia (OR: 1.29, CI: 1.16-1.23). This study demonstrated clearly familial aggregation and recurrence risk ratio of metabolic syndrome and components among the general ethnic Chinese population in Taiwan.

Pulse pressure, aortic regurgitation and carotid atherosclerosis: a comparison between hypertensives and normotensives.

Pulse pressure (PP) has often been associated with cardiovascular morbidity and mortality. Patients with aortic regurgitation (AR) often have increased PP. The aim of this study is to investigate the associations among PP, AR and extracranial carotid artery (ECCA) carotid atherosclerosis (CA) in hypertensives and age- and sex-matched normotensives. Two hundred and sixty-three hypertensive patients and 270 normotensive subjects from the Chin-Shan Community Cardiovascular Cohort participated in this study in 1996. CA, expressed as maximal common carotid artery intima-media thickness (IMT) > or = 75th percentile and ECCA plaque score > 6, was measured using high-resolution B-mode ultrasonography. The presence of AR was assessed by echocardiography, and their relationships with CA were evaluated. Results showed measurements of CA significantly associated with increased PP. Presence of AR associated with CA, but this relationship was attenuated after controlling for age. Multivariate logistic regression analyses revealed that an ECCA score > 6 significantly increase the risk in conjunction with PP, age and smoking in hypertensives. Correspondingly, CA increased with age, smoking and left ventricular hypertrophy on electrocardiography but not PP in normotensives. In conclusion, higher PP is strongly associated with CA in patients with hypertension. In terms of risk stratification, PP is more important in hypertensives than in normotensives which seem to imply that pulsatile haemodynamic component of BP is crucial in association with atherosclerosis.

Automation model of sewerage rehabilitation planning.

The major steps of sewerage rehabilitation include inspection of sewerage, assessment of structural conditions, computation of structural condition grades, and determination of rehabilitation methods and materials. Conventionally, sewerage rehabilitation planning relies on experts with professional background that is tedious and time-consuming. This paper proposes an automation model of planning optimal sewerage rehabilitation strategies for the sewer system by integrating image process, clustering technology, optimization, and visualization display. Firstly, image processing techniques, such as wavelet transformation and co-occurrence features extraction, were employed to extract various characteristics of structural failures from CCTV inspection images. Secondly, a classification neural network was established to automatically interpret the structural conditions by comparing the extracted features with the typical failures in a databank. Then, to achieve optimal rehabilitation efficiency, a genetic algorithm was used to determine appropriate rehabilitation methods and substitution materials for the pipe sections with a risk of mal-function and even collapse. Finally, the result from the automation model can be visualized in a geographic information system in which essential information of the sewer system and sewerage rehabilitation plans are graphically displayed. For demonstration, the automation model of optimal sewerage rehabilitation planning was applied to a sewer system in east Taichung, Chinese Taiwan.

Components of insulin resistance syndrome in a community-based population assessed by log-linear models.

BACKGROUND AND PURPOSE: To investigate the clustering of insulin resistance syndrome with hyperinsulinemia, hypertriglyceridemia, low high-density lipoprotein (HDL) cholesterol, hypertension, and obesity, we conducted this cross-sectional study and analyzed the patterns of conditional independence among these five elements. METHODS: Fasting insulin, lipid profiles, blood pressure, and anthropometric data from 2165 Taiwanese older than 35 years in the Chin-Shan community were examined. The cut-off points of these five factors (all binary variables) were defined. The hierarchical log-linear regression with nested effects model was applied to fit this higher-order contingency table of five variables, and likelihood ratio (chi2) statistics were used to test the goodness of fit. RESULTS: Hyperinsulinemia was independently correlated with obesity (odds ratio [OR] 5.7, 95% confidence interval [CI] 4.5-7.3), low HDL (OR 2.3, 95% CI 1.8-2.9), and hypertriglyceridemia (OR 1.6, 95% CI 1.2-2.2). Hypertriglyceridemia was significantly associated with low HDL (OR 3.6, 95% CI 2.7-4.8), and non-significantly associated with hypertension (OR 1.3, 95% CI 0.9-1.7) and obesity (OR 1.1, 95% CI 0.8-1.6). In persons with normal triglyceride levels, hypertension was positively associated with obesity (OR 2.8, 95% CI 2.1-3.7) and low HDL (OR 2.0, 95% CI 1.5-2.8). Analyses from forward and backward selection methods gave similar results. Graphical models with conditional independence relationships among these five variables were demonstrated. CONCLUSIONS: The components of insulin resistance syndrome have intricate relationships. Hyperinsulinemia was most related to obesity, and hypertriglyceridemia was most related to low HDL.

Hypertension status is the major determinant of carotid atherosclerosis: a community-based study in Taiwan.

BACKGROUND AND PURPOSE: Extracranial carotid artery (ECCA) atherosclerosis has been associated with hypertension-related stroke. The present study was aimed at investigating the determinants of ECCA atherosclerosis in patients with hypertension in Taiwan. METHODS: The extent and severity of ECCA atherosclerosis were measured by high-resolution B-mode ultrasonography and expressed as maximal intima-media thickness (IMT) of the common carotid artery, ECCA plaque score, and carotid stenosis >/=50%. From July through December 1996, 263 hypertensive patients (146 with hypertension and 117 with borderline hypertension) and 270 normotensive adults from the Chin-Shan Community Cardiovascular Cohort participated in this study. Risk factors and ECCA atherosclerosis were stratified by the blood pressure status. RESULTS: A significant dose-response relationship was found between the status of hypertension and the severity of carotid atherosclerosis. Multivariate logistic regression models revealed that hypertension (including borderline), male gender, smoking, and age >/=65 years significantly increased the risk of thicker IMT. The risk of ECCA plaque score >6 increased significantly in conjunction with hypertension, age >/=65 years, left ventricular hypertrophy on ECG, and smoking. However, hypertension and smoking were the 2 evident determinants of carotid stenosis >/=50% after adjustment for other covariates. Compared with the normotensive subjects, the ORs (and 95% CIs) for the hypertensive patients to develop carotid atherosclerosis were 5.0 (3.0 to 8.4) indexed by maximal common carotid artery IMT >/=75th percentile, 3.7 (1.8 to 7.9) by ECCA score >6, and 4.8 (1.4 to 16.5) by carotid stenosis >/=50%. CONCLUSIONS: Hypertension strongly influence carotid atherosclerosis. Our findings reinforce the hypothesis that hypertension has a major role in the pathogenesis of atherosclerosis.

Increased levels of tissue plasminogen activator antigen and factor VIII activity in nonvalvular atrial fibrillation: relation to predictors of thromboembolism.

INTRODUCTION: Given that nonvalvular atrial fibrillation (AF)-associated stroke can be either cardioembolic or atherothrombotic, we investigated the relationships between nonvalvular AF and hemostatic factors reflecting intrinsic thrombogenic and atherogenic potentials (tissue plasminogen activator [t-PA] antigen, plasminogen activator inhibitor-1, and factor VIII activity). We also evaluated the clinical applicability of these hemostatic factors by examining whether AF subjects with established clinical or echocardiographic predictors of thromboembolism had higher levels of these factors. METHODS AND RESULTS: Of the 3,212 participants of a Chinese population-based study, 53 subjects (1.7%) with AF were identified. Among the hemostatic factors measured, t-PA antigen (median 12.8 vs 8.1 ng/mL; P < 0.01) and factor VIII activity (median 155% vs 133%; P < 0.05) were significantly higher in AF subjects after adjustment for age and sex. In multivariate analysis, features independently associated with t-PA antigen levels were AF, sex, body mass index, systolic blood pressure, total cholesterol, triglycerides, and left ventricular systolic dysfunction. Features independently associated with factor VIII activity levels included AF, age, and total cholesterol. Levels of both t-PA antigen and factor VIII activity were primarily elevated in AF subjects with predictors of thromboembolism (age > 75 years, hypertension, diabetes, and left ventricular systolic dysfunction), whereas in AF subjects with no thromboembolic predictors, plasma levels of hemostatic factors examined were similar to those without AF. CONCLUSION: We demonstrated that nonvalvular AF was independently associated with increased peripheral levels of t-PA antigen and factor VIII activity. Levels of both hemostatic factors were primarily elevated in AF subjects with predictors of thromboembolism. Whether these hemostatic factors are independently predictive of future thromboembolic events in AF patients requires further investigation.

Left ventricular mass and correlated atherosclerotic risk factors in young adolescents: report from Chin-Shan community cardiovascular study in Taiwan.

Various subclinical disease indicators can be used as an early stage marker of atherosclerosis. Left ventricular (LV) mass has been related to cardiovascular morbidity and mortality. The distribution of LV mass in Chinese is rarely studied and nothing is known about its relationships with various atherosclerotic risk factors in young teenagers, in particular, aspects of lipid profiles. We performed a community-based survey of 523 males and 555 females, aged 12-15, in Chin-Shan, a suburb area near Taipei, Taiwan. LV mass was calculated from the Penn convention. Normalized LV mass by height with power of 2.7 was defined. LV mass and normalized LV mass were significantly greater in males than in females. There were significant positive correlation coefficients between LV mass and age, blood pressure, body mass index, low density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) B, fasting insulin levels and significant negative correlation coefficients between LV mass and high density lipoprotein cholesterol (HDL-C) and Apo A1 level in both genders. Multiple linear regression models showed gender and body mass index (BMI) were important factors associated with LV mass or normalized values for adolescents. Age and systolic blood pressure were also significant predictors of LV mass, but not of normalized LV mass values. LV mass values were found to be negatively associated with HDL-C values at marginal statistically significant level. Age and BMI are the most significant factors of echocardiographic LV mass distributions in young adolescent in Taiwan. LV mass may also be associated with atherosclerotic risk factors.

A randomized crossover evaluation of antianginal efficacy and safety of nitrolingual-spray and nitroglycerin tablet form in coronary artery disease patients.

Twenty-eight coronary artery disease patients with more than 50% stenosis in at least one major coronary artery completed this randomized crossover clinical trial for the comparison of efficacy and safety of Nitrolingual-Spray and nitroglycerin (NTG) tablets. Exercise time was lengthened to 399.1 s (spray) or 408.5 s (tablets), compared to a baseline of 387.3 s. Ischemic burden decreased to about -4.0 mm with both forms, compared to -7.5 mm at baseline (ANOVA: p = 0.003). The ischemic time improved to 137.2 s (spray) or 152.9 s (tablets), compared to 253.4 s at baseline (ANOVA: p = 0. 005). Patients taking tablets experienced more episodes of hypotension and/or headache compared to patients taking the spray. Nitrolingual-Spray is as effective and safe as NTG tablets for the treatment of symptomatic coronary heart disease.

Dimethylacetamide, ethylenediamine, and diphenylmethane diisocyanate poisoning manifest as acute psychosis and pulmonary edema: treatment with hemoperfusion.

CASE REPORT: A 27-year-old man, employed by a synthetic fiber company, had been exposed to dimethylacetamide, ethylenediamine, and diphenylmethane diisocyanate in a confined space continuously for 4-6 hours per day for 3 days before admission. Hallucinations and delusions were noted at admission; pulmonary edema developed subsequently. The electroencephalogram showed diffuse moderate cortical dysfunction and slow waves at 4-7 Hz, 20-80 microV. Seizures, liver injury, and rhabdomyolysis were noted on the 4th hospital day. The patient was treated by hemoperfusion with a decrease in urine dimethylacetamide from 3,265 mg/g to 4 mg/g creatinine over 4 days. Serial urinary dimethylacetamide and electroencephalogram correlated with the clinical condition.

Effects of menopause and obesity on lipid profiles in middle-aged Taiwanese women: the Chin-Shan Community Cardiovascular Cohort Study.

In this cross-sectional study, we examined the associations between lipid profiles and menopausal status, age, and obesity in Taiwanese women. The study population, established in 1990-91, consisted of 671 premenopausal and 872 postmenopausal women from the Chin-Shan Community Cardiovascular Cohort (CCCC). The associations of age, body mass index (BMI), and menopausal status with serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), apoproteins (Apo) A-1 and B, and lipoprotein (a) [Lp (a)] were evaluated. The results showed that menopause was associated with significant increases in TC, LDL-C, TG, and Apo B levels (all P < 0.001). Total cholesterol, LDL-C, TG, and Apo B levels increased consistently with BMI in middle-aged women, regardless of menopausal status. Among women aged 45-49, menopausal women had significantly higher levels of TC and LDL-C than premenopausal women (P < 0.01). However, TG and Apo B levels were higher in postmenopausal than in premenopausal women aged 50-54 years (P < 0.05). Standardized regression analyses showed all lipid variables, except those of Apo A1 and Lp (a) before menopause and TC, LDL-C, and Lp (a) after menopause, were significantly associated with BMI (all P < 0.01). We conclude serum lipid levels in Taiwanese women are no more strongly associated with menopause and BMI than with age.