Mass spectrometry-guided refinement of chemical energy buffers.

Biocatalytic reactions often require supplying chemical energy and phosphate groups in the form of adenosine triphosphate (ATP). Auxiliary enzymes can be used to convert a reaction by-product-adenosine diphosphate (ADP)-back to ATP. By employing real-time mass spectrometry (RTMS), one can gain an insight into inter-conversions of reactants in multi-enzyme reaction systems and optimize the reaction conditions. In this study, temporal traces of ions corresponding to adenosine monophosphate (AMP), ADP and ATP provided vital information that could be used to adjust activities of the 'buffering enzymes'. Using the RTMS results as a feedback, we also characterized a bienzymatic energy buffer that enables the recovery of ATP in the cases where it is directly hydrolysed to AMP in the main enzymatic reaction. The significance of careful selection of enzyme activities-guided by RTMS-is exemplified in the synthesis of glucose-6-phosphate by hexokinase in the presence of a buffering enzyme, pyruvate kinase. Relative activities of the two enzymes, present in the reaction mixture, influence biosynthetic reaction yields. This observation supports the conclusion that optimization of chemical energy recycling procedures is critical for the biosynthetic reaction economy.

The effective dose assessment of C-arm CT in hepatic arterial embolisation therapy.

OBJECTIVE: To assess the effective dose of the liver C-arm computed tomography (CT) scan during hepatic arterial embolisation surgery with clinical dose-area product (DAP) data from Taiwan. METHODS: The experiment used two kinds of phantoms: RANDO® Man and RANDO Woman (The Phantom Laboratory, Salem, NY), embedded with thermoluminescent dosemeters at locations according to the International Commission on Radiological Protection 103 report. The conversion factors of DAP to effective doses for males and females, respectively, were obtained. The clinical DAP data of liver C-arm CT scan during hepatic arterial embolisation surgery were collected in a hospital in Taiwan. RESULTS: There were 125 liver transarterial embolisation therapy cases, including 94 males and 31 females, from February 2009 to June 2010. C-arm CT was used 38 times for males and 17 times for females. The corresponding average and standard deviation of clinical DAP were 61.0±6.6 Gy cm(2) and 52.2±8.3 Gy cm(2), respectively. CONCLUSION: The DAP of RANDO Man and RANDO Woman phantoms simply scanned by C-arm CT are much lower than that of patients. After consideration of the clinical DAP of patients, the effective doses of a liver C-arm CT scan recommended for males and females in Taiwan are 11.5±2.3 mSv and 11.3±3.0 mSv, respectively. ADVANCES IN KNOWLEDGE: The conversion factors of DAP to effective doses for males and females are 0.19±0.03 mSv Gy(-1) cm(-2) and 0.22±0.05 mSv Gy(-1) cm(-2). Only if the actual DAP value of a patient scan is multiplied by the conversion factor can the correct effective dose be determined.

Coral communities of the remote atoll reefs in the Nansha Islands, southern South China Sea.

During the months of May and June in the year 2007, a survey was conducted regarding coral reef communities in the remote atolls (Zhubi Reef and Meiji Reef) of Nansha Islands, southern South China Sea. The goals of the survey were to: (1) for the first time, compile a scleractinian coral check-list; (2) estimate the total richness, coral cover, and growth forms of the community; and (3) describe preliminary patterns of community structure according to geomorphological units. Findings of this survey revealed a total of 120 species of scleractinia belonging to 40 genera, while the average coral cover was 21 %, ranging from less than 10 % to higher than 50 %. Branching and massive corals were also found to be the most important growth forms of the whole coral community, while Acropora, Montipora, and Porites were the three dominant genera in the overall region, with their contributions to total coral cover measuring 21, 22, and 23 %, respectively. Overall, coral communities of the Nansha Islands were in a relative healthy condition with high species diversity and coral cover. Spatial pattern of coral communities existed among various geomorphological units. Mean coral cover was highest in the patch reef within the lagoon, followed by the fore reef slope, reef flat, and lagoon slope. The greatest contributors to total coral cover were branching Acropora (45 %) in the lagoon slope, branching Montipora (44 %) in the reef flat, and massive Porites (51 %) in the patch reef. Coral cover in the fore reef revealed a greater range of genera than in other habitats. The leeward fore reef slope had higher coral cover (> 50 %) when compared with the windward slope (< 10 %). The coral communities of the inner reef flat were characterized by higher coral cover (27 %) and dominant branching Montipora corals, while lower coral cover (4 %) was dominated by Psammocora with massive growth forms on the outer reef flat. Destructive fishing and coral bleaching were two major threats to coral communities in the study area.

Intensive insulin therapy in severe acute pancreatitis: a meta-analysis and systematic review.

OBJECTIVE: To assess the effect of intensive insulin therapy on outcomes of patients with severe acute pancreatitis. METHODS: Relevant literatures cited in these electronic databases: Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNK1) database, and Excerpta Medical database (Embase) were systematically searched for randomized controlled trials (RCTs) in which intensive insulin therapy was used in severe acute pancreatitis. Length of hospitalization, acute physiology and chronic health evaluation II (APACHE II) score, incidence of complications, and adverse effects were recorded for statistical analysis. The methodological quality of the eligible studies was assessed by Jadad scale. The results were analysed by Revman 4.3 software. RESULTS: Three studies, which included a total of 118 cases, were finally reviewed. The methodological quality of the trials varied substantially In patients with severe acute pancreatitis, intensive insulin therapy was associated with shorter length of hospitalization (weighted mean difference (WMD) = -12.13, 95% confidence interval (CI) [-15.48, 8.78], p > 0.00001) and lower APACHE II score after 72 hours treatment (WMD = -3.80, 95% CI [-4.88,2. 72], p > 0.00001). One study reported insulin-related adverse event. CONCLUSION: In patients with severe acute pancreatitis, intensive insulin therapy could relieve the patient's condition earlier and shorten the length of hospitalization without serious adverse effect.

Ambient and personal dose assessment of a container inspection site using a mobile X-ray system.

Ambient monitor and phantom studies of absorbed and effective doses by TLDs were carried out in a non-intrusive inspection station for containers, Terminal I, of Taichung harbor, Taiwan. The doses from the X-ray scan in the control room and driver waiting room, located outside of the radiation control area, were quite small and could not be distinguished from the natural background radiation. The doses in the driver cab and the inspector cab of the X-ray scan car were also within background radiation levels. The protection wall, a 40-cm thick concrete barrier, can effectively attenuate the intensity of the primary X-ray scan. The possible effective dose of a person in the container or trailer is about 3.15 ± 0.23 µSv/scan and 2.31 ± 0.38 µSv/scan. This dose is below the annual background dose. If someone was to be scanned by the X-ray, the effective dose would be at an acceptable level.

Population dose from medical exposure in Taiwan for 2008.

PURPOSE: The largest contribution to the population dose from man-made ionizing radiation sources is the medical exposure. Exposure to patients from medical examinations is of interest because it is a global indicator for the quality of radiology practice. Due to the different healthcare systems and the considerable variations in the equipment and manpower in radiology, the population dose from medical exposure varies by a large extent in different countries. This dose from different diagnostic procedures provides information that can be used to establish national reference levels. It is also useful to determine the priority in terms of dose reduction so as to optimize the protection of patients in a cost-effective manner. In the present work, the collective effective doses due to different medical modalities were estimated for the Taiwan population in 2008. METHODS: The collective effective dose from medical exposure was calculated using information on the number of procedures and the average effective dose per procedure. The frequency of procedures was extracted from the National Health Insurance (NHI) research database. The enrollment of Taiwan population in the NHI program was 99.48% in 2008. The average effective dose per procedure was derived from hospital surveys, measured data, and published results. RESULTS: Estimates of the collective effective dose were made for different medical modalities, i.e., the conventional radiography and fluoroscopy, computed tomography, interventional fluoroscopy, nuclear medicine, and dental radiography. Each modality was further divided into relevant classes by the body part or organ system. Among 23 037 031 Taiwan population in 2008, the annual examination frequencies per 1000 population were 550, 55.1, 15.6, 13.6, and 112 for the conventional radiography and fluoroscopy, computed tomography, interventional fluoroscopy, nuclear medicine, and dental radiography, respectively. The corresponding collective effective doses were 3277, 8608, 2743, 2303, and 28 man-Sv, respectively. Thus, the average effective dose per caput was 0.74 mSv, which was in the range of 0.3-1.5 mSv for the 12 European countries estimated for 2008. CONCLUSIONS: In the period from 1997 to 2008, the procedure frequency per 1000 population increased by a factor of 2.3 for computed tomography, 2.2 for interventional fluoroscopy, 1.8 for conventional radiography and fluoroscopy, and 1.5 for nuclear medicine. It demonstrated that the medical utilization of imaging facilities raised rapidly.

Population dose from medical diagnostic exposure in Taiwan.

Medical exposure showed a continuous increasing trend. This trend was due to the growth of diagnostic procedures such as computed tomography (CT) and interventional fluoroscopy (IVF). In the present work, results of a recent study on medical exposure in Taiwan are reported. This study analysed data from the National Health Insurance Research Database. Surveyed data on the dose indices, including the entrance surface dose in radiography, dose area product in fluoroscopy, CT dose index in CT and mean glandular dose in mammography, were applied. Using programmes and databases, dose indices were converted to the effective dose. For the year 2008, individual effective doses in Taiwan were estimated as 0.16, 0.37, 0.12 and 0.12 mSv for conventional radiography and fluoroscopy, CT, IVF and nuclear medicine, respectively. The total collective effective dose and the effective dose per individual for medical exposure were 17 788 person-Sv and 0.77 mSv, respectively.

Development and use of PCR primers for the investigation of C1, C2 and C3 enterotoxin types of Staphylococcus aureus strains isolated from food-borne outbreaks.

Staphylococcus aureus is a major food-borne pathogen in many countries. Enterotoxins produced by S. aureus strains include staphylococcal enterotoxins (SEs) A, B, C, D, E and G, H, I, etc. For SEC, in addition to the three major SEC subtypes, i.e., SEC1, C2 and C3, other molecular variants may exist. Although the detection methods and the distribution of SEA, B, C, D, E types of S. aureus in staphylococcal infections or food-borne outbreaks have been well documented, the differentiation method and the distribution of SEC subtypes in staphylococcal infections are rarely reported. In this study, four polymerase chain reaction (PCR) primers used in pairs (ENTC1/ENTCR, ENTC2/ENTCR and ENTC3/ENTCR) for the specific detection of SEC1, C2 and C3 genes of S. aureus strains were developed. When 39 SEC S. aureus strains isolated from fecal samples of randomly selected diarrheal patients associated with food-borne outbreaks in central Taiwan in 6 years (1995-2000) were analyzed, it was found that the major SEC subtypes for these S. aureus strains were SEC2 and C3.

Absence of human papillomavirus E6-E7 transforming genes from HPV 16 and 18 in malignant ovarian carcinoma.

Ovarian carcinoma is one of the frequent causes of death from malignancies in the United States. A report excited the scientific community when human papillomavirus were identified in advanced epithelial ovarian carcinoma tissues in 10 of 12 patients. A few studies also identified HPV DNA in ovarian carcinoma tissues. However, several researchers employing polymerase chain reaction techniques and using different oligonucleotide probes did not detect HPV DNA in ovarian carcinoma tissues. The objective was to determine the presence of the E6-E7 genes of HPV types 16 and 18 in archived paraffin-embedded malignant ovarian carcinoma using primers targeting. Archived human malignant ovarian cancer tissues (N = 20 cases) embedded in paraffin blocks were processed, and DNA was extracted and the presence of DNA verified by p53 amplifications. PCR analyses were performed on the extracted DNA together with appropriate controls. The results showed an absence of E6-E7 genes of HPV types 16 and 18 in ovarian carcinoma. However, the presence of other HPV types or gene regions is not ruled out and more studies are needed to resolve the question of HPV involvement in ovarian carcinogenesis.

Consistency between preference and use of long-term care among caregivers of stroke survivors.

Effective arguments have been made for the importance of expanded attention to understanding how family preferences influence decisions to choose long-term care. The effects of preference on the utilization of long-term care deserve further research, especially on a longitudinal basis. The family members of 582 first-time stroke patients from the neurology departments of four teaching hospitals in Taiwan were categorized into two groups based on their attitudes toward type of long-term care, i.e., a preference for nursing home care (n1 = 324) or a preference for home care (n2 = 258). The consistency rate between preference and utilization of the type of long-term care was estimated by the division of number of families preferring one type of long-term care by the number of families actually utilizing the services preferred. Results indicated that the consistency rate for those with nursing home preference was 8.3% while the consistency rate for those with home care preference was 94.2%. Accessibility of nursing home facilities near family residences was significantly associated with whether those preferring nursing home services actually utilized them, and the odds ratio was 20.8. The family manpower available for caregiving at home was tremendously associated with whether families utilized home care when home care was preferred; the odds ratio was 33.3. The preference for the type of long-term care was a strong predictor of the utilization when home care was preferred, yet not when a nursing home was preferred. The low consistency between preference and utilization for nursing homes preferred is due to the low accessibility of nursing home facilities in Taiwan. How to provide sufficient support to families for caregiving at home, and how to deal with the barrier of accessibility to nursing home services should be two major concerns for those who are planning and operating the long-term care system and for those trying to design institutional services and noninstitutional services as alternatives.

Did the four human cancer cell lines DLD-1, HCT-15, HCT-8, and HRT-18 originate from one and the same patient?

Four human colon cancer cell lines, HCT-8, HRT-18, DLD-1, and HCT-15, with an epithelioid morphotype reproducibly formed alpha-catenin-deficient round cells. Using DNA fingerprinting, we found that these four cell lines have an identical genetic background. Our finding strongly suggests a genetic background for the reproducible loss of alpha-catenin and the ensuing acquisition of invasiveness in all four cell lines.

Analysis of costs borne by families of patients hospitalized for stroke.

BACKGROUND: Studies focusing on the economic impact of cancer on families have emphasized that costs of chronic disease are substantial for patients and their families. However, little effort has been devoted to measuring the costs of care for families of patients hospitalized with stroke. METHODS: A total of 215 stroke patients and their families from four teaching hospitals in the Taipei metropolitan area were monitored from the date of the patient's admission to hospital until the date of discharge. The value of labor contributed by families was estimated by assigning the current monetary market rate of providing health aide to the time families spent caring for patients in hospital. Lost earnings of patients and families, expenditure for medical care, and expenses for food, clothes, adult diapers, transportation and other miscellaneous items were determined and summed to arrive at the total family cost of providing care. RESULTS: The average cost of care for one family per inpatient day was NT$4,358.20. A total of 98.6% of the families incurred labor costs, which accounted for about half of family costs for providing care. Hospital bills accounted for almost 19% of total family costs. The income loss for families and patients accounted for about 25% of total family costs. Expenses for food, clothes, transportation, diapers and other illness-related miscellaneous items accounted for about 12% of total family costs. Multiple regression analyses demonstrated that the number of family members involved in giving care and the length of stay are important predictors for the total cost of care. Average total family costs per day increased by 24.3% when an additional family member was involved in providing care. Total family costs increased 2.5% for each hospital day. CONCLUSIONS: If direct and indirect nonmedical costs are not included in the total cost calculation for providing hospital care to stroke patients, the economic impact of care on families is likely to be underestimated.

Dose reconstruction for residents living in 60Co-contaminated rebar buildings.

The first 60Co-contaminated rebar building was discovered in Taipei city in 1992. As of 18 July 1997, 144 buildings with 1,327 housing units were confirmed to contain 60Co-contaminated rebars. All these reinforced concrete buildings were constructed between 1982 and 1984. Thousands of residents have been exposed to ionizing radiation of various degrees. Preliminary assessments by the Atomic Energy Council showed that the accumulated maximal doses ranged from a few mSv to several Sv. The purpose of this work was to reconstruct more reliable individual doses for epidemiologic and medical uses. This reconstruction provided the best estimated doses as well as conceivable upper and lower bounds. The variation of residential day-life activities by individual members in a family was considered according to their sex, age, profession, etc. Intensive data on exposure rates were collected using thermoluminescent dosimeters positioned at 1 m height and 1 m x 1 m intersections with additional measurements at special locations such as bed, sofa, dining table, etc. Thermoluminescent dosimeter measurements were performed in all 24 residences studied in this work. This showed that the Atomic Energy Council maximal doses were 2-6 times higher than the present best estimated doses. Among all family members, elders and housewives received the highest doses; children received the lowest doses. The difference in doses among all family members belonging to different cohort categories is within a factor of two.

Liver metastasis of a human colorectal cancer containing two actively growing subclones.

A common pattern of karyotype evolution between clones involves gradual changes of one or only a few chromosomes. Karyotypes of one day-old cultures derived from a tumor nodule of colorectal cancer liver metastasis were studied by GTG chromosome banding. Two karyotypically distinct aneuploid CC-9-a and CC-9-b clones were found respectively, at about 1:3 ratio. Both clones showed common karyotype characteristics with the same number of copies for 13 normal and four marker chromosomes, indicating their common genetic origin. However, CC-9-b differed from CC-9-a by the loss of one copy each of eight normal and four common marker chromosomes. This mode of gross single-chromosome losses is also seen in established cell lines, and probably plays an important role in the drastic chromosome changes associated with the duplication-reduction cycle of karyotype evolution.

A cost-effectiveness analysis of home care and community-based nursing homes for stroke patients and their families.

A prospective study designed for 336 hospitalized patients with stroke and their families, who were followed from the discharge day to the third month after being discharged, was carried out in order to compare the costs and effectiveness of home care with the community-based nursing homes for stroke patients with different physical function disabilities in terms of ADL scores and their families. The ADL scores of the patients with severe physical function disability did not improve with or without long-term care; however, the patients with moderate physical function disability were significantly improved at the end of the third month, even without interventions from long-term care. The family costs of the patients in nursing homes were substantially lower than the costs for the patients who stayed at home, and the relationship of the family costs of the patients cared for in their own homes was proportional to the patients' physical function status. The labour input from family caregiving accounted for at least 60% of the total family costs of the patients who stayed at home, and the paid for long-term care services accounted for at least 60% of total family costs when the patients stayed in nursing homes. The multiple linear regression demonstrated that the degree of caregiving from families was a predictor of the amount of the costs families incurred for patients with severe physical function disability; as a result the ADL scored on discharge significantly influenced the average total family costs for the patients cared for in their own homes.

Family caregivers' priorities for home care: a need assessment study.

BACKGROUND: Many studies have demonstrated that patients prioritize some attributes of health care over others. However, little effort has been devoted to measure which service attributes are most important to consumers, regardless of their satisfaction, in the field of home care. Moreover, home care requires family members to participate as caregivers. Thus, evaluating the needs of family caregivers who also provide home care should provide an opportunity to envision an effective home care system. METHODS: This study was designed to measure family caregivers' need for auxiliary home care services by examining their priorities for attributes of home care services. The respondents were asked to select 5 attributes, which were most important for them, from 19 choices of home care services, and then to rank 5 attributes in decreasing order of importance to determine their priorities, coded from 1 (the first priority) to 5 (the last important priority). The degree of satisfaction from a single attribute, whether or not the desired attribute was in fact provided, personal data of family caregivers, and types of patient's insurance were also included in this study. RESULTS: The interviewees were inclined to assign high priority to the ease of contacting home care nurses by telephone (73.6%) and the timeliness of obtaining needed services in an emergency (63.6%); they were less likely to attach high priority to provision of spiritual support (6.3%), respect given by home care nurses (5.4%), and acceptance of suggestions (4.5%). Whether a single attribute was selected as a top five priority was significantly associated with family caregiver's education level, degree of satisfaction with the attribute and whether the desired attribute was actually received. CONCLUSIONS: The interviewees had different priorities for attributes of home care, and they assigned high importance to the attributes less satisfied and received; examples are the timeliness of obtaining needed services in an emergency, and the ease of contacting home care nurses by telephone.

Coexisting clones in diploid and near-diploid cell lines.

The karyotypic characteristics and clonal composition of human normal diploid MRC-5 (46,XY) and tumorigenic SK-UT-1 (45,XX,-13) and SK-UT-IB (46,XX) cell lines were studied. In MRC-5, 45, XX, -6; 45,X; 46, XY, t(7;14) (p11:q24) and 47, XY, M1 clones were identified. Other karyotypic characteristics included 2.4% polyploidy, 4.8% breaks/gaps, 4.1% structural anomalies, 1.4% hyperdiploidy, and 5.4% hypodiploidy. In SK-UT-1, 45, XX, -13, and clones with t(18;22) (q22.2;q11.23) and 46, XX, 4p+ occurred at 56.6%, 39.3%, and 4.1%, respectively. The t(18;22) karyotypes differed by either paired N13, one N13 plus one i(13q), or one i(13q). The significance of single chromosome amplification relating to the outgrowth in one culture by the t(18;22) clone is discussed. Structural aberrations occurred at high frequencies in N3, N6, and N7, and breaks from these chromosomes were clustered at 3p12, 3q21, 6q21, 6q23, and 7q11.2. The highly malignant SK-UT-IB had the stable karyotype and one 46X, f clone only. Clearly, the cell population was basically mosaic, containing more than one co-existing clone plus the polyploidy of each clone.

Cell line banks and their role in cancer research.

The utility of centralized cell banks in providing reference cultures for cancer research is reviewed. Procedures applied at The American Type Culture Collection in development, maintenance and expansion of such a resource are discussed for example, with emphasis on human tumor cell lines. The various categories of cell-line holdings are explained, and status with regard both to the numbers of lines available and distribution experienced are documented. The locations of other national cell repositories plus contact data are provided.