bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural features of the Nostoc punctiforme debranching enzyme reveal the basis of its mechanism and substrate specificity
Authors: Dumbrepatil Arti Baban , Choi Ji‐Hye , Park Jong Tae , Kim Myo‐Jeong , Kim Tae Jip , Woo Eui‐Jeon , Park Kwan Hwa
Published: July 2009

The debranching enzyme Nostoc punctiforme debranching enzyme (NPDE) from the cyanobacterium Nostoc punctiforme (PCC73102) hydrolyzes the α‐1,6 glycosidic linkages of malto‐oligosaccharides. Despite its high homology to cyclodextrin/pullulan (CD/PUL)‐hydrolyzing enzymes from glycosyl hydrolase 13 family (GH‐13), NPDE exhibits a unique catalytic preference for longer malto‐oligosaccharides (>G8), performing hydrolysis without the transgylcosylation or CD‐hydrolyzing activities of other GH‐13 enzymes. To investigate the molecular basis for the property of NPDE, we determined the structure of NPDE at 2.37‐Å resolution. NPDE lacks the typical N‐terminal domain of other CD/PUL‐hydrolyzing enzymes and forms an elongated dimer in a head‐to‐head configuration. The unique orientation of residues 25–55 in NPDE yields an extended substrate binding groove from the catalytic center to the dimeric interface. The substrate binding groove with a lengthy cavity beyond the −1 subsite exhibits a suitable architecture for binding longer malto‐oligosaccharides (>G8). These structural results may provide a molecular basis for the substrate specificity and catalytic function of this cyanobacterial enzyme, distinguishing it from the classical neopullulanases and CD/PUL‐hydrolyzing enzymes. Proteins 2010. © 2009 Wiley‐Liss, Inc.
PIE—Efficient filters and coarse grained potentials for unbound protein–protein docking
Authors: Ravikant D. V. S. , Elber Ron
Published: July 2009

Identifying correct binding modes in a large set of models is an important step in protein–protein docking. We identified protein docking filter based on overlap area that significantly reduces the number of candidate structures that require detailed examination. We also developed potentials based on residue contacts and overlap areas using a comprehensive learning set of 640 two‐chain protein complexes with mathematical programming. Our potential showed substantially better recognition capacity compared to other publicly accessible protein docking potentials in discriminating between native and nonnative binding modes on a large test set of 84 complexes independent of our training set. We were able to rank a near‐native model on the top in 43 cases and within top 10 in 51 cases. We also report an atomic potential that ranks a near‐native model on the top in 46 cases and within top 10 in 58 cases. Our filter+potential is well suited for selecting a small set of models to be refined to atomic resolution. Proteins 2010. © 2009 Wiley‐Liss, Inc.
The other 90% of the protein: Assessment beyond the Cαs for CASP8 template‐based and high‐accuracy models
Authors: Keedy Daniel A. , Williams Christopher J. , Headd Jeffrey J. , Arendall W. Bryan , Chen Vincent B. , Kapral Gary J. , Gillespie Robert A. , Block Jeremy N. , Zemla Adam , Richardson David C. , Richardson Jane S.
Published: July 2009

For template‐based modeling in the CASP8 Critical Assessment of Techniques for Protein Structure Prediction, this work develops and applies six new full‐model metrics. They are designed to complement and add value to the traditional template‐based assessment by the global distance test (GDT) and related scores (based on multiple superpositions of Cα atoms between target structure and predictions labeled “Model 1”). The new metrics evaluate each predictor group on each target, using all atoms of their best model with above‐average GDT. Two metrics evaluate how “protein‐like” the predicted model is: the MolProbity score used for validating experimental structures, and a mainchain reality score using all‐atom steric clashes, bond length and angle outliers, and backbone dihedrals. Four other new metrics evaluate match of model to target for mainchain and sidechain hydrogen bonds, sidechain end positioning, and sidechain rotamers. Group‐average Z‐score across the six full‐model measures is averaged with group‐average GDT Z‐score to produce the overall ranking for full‐model, high‐accuracy performance. Separate assessments are reported for specific aspects of predictor‐group performance, such as robustness of approximately correct template or fold identification, and self‐scoring ability at identifying the best of their models. Fold identification is distinct from but correlated with group‐average GDT Z‐score if target difficulty is taken into account, whereas self‐scoring is done best by servers and is uncorrelated with GDT performance. Outstanding individual models on specific targets are identified and discussed. Predictor groups excelled at different aspects, highlighting the diversity of current methodologies. However, good full‐model scores correlate robustly with high Cα accuracy. Proteins 2009. © 2009 Wiley‐Liss, Inc.
Key safety roles in organizational changes
Authors: Davidson Paul A. , Mooney S.D.
Published: July 2009

As, business moves to lean manufacture to minimize costs, it inherently leads to reduced staff and a flatter management structure. During these organizational changes, it is important that safety is not compromised by the removal of key people. A number of layers of controls and defenses are put in place, to both prevent an event and to mitigate the consequences if an event occurs. There are many competing techniques for assessing the impact of organizational change, each of which has its pros and cons.

This article discusses a technique based on the use of the Bow Tie methodology to analyze major accident scenarios for a high‐hazard site, and presents an example from a real life case study. Controls identified in the analysis have a responsible person assigned to them and a summary of these roles is used to define the impact of removing a role. Key roles for safety controls are maintained and any eliminated roles have their responsibilities reassigned. After the change, final role descriptions would specifically include descriptions of key safety control responsibilities.

Within this article, we have discussed the application of the Bow Tie technique to Organizational Change on a site during a 15% staff reduction. This application and technique is easily followed, leading to identification and correction of gaps in the management systems. © 2009 American Institute of Chemical Engineers Process Saf Prog, 2010
A comparison of aircraft‐based surface‐layer observations over Denmark Strait and the Irminger Sea with meteorological analyses and QuikSCAT winds
Authors: Renfrew I. A. , Petersen G. N. , Sproson D. A. J. , Moore G. W. K. , Adiwidjaja H. , Zhang S. , North R.
Published: July 2009

A compilation of aircraft observations of the atmospheric surface layer is compared with several meteorological analyses and QuikSCAT wind products. The observations are taken during the Greenland Flow Distortion Experiment, in February and March 2007, during cold‐air outbreak conditions and moderate to high wind speeds. About 150 data points spread over six days are used, with each data point derived from a 2‐min run (equivalent to a 12 km spatial average). The observations were taken 30–50 m above the sea surface and are adjusted to standard heights. Surface‐layer temperature, humidity and wind, as well as sea‐surface temperature (SST) and surface turbulent fluxes are compared against co‐located data from the ECMWF operational analyses, NCEP Global Reanalyses, NCEP North American Regional Reanalyses (NARR), Met Office North Atlantic European (NAE) operational analyses, two MM5 hindcasts, and two QuikSCAT products.

In general, the limited‐area models are better at capturing the mesoscale high wind speed features and their associated structure; often the models underestimate the highest wind speeds and gradients. The most significant discrepancies are: a poor simulation of relative humidity by the NCEP global and MM5 models, a cold bias in 2 m air temperature near the sea‐ice edge in the NAE model, and an overestimation of wind speed above 20 m s−1in the QuikSCAT wind products. In addition, the NCEP global, NARR and MM5 models all have significant discrepancies associated with the parametrisation of surface turbulent heat fluxes. A high‐resolution prescription of the SST field is crucial in this region, although these were not generally used at this time. Copyright © 2009 Royal Meteorological Society
Processability and mechanical properties of commercial PVC plastisols containing low‐environmental‐impact plasticizers
Authors: Persico Paola , Ambrogi Veronica , Acierno Domenico , Carfagna Cosimo
Published: July 2009

Preliminary results are presented concerning the use of less‐toxic plasticizers such as dioctyl adipate (DOA) and acetyl tributyl citrate (ATBC) in plastisol formulations for rotational molding technology. The DOA and ATBC plasticizers have been studied by comparing the effects of their content, molecular architecture, and polarity on the rheological behavior of liquid plastic systems and on the mechanical properties of the ultimate products prepared with PVCs having different particle sizes and molecular‐weight distributions. Rheological tests have confirmed the differences in solvent power of the diethylhexyl phthalate (DOP), DOA, and ATBC plasticizers. The glass transition temperatures measured on rotomolded samples have shown that the use of ATBC leads to a more nearly rigid system as a consequence of the branched structure and polarity of this plasticizer when compared with DOA. Mechanical tests carried out on final products after natural and forced environmental aging revealed a slight decrease in their performance. J. VINYL ADDIT. TECHNOL., 2009. © 2009 Society of Plastics Engineers
Thermal stabilization of poly(vinyl chloride) by hydrotalcites, zeolites, and conventional stabilizers
Authors: Gupta Savita , Agarwal D.D. , Banerjee Susanta
Published: July 2009

Unwanted discoloration and degradation of Poly(vinyl chloride) (PVC) at processing temperatures is a matter of concern to the industrial community. Many formulations have been suggested, but to meet environmental regulations and today's market demand, a new combination of stabilizers has been designed in order to explore the probable mechanism of stabilization. A combination of hydrotalcite, zeolite, calcium stearate, and magnesium acetylacetonate is proposed. Thermal behavior in terms of released HCl and visual color examination for color stability have been investigated. Results indicate that both hydrotalcite and zeolite behave as long‐term stabilizers. In a PVC formulation having 2 phr of hydrotalcite or zeolite, the evolution times for 2 mmol of HCl were 497 and 337 min, respectively, at 180°C, but when a part of these stabilizers was replaced by some other stabilizer, a noticeable change in HCl evolution time was observed. J. VINYL ADDIT. TECHNOL., 2009. © 2009 Society of Plastics Engineers
Ligand Exchange Processes on Solvated Zinc Cations – DFT Analysis of Hydrogen Cyanide Exchange on [Zn(HCN)6]2+
Authors: Alzoubi Basam M. , Puchta Ralph , van Eldik Rudi
Published: July 2009

The mechanisms for hydrogen cyanide exchange on [Zn(HCN)6]2+ were studied using density functional theory (B3LYP/6‐311+G**), and showed that the limiting dissociative (D) pathway is more favorable than the associative interchange (Ia) mechanism. The activation barrier for the dissociative mechanism (7 kcal·mol–1) is clearly lower than for the interchange mechanism (15.9 kcal·mol–1).
Video‐Assisted Thoracic Surgery (VATS) Compares Favorably with Thoracotomy for the Treatment of Lung Cancer: A Five‐Year Outcome Comparison
Authors: Yang Xueying , Wang Shumin , Qu Jiaqi
Published: July 2009

Background

Although video‐assisted thoracic surgery (VATS) lobectomy has been demonstrated to be safe and technically feasible, it is infrequently performed in most Chinese hospitals and few thoracic surgeons have performed the operation. We have therefore reviewed our experience with all VATS lobectomies, attempting to define long‐ and short‐term outcomes of these surgeries.

Methods

We retrospectively analyzed the results in patients who underwent VATS lobectomy and open lobectomy between March 1996 and August 2003. The VATS surgery was performed with the endoscopic hilar dissection technique. Perioperative data were collected and long‐term outcomes were assessed by 5‐year census.

Results

We successfully performed VATS procedures in 113 of 120 patients. The median operative time was 152 min and the median hospitalization was 8.6 days. The median operative blood loss was 130 ml and the median drainage time was 3.5 days. The operative and perioperative (30‐day) mortality rates were 0% and 0.9%, respectively; the postoperative complications rate was 10.6%. The 5‐year overall survival rates for stage I, stage II, and stage III or greater non‐small cell lung cancer (NSCLC), secondary pulmonary malignancy, and benign disease were 79.1%, 45.5%, 22.2%, 33.3%, and 88.6%, respectively.

Conclusions

Video‐assisted lobectomy is a safe and feasible surgical procedure, and it gives the same long‐term results as conventional open lobectomy. The VATS approach to lobectomy is a beneficial alternative to standard thoracotomy for selected cases of pulmonary lesions.
A Randomized, Clinical Trial of Frozen Versus Standard Nasogastric Tube Placement
Authors: Chun Duk‐Hee , Kim Na Young , Shin Yang‐Sik , Kim Soo Hwan
Published: July 2009

Background

Insertion of a nasogastric tube (NGT) in an anesthetized, paralyzed, and intubated patient is difficult, and many methods have been proposed to aid in the procedure. We present a simple insertion technique.

Methods

A silicone NGT was made rigid by filling it with distilled water and freezing it. Patients were randomized into either the control or the frozen group, and an NGT was inserted after intubation.

Results

A total of 100 patients (50 in each group) were included in this study. The success rate increased significantly by making the tube more rigid (control:frozen = 58%:88%; p = 0.001). There was no difference between groups in the incidence of nasal bleeding.

Conclusions

A simple method of freezing an NGT with distilled water increased the success rate of insertion for intubated patients.
Functional Properties of Soy Protein Isolates Produced from Ultrasonicated Defatted Soy Flakes
Authors: Karki Bishnu , Lamsal Buddhi P. , Grewell David , Pometto Anthony L. , van Leeuwen J. , Khanal Samir K. , Jung Stephanie
Published: July 2009

This study aimed to determine the effect of pretreating defatted soy flakes with ultrasound on soy protein isolate (SPI) yield and functionality. Defatted soy flakes dispersed into water (16%, w/w) were sonicated for 30, 60 and 120 s at ultrasonic amplitudes of 21 and 84 µmpp (peak to peak amplitude in µm), representing low and high power, respectively. The power densities were 0.30 and 2.56 W mL−1, respectively. The SPI yield increased by 13 and 34%, after sonication for 120 s at low and high power, respectively. The sonication of defatted soy flakes for 120 s at the higher power level improved the SPI solubility by 34% at pH 7.0, while decreasing emulsification and foaming capacities by 12 and 26%, respectively, when compared to control SPI. Rheological behavior of the SPI was also modified with significant loss in consistency coefficient due to sonication. Some of these results could be explained by the loss of the protein native state with increased sonication time and power.
Animal models of human amyloidoses: Are transgenic mice worth the time and trouble?
Authors: Buxbaum Joel N.
Published: July 2009

The amyloidoses are the prototype gain of toxic function protein misfolding diseases. As such, several naturally occurring animal models and their inducible variants provided some of the first insights into these disorders of protein aggregation. With greater analytic knowledge and the increasing flexibility of transgenic and gene knockout technology, new models have been generated allowing the interrogation of phenomena that have not been approachable in more reductionist systems, i.e. behavioral readouts in the neurodegenerative diseases, interactions among organ systems in the transthyretin amyloidoses and taking pre‐clinical therapeutic trials beyond cell culture. The current review describes the features of both transgenic and non‐transgenic models and discusses issues that appear to be unresolved even when viewed in their organismal context.
Expression of Thyroid Hormone Receptors in Intracranial Meningiomas
Authors: Wang Chih‐Jen , Lin Pi‐Chu , Howng Shen‐Long
Published: July 2009

Thyroid hormone has a unique function in human organs. Many of its effects occur at the level of gene expression and are mediated by thyroid hormone receptors (TRs). We investigated the relationship between TRs and the prognosis of meningiomas. We investigated TR expression in human intracranial meningiomas using reverse transcription‐polymerase chain reaction. Specimens of 25 tumors were obtained by craniotomy from various intracranial meningiomas. We found that the expression of TRs was receptor subtype‐ and cell type‐dependent. Human TRα1 (hTRα1) was expressed in nine cases, hTRα2 was expressed in 14 cases, and both hTR‐alpha‐1 and hTR‐alpha‐2 were expressed in five cases; hTRβ1 was expressed in nine cases of recurrent or malignant tumors. The expression of hTRβ1 may be an indicator of recurrent or malignant meningiomas.
Association Between Social Support and Health Outcomes: A Meta‐analysis
Authors: Wang Hsiu‐Hung , Wu Su‐Zu , Liu Yea‐Ying
Published: July 2009

The purpose of this study was to examine the relationship between social support and health outcome variables, and the effect size of social support on health outcomes. Meta‐analysis was used to synthesize the primary studies identified initially from a computer search of the literature in Taiwan. Through preliminary screening related to the inclusion criteria, 165 dissertations and theses and 43 journal articles were included in this study. Finally, 182 primary studies, including 145 dissertations and theses and 37 journal articles, were retained after eliminating outliers of each outcome variable to achieve homogeneity. Based on Smith's four modes of health, 16 health outcome variables were used. Health status, physical symptoms and responses, psychologic symptoms and responses, and depression were categorized as clinical variables. Role function and behaviors and role burden were categorized as role‐function variables. Physical adjustment, psychosocial adjustment, adjustment of life, coping behavior, and stress were categorized as adaptive variables. Health belief, health promotion behavior, quality of life, well‐being, and self‐actualization were categorized as eudemonistic variables. Other than physical adjustment, social support could significantly predict all health outcomes (p< 0.0001). The results provided information not only on the magnitude of the sample size required to achieve statistical significance between social support and each outcome variable as a measure of health in future studies, but also on strategies to guide further intervention programs and to evaluate their effectiveness.
Biological Evaluation of an Antibiotic DC‐81–Indole Conjugate Agent in Human Melanoma Cell Lines
Authors: Hu Wan‐Ping , Chen Yen‐Chi , Wang Jeh‐Jeng , Yu Hsin‐Su
Published: July 2009

Pyrrolo[2, 1‐c][1, 4]benzodiazepines (PBDs) are potent inhibitors of nucleic acid synthesis because of their ability to recognize and bind to specific sequences of DNA and form a labile covalent adduct. DC‐81, an antitumor antibiotic produced by Streptomyces species, is a PBD. We combined DC‐81 and an indole carboxylate moiety to synthesize a hybrid designed to have much higher sequence selectivity in DNA interactivity. In this paper, the cytotoxic potency of the hybrid in human melanoma cell lines was studied. XTT assay demonstrated that the DC‐81‐indole conjugate possessed cytotoxicity against human melanoma cell lines.
A Community‐Based Surveillance on Determinants of Rodent Infestation
Authors: Pai Hsiu‐Hua , Hong Yu‐Jue , Wang Cheng‐Hsung
Published: July 2009

Rodent infestation is an important factor in the transmission of infectious diseases of public health importance. From October to November 1998, surveillance stations were established in 110 boroughs of Kaohsiung City in southern Taiwan. Boroughs were chosen by random sampling 10 boroughs from each of 11 districts (464 boroughs) in the city. The extent of rodent infestation was determined by cage trapping. The possibility of applying a community‐based control program was evaluated by investigating associated demographic and environmental factors as well as related knowledge, attitudes, and behaviors. A total of 90 rodents were trapped in 41% of the 110 boroughs. Using univariate analyses, 17 factors were significantly associated with rodent infestation. A lack of knowledge that rodent control relies on community cooperation was the most important factor among the seven variables associated with the extent of rodent infestation (OR 3.1) by logistic multiple regression. This revealed the importance of community cooperation in controlling rodent infestation. Moreover, improvement of environmental hygiene associated with garbage problems, such as cleanliness of storage rooms and closets, and the hygiene of empty space and resource recycling stations should not be ignored.
Orbital Hemangiopericytoma — A Case Report
Authors: Lee Yang‐Chen , Wang Jyh‐Seng , Shyu Jeng‐Shyong
Published: July 2009

A 50‐year‐old male presented with progressive proptosis in the right eye for 10 years. Decreased visual acuity to hand‐motion level was also noted. Orbital computed tomography revealed a large homogenously enhanced mass lesion in the right retrobulbar region with optic nerve compression. The remainder of the ocular examination was normal, except for right mature cataract. The tumor was completely removed through lateral orbitotomy. Histologic findings showed a picture of hemangiopericytoma. One month after cataract extraction and intraocular lens implantation in the right eye, the patient had restored vision. Through 2 years' follow‐up, no more orbital tumor was noted. Orbital hemangiopericytoma may have potentially malignant behavior, and a high local recurrence rate if incompletely excised. Complete, intact removal prevents tumor recurrence and provides a good result.
Current Indications for Transurethral Resection of the Prostate and Associated Complications
Authors: Liu Chia‐Chu , Huang Shu‐Pin , Chou Yii‐Her , Wang Chii‐Jye , Huang Chun‐Hsiung
Published: July 2009

Transurethral resection of the prostate (TURP) is the most common surgical procedure for relieving symptoms of benign prostatic hyperplasia. Here, we report our experience of current indications for TURP and their associated outcomes at Kaohsiung Medical University Hospital (KMUH). A total of 111 patients who underwent TURP at KMUH between May 2000 and December 2001 were included in this retrospective review. For each patient, the surgical indication was categorized into acute urinary retention, chronic complications (including renal impairment, recurrent urinary infection, bladder stone/diverticulum, post‐void residue, and recurrent hematuria), and symptomatic prostatism. Thirty‐five patients (31%) had acute urinary retention, 28 (27%) had chronic complications, and 48 (42%) had symptomatic prostatism. Most patients chose TURP only when medical treatment had failed to relieve symptoms, no matter what category they belonged to. Patients with acute urinary retention and chronic complications had larger prostates (p = 0.002) and more tissue resected (p = 0.05) than those with symptomatic prostatism. Patients with acute urinary retention seemed to be at greater risk of postoperative complications such as recurrent urinary retention and urinary tract infection. We suggest that urodynamic study may be necessary to rule out concomitant bladder dysfunction before surgery and that adequate prophylactic antibiotic treatment be used to decrease the risk of urinary tract infection during or after TURP, especially when pyuria is noted preoperatively in patients with acute urinary retention.
Intraductal Papillary Mucinous Tumor of the Pancreas: Computerized Tomography and Magnetic Resonance Imaging Features
Authors: Hong Tun‐Mei , Lee Rheun‐Chuan , Chiang Jen‐Huey , Chang Cheng‐Yen
Published: July 2009

The aim of this study was to analyze the computerized tomography (CT) and magnetic resonance imaging (MRI) features of intraductal papillary mucinous tumor (IPMT) of the pancreas. The cases of eight patients with pathologically proven IPMT (1 papillary hyperplasia, 7 adenocarcinoma) of the pancreas were retrospectively reviewed. There were five men and three women with ages ranging from 42 to 82 years. Imaging studies included six thin‐section dynamic CT scans, seven MRI scans, one MR cholangiopancreatography scan, and two endoscopic retrograde cholangiopancreatography scans. There was only one benign IPMT, which presented as a unilocular cyst in the pancreatic body with no mural nodules and no dilatation of the main pancreatic duct (MPD). All seven patients with malignant IPMT had multilocular cysts with papillary projections in the pancreatic head and/or uncinate process accompanied by dilated MPD (5 diffuse, 2 segmental). Communication between the cystic lesions and the MPD were evident in all seven patients. One patient had small mural nodules in the branch ducts of the pancreatic body and five had a bulging papilla with a patulous orifice. A mass effect resulting in biliary obstruction was shown in one patient. One patient had a ruptured cyst with mucin leakage into the right anterior pararenal space following sono‐guided aspiration. In conclusion, the main imaging feature of IPMT in our patients was a multilocular cyst with papillary projections located in the pancreatic head and uncinate process. Although CT and MRI cannot differentiate mucin content from pancreatic juice, communication between the cystic lesion and the dilated MPD and a bulging papilla with a patulous orifice are characteristics of IPMT.
Exposure to Environmental Tobacco Smoke and Urinary 1‐Hydroxypyrene Levels in Preschool Children
Authors: Tsai Hsiu‐Ting , Wu Ming‐Tsang , Hauser Russ , Rodrigues Ema , Ho Chi‐Kung , Liu Chia‐Ling , Christiani David C.
Published: July 2009

Environmental tobacco smoke (ETS) contains relatively high concentrations of polycyclic aromatic hydrocarbons (PAHs). Urinary 1‐hydroxypyrene (1‐OHP), a metabolite of pyrene, is a good indicator of PAH exposure in occupational studies. In this study, we investigated the relationship between urinary 1‐OHP concentration and ETS exposure in preschool children. Forty preschool children, aged 24‐76 months, were studied during November and December, 1999. Two spot‐urine specimens (one in the morning immediately after the subject woke up and the other at night before the subject went to bed) were collected 1 day after completion of a questionnaire, in order to determine 1‐OHP concentrations by fluorescent spectrophotometry. Overall, urinary 1‐OHP concentrations were relatively low but detectable (morning: median, 0.021 μg/g creatinine; range, 0.002‐1.019 μg/g creatinine; night: median, 0.015 μg/g creatinine; range, 0.002‐1.328 μg/g creatinine). Multiple linear regression analyses revealed that the total number of cigarettes smoked by the children's fathers during the 3 days prior to collection of the urine specimens was significantly associated with their urinary 1‐OHP concentrations, after adjusting for other confounders. Each cigarette smoked by a child's father resulted in an average 9.6% increase in 1‐OHP concentration in the morning urine specimen (95% confidence interval = 1.8‐18.1%; p = 0.02). We did not find a significant increase in the 1‐OHP concentration in night urine specimens (p = 0.19). Although the sample size was small, these findings indicate that urinary 1‐OHP may be a suitable biomarker of ETS carcinogen exposure in children.
Analysis of Emergency Department Utilization by Elderly Patients Under National Health Insurance
Authors: Huang Jin‐An , Hu Wei‐Hsiung , Yang Dar‐Yu , Weng Rhay‐Hung , Tsai Wen‐Chen
Published: July 2009

Elderly persons are thought to use emergency departments (EDs) disproportionately. This phenomenon has implications for policy‐making as the population of the elderly continues to increase. This study aimed to characterize national ED utilization by elderly patients (≥ 65 years old), compared with that by younger patients (15‐64 years old). The sample was selected from the National Health Insurance Research Database for the year 2000. There were 519,003 visits to adult EDs in the 12 medical centers sampled. The study used a secondary data analysis and included 14 variables. The elderly accounted for 28.5% of all adult ED visits. Compared with younger patients, a greater proportion of elderly patients were male (61.6% vs. 47.7%, p < 0.001), had chronic diseases (11.9% vs. 8.0%, p < 0.001), were major cases (6.7% vs. 4.1%, p < 0.001), made no co‐payment (38.5% vs. 5.8%, p < 0.001), were frequent users of outpatient services (28.4% vs. 9.9%, p < 0.001), were higher‐level emergencies (60.0% vs. 43.7%, p < 0.001), had longer stays in the ED (14.0% vs. 4.7%, p < 0.001), and had higher costs per visit (NT$4,814 ± 6,046 vs. 2,779 ± 5,533, p < 0.001). In addition, elderly patients used 40.8% of total adult ED costs. Older patients have distinct patterns of ED use, and use emergency services at a higher rate than younger patients. ED staff should be knowledgeable about the unique and complex presentations of older ED patients.
Paraganglioma of the Urinary Bladder: A Case Report
Authors: Kang Wan‐Yi , Chai Chee‐Yin , Shen Jung‐Tsung
Published: July 2009

Paragangliomas of the urinary bladder are very rare. To date, there are no reliable methods for predicting their clinical behavior, so long‐term follow‐up is required. We describe a paraganglioma of the urinary bladder in a 32‐year‐old male who presented with painless gross hematuria. Abdominal ultrasonography revealed a protruding mass with hematoma over the right lateral wall of the urinary bladder. The tumor was not completely resected by transurethral resection of bladder tumor (TURBT) due to intermingling with the bladder wall. Follow‐up I131‐metaiodobenzylguanidine was performed 3 weeks after surgery and suspected incomplete resection lesions were noted. Histologic examination of the tumor indicated paraganglioma of the urinary bladder. We also provide a brief review of the literature for comparison.
Hearing Loss in Patients with Nasopharyngeal Carcinoma after Chemotherapy and Radiation
Authors: Wang Ling‐Feng , Kuo Wen‐Rei , Ho Kuen‐Yao , Lee Ka‐Wo , Lin Chih‐Shin
Published: July 2009

In light of the possible adverse effects of radiation on hearing, we conducted a study to evaluate the long‐term sensorineural hearing status following radiotherapy (RT) in patients suffering from nasopharyngeal carcinoma. Audiologic examinations were performed at regular intervals before and after RT. We also analyzed the effects of age, chemotherapy, pre‐RT hearing status, and post‐RT otitis media with effusion (OME) on post‐RT hearing change. A total of 150 patients (261 ears) were enrolled in this study and followed up for a mean of 43.8 months. After RT, 8.9‐28.8% of ears had at least a 10 dB loss in bone conduction threshold at speech frequency, which was defined as an average of hearing threshold at 0.5 kHz, 1 kHz, and 2 kHz, while the percentage was 18‐34.2% at 4 kHz. Patient age was related to these changes at speech frequency, and the presence of post‐RT OME was related to significant loss at both speech frequency and 4 kHz. Pre‐RT hearing status and chemotherapy did not influence hearing change. To sum up, sensorineural hearing loss began as early as after completion of RT. Early changes may be transient, but the effect of radiation on hearing tended to be chronic and progressive.
Patient‐ and Family‐Rated Scale for Bipolar Disorder Symptoms: Internal State Scale
Authors: Huang Chieh‐Liang , Yang Yen‐Kuang , Chen Mitchell , Lee I‐Hui , Yeh Tzung‐Lieh , Yang Ming‐Jen
Published: July 2009

The monitoring of patients, by themselves and their caregivers, is very important in the prophylaxis of bipolar disorder. This study aimed to develop a Chinese‐language version of an instrument for assessment of manic and depressive symptoms by patients and their families. Fifty‐eight inpatients and outpatients with a DSM‐IV (Diagnostic and Statistical Manual of Mental Disorders) diagnosis of bipolar disorder were recruited. All subjects underwent clinical psychopathologic assessment by experienced psychiatrists using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS). At the same time, each patient and key family members filled out the Chinese‐language version of the Internal State Scale (ISS) for monitoring mental symptoms. Patients were examined a second time if they had entered remission or a new episode of the opposite polarity. The ISS was divided into two subscales, of well‐being/activation and of irritability. Patients' well‐being/activation and irritability subscales were significantly correlated with YMRS scores and the well‐being/activation subscale was also significantly correlated with the HDRS score. Family members' irritability subscales were significantly correlated with HDRS scores only. The reliability and constructive validity of the ISS was good in both patients with bipolar disorder and their families.
Intramuscular Metastasis of Cutaneous Squamous Cell Carcinoma: A Case Report
Authors: Yang Yu‐Li , Lai Chung‐Sheng , Lin Sin‐Daw , Wang Chien‐Kuo , Tsai Kun‐Bow
Published: July 2009

Cutaneous squamous cell carcinoma (SCC) is a common cancer. Although most patients with primary cutaneous SCC have an excellent prognosis, for those with metastatic disease, the long‐term prognosis is poor. The most common sites of metastasis are regional lymph nodes, lung, liver, brain, skin, and bone. However, metastatic soft tissue SCC from cutaneous lesions is extremely rare, with only two reported cases. We report a case in which the patient had a primary SCC lesion on his left palm in 1986. A second primary SCC on his left forearm was confirmed in 2001, with subsequent metastasis to the proximal muscles and bone invasion in spite of the initial wide excision.
Tacrolimus Ointment for the Treatment of Atopic Dermatitis: Report of First Clinical Experience in Taiwan
Authors: Lan Cheng‐Che E. , Lin Chien‐Te , Chen Gwo‐Shing , Huang Chieh‐Chen , Chen Yu‐Ting , Wang Li‐Fang
Published: July 2009

Atopic dermatitis (AD) is a pruritic recurring inflammatory skin disease. Recently, topical tacrolimus has been developed to treat AD. This report presents the first clinical experience with topical tacrolimus in Taiwan. This open‐label, single‐arm study was conducted at three centers from February to May 2002. The duration of each individual treatment was 4 weeks. Two groups were defined: pediatric and adult. Efficacy was evaluated on the basis of the physician's global evaluation at the end of treatment. Success was defined as at least 50% improvement. Other evaluations included the Eczema Area and Severity Index (EASI), the percentage of body surface area (BSA) involved, the patient's assessment of pruritus, and the patient's assessment of overall response. Safety profile was established by monitoring changes in hematology and biochemistry profiles and tacrolimus concentration in blood. All adverse events were recorded. Twenty‐six pediatric patients and 42 adult patients were enrolled. Overall success rates were 80.8% and 82.1% in the pediatric and adult groups, respectively. The declines in EASI, percentage of BSA affected, and patient's assessment of pruritus were significant (p < 0.001); 88% and 100% of pediatric and adult patients, respectively, reported a favorable response to treatment. Changes in blood samples were unremarkable. Of pediatric and adult patients, 61.5% and 76.2%, respectively, reported adverse events. The most common adverse event reported was skin burning, which did not result in discontinuation of therapy. This report reveals that tacrolimus ointment is effective and safe for the treatment of AD in Taiwanese patients.
Mitomycin C‐Induced Renal Insufficiency: A Case Report
Authors: Wen Mei‐Chin , Ho William L. , Chen Cheng‐Hsu
Published: July 2009

A 58‐year‐old normotensive male with normal renal function and gastric cancer underwent total gastrectomy and received adjuvant chemotherapy with mitomycin C (MMC) for 10 months. He developed anemia, hypertension, and renal function impairment 9 months after initiation of chemotherapy. Kidney biopsy showed thrombotic microangiopathy with marked mesangiolysis and expansion of the subendothelial space resulting in cystic dilation of the glomerular capillaries, and cellular atypia in the tubular cells. His renal function deteriorated gradually then stabilized after treatment with plasma exchange, antihypertensive agents, and antiplatelet agents. He had no sign of tumor recurrence after 3 years of follow‐up. We suggest that patients receiving MMC should have their blood pressure and renal function closely monitored for the possibility of development of drug‐induced renal insufficiency.
Potential Role of Vascular Endothelial Growth Factor, Interleukin‐8 and Monocyte Chemoattractant Protein‐1 in Periodontal Diseases
Authors: Lee En , Ho Ya‐Ping , Ho Kun‐Yen , Tsai Chi‐Cheng , Yang Yi‐Hsin
Published: July 2009

Host‐mediated immunoinflammatory pathways activated by bacteria lead to destruction of the periodontal connective tissues and alveolar bone. The objective of this study was to elucidate the activation of the inflammatory processes in periodontal disease by quantitative assessment of cytokines and periodontopathogens. Gingival crevicular fluids (GCF) and subgingival plaque samples were collected from patients with chronic periodontitis and gingivitis and from periodontally healthy sites. Vascular endothelial growth factor (VEGF), monocyte chemoattractant protein‐1 (MCP‐1), and interleukin 8 (IL‐8) in GCF were analyzed by enzyme‐linked immunosorbent assay. Periodontopathogens, including Bacteroides forsythus, Campylobacter rectus, Porphyromonas gingivalis and Prevotella intermedia, were analyzed by immunofluorescence and dark‐field microscopy. There was significantly more VEGF and IL‐8 in chronic periodontitis and gingivitis sites than in periodontally healthy sites. There were significant positive correlations between the concentrations and total amounts of VEGF and IL‐8 in chronic periodontitis and gingivitis sites, and between the levels of periodontopathogens and the total amounts of VEGF, MCP‐1 and IL‐8. These data indicate that inflammatory processes induced by periodontopathogens and the activation of certain cytokines (VEGF, MCP‐1, IL‐8) in periodontal diseases may be relevant to host‐mediated destruction in chronic periodontitis.
Combined Interferon‐α and Inosiplex Treatment of Subacute Sclerosing Panencephalitis: A Case Report
Authors: Han Chy‐Yuan , Lin Hsiu‐Fen , Shin Pang‐Ying , Liu Ching‐Kuan , Liu Chiang‐Shin
Published: July 2009

Subacute sclerosing panencephalitis (SSPE) is rare in Taiwan. On admission to hospital, a 15‐year‐old boy was diagnosed with SSPE based on the clinical picture, electroencephalogram, cerebrospinal fluid studies, and brain biopsy. The initial clinical picture was a decline in school performance and a change in personality, followed by progressive tic‐like involuntary movements and mental impairment for 8 months, then a rapidly progressive course. After the patient was treated with oral inosiplex and intraventricular interferon‐! (IFN‐!), his condition stabilized and the neurologic disability index score improved slightly. There were no major side effects during treatment except for a transient initial elevation of body temperature that lasted for several days. Oral inosiplex and intraventricular IFN‐! appear to be safe and effective. Early identification and aggressive treatment of SSPE is important.
Primary Malignant Fibrous Histiocytoma of the Lung: A Case Report
Authors: Wang Chuan‐Sheng , Tsai Jong‐Rung , Sheu Chau‐Chyun , Hung Jen‐Yu , Hsu Te‐Hung , Huang Ming‐Shyan , Tsai Kun‐Bow
Published: July 2009

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. However, primary MFH of the lung is rare, with only a few cases reported in the literature. Here, we report the case of an 86‐year‐old male who was admitted to our hospital with the chief complaint of exertional dyspnea and poor appetite. Chest roentgenography revealed a 9 × 15 cm, pleural‐based opacity in the left lower lobe. Chest computerized tomography disclosed a well‐defined mass with heterogeneous density in the left lower lung field. The diagnosis of MFH was confirmed by thoracoscopic lung biopsy and pathologic examination. Supportive care was given because of extreme old age and poor performance status (the patient's Karnofsky performance status was 30). The patient died from respiratory failure 2 months later.
Relationship Between Retinal Vein Occlusion and Axial Length
Authors: Tsai San‐Chang , Chen Hsin‐Yi , Chen Chiu‐Ying
Published: July 2009

This study examined whether axial length is a local risk factor for central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). The study group consisted of 40 patients with unilateral CRVO and 77 patients with unilateral BRVO. The control group included 67 individuals who matched the study group patients in age, systemic hypertension, and diabetes mellitus status. The axial lengths of affected and fellow eyes of patients and controls were measured using A‐scan ultrasonography. The axial length of affected eyes was statistically significantly shorter than that of unaffected eyes in the BRVO group (p < 0.05) but not in the CRVO group (p = 0.05). There were also statistically significant differences in axial length between control eyes and affected eyes in both the CRVO group (p < 0.05) and BRVO group (p < 0.05). Thus, shorter axial length could be a risk factor for developing CRVO and BRVO. The axial lengths of affected eyes in retinal vein occlusion patients tend to be shorter than those of unaffected eyes, especially in BRVO patients.
Spontaneous Left Main Coronary Artery Dissection: A Case Report
Authors: Lin Tsung‐Hsien , Lee Kun‐Tai , Lai Wen‐Ter , Sheu Sheng‐Hsiung , Chiu Chaw‐Cho , Lin Young‐Yso
Published: July 2009

Coronary artery dissection is a devastating disease, but spontaneous left main coronary artery dissection is extremely rare. We present the case of a 58‐year‐old diabetic man who was found to have primary spontaneous left main coronary artery dissection during a coronary angiography examination. Although the dissecting lesion persisted, he had no peri‐procedural chest discomfort or electrocardiographic change. We performed urgent coronary artery bypass grafting, which was uneventful. The patient received regular cardiovascular follow‐up and did not complain of any postoperative chest discomfort. He had an uneventful recovery.
Immunohistochemical Localization of Endothelin‐Converting Enzyme‐1 in Neuroendocrine Tumors and Normal Human Tissue
Authors: Hsu Yung‐Hsiang , Huang Shih‐Che
Published: July 2009

Endothelin‐converting enzyme‐1 (ECE‐1) is the key enzyme of endothelin biosynthesis, catalyzing the final step in the process. In this study, we investigated the cellular distribution of ECE‐1 in 19 normal human tissues and 16 neuroendocrine tumors using immunohistochemical staining with antigen retrieval. ECE‐1 was expressed in vessel endothelial cells as well as nearly all epithelial cells, glands and duct cells in normal human tissues including the esophagus, stomach, small intestine, appendix, colon, liver, gallbladder, pancreas, endometrium, cervix, breast, skin, prostate, urinary bladder, lung, kidney, sympathetic ganglion, thyroid gland, and adrenal gland. The most interesting finding was that ECE‐1 was expressed in normal neuroendocrine cells. ECE‐1 was also expressed in all 16 neuroendocrine tumors, including three paragangliomas, five pheochromocytomas, three carcinoid tumors, four medullary carcinomas of the thyroid, and one islet cell tumor of the pancreas. In conclusion, ECE‐1 is enriched in neuroendocrine cells and neuroendocrine tumors, suggesting an important biologic role for the enzyme in the neuroendocrine system.
Pelvic Congestion Syndrome – Findings on Multi‐Detector Row Computerized Tomography: A Case Report
Authors: Liu Shi‐Zuo , Chou Chen‐Pin , Huang Jer‐Shyung , Pan Huay‐Ben , Lion Wen‐Shiung
Published: July 2009

Chronic pelvic pain is a common gynecologic complaint, sometimes without any obvious etiology. We report a case of pelvic congestion syndrome with chronic pelvic pain. The diagnosis can be overlooked by clinical physicians but diagnosed using multi‐detector row computerized tomography. This method seems to be an effective and non‐invasive imaging modality.
Giant Extrarenal Retroperitoneal Angiomyolipoma: A Case Report and Literature Review
Authors: Lee Yung‐Chin , Huang Shu‐Pin , Liu Chia‐Chu , Wu Wen‐Jeng , Chou Yii‐Her , Huang Chun‐Hsiung
Published: July 2009

Extrarenal angiomyolipoma is an uncommon disease entity and is rare in the retroperitoneum. We report a case of giant extrarenal retroperitoneal angiomyolipoma mimicking liposarcoma. A 35‐year‐old woman presented with a history of increased abdominal circumference and urinary frequency. Abdominal computerized tomography demonstrated a 24 × 21 × 16 cm retroperitoneal fatty tumor displacing the right kidney to the left upper quadrant of the abdomen. At laparotomy, the tumor was widely excised and the right kidney was successfully preserved. Final histologic examination identified the tumor as an angiomyolipoma. At 4‐month postoperative follow‐up, no evidence of tumor recurrence was found and the right kidney was fully functional.
Hyalinizing Spindle Cell Tumor with Giant Rosettes: A Case Report
Authors: Yang Sheau‐Fang , Liu Chiang‐Shin , Chai Chee‐Yin , Chien Song‐Hsiung , Wang Chien‐Kao
Published: July 2009

Hyalinizing spindle cell tumor with giant rosettes (HSCTGR) is characterized by both giant rosette‐like structures with collagen cores sparsely distributed throughout the tumor and fibromyxoid stroma. It is a rare low‐grade sarcoma with indolent behavior, and wide excision with long‐term follow‐up is the best treatment. Although originally considered a distinct entity, it is now regarded as a variant of low‐grade fibromyxoid sarcoma. We present a case of HSCTGR arising in the deep soft tissue of the left knee in a 50‐year‐old woman and provide a brief review of the literature for comparison.
Intravitreous Recombinant Tissue Plasminogen Activator and Gas to Treat Submacular Hemorrhage in Age‐Related Macular Degeneration
Authors: Tsai San‐Chang , Lin Jane‐Ming , Chen Hsin‐Yi
Published: July 2009

We evaluated the safety and efficacy of intravitreous recombinant tissue plasminogen activator (rTPA) and gas for the treatment of submacular hemorrhage in age‐related macular degeneration (ARMD). From January 2000 to April 2002, we enrolled 15 patients with submacular hemorrhage secondary to ARMD. All patients received 100 μg rTPA and 0.3 mL perfluoropropane intravitreously. Postoperatively, all patients were kept in a supine position for 4 hours followed by a face‐down position for 4 days. Anatomic and functional results were evaluated during a follow‐up period of 6 to 19 months. Submacular blood was completely displaced in 12 patients (80%) and partially in three (20%). Best postoperative visual acuity improved in all 15 eyes; in seven eyes (47%), the improvement was two or more lines. Final visual acuity improved in 12 eyes, remained stable in two eyes, and worsened in one eye. Onset of hemorrhage within 21 days was associated with better gains of lines in best postoperative (p = 0.0256) and final visual acuity (p = 0.044). Although two patients developed mild breakthrough vitreous hemorrhage within 1 day after treatment, no rTPA‐related retinal toxicity was observed. Intravitreous injections of rTPA and gas are safe and effective in improving visual acuity in patients with submacular hemorrhage secondary to ARMD. Although the final visual outcome is often limited by the progression of the disease, significant and stable visual recovery over an extended follow‐up period is possible using this easy and convenient technique.