bluuebunny/crossref_metadata_2025 huggingface dataset:
Demonstration of high‐precision continuous measurements of water vapor isotopologues in laboratory and remote field deployments using wavelength‐scanned cavity ring‐down spectroscopy (WS‐CRDS) technology
Authors: Gupta Priya , Noone David , Galewsky Joseph , Sweeney Colm , Vaughn Bruce H.
Published: July 2009

This study demonstrates the application of Wavelength‐Scanned Cavity Ring‐Down Spectroscopy (WS‐CRDS) technology which is used to measure the stable isotopic composition of water. This isotopic water analyzer incorporates an evaporator system that allows liquid water as well as water vapor to be measured with high precision. The analyzer can measure HO, HO and HD16O content of the water sample simultaneously. The results of a laboratory test and two field trials with this analyzer are described. The results of these trials show that the isotopic water analyzer gives precise, accurate measurements with little or no instrument drift for the two most common isotopologues of water. In the laboratory the analyzer has a precision of 0.5 per mil forδD and 0.1 per mil forδ18O which is similar to the precision obtained by laboratory‐based isotope ratio mass spectrometers. In the field, when measuring vapor samples, the analyzer has a precision of 1.0 per mil forδD and 0.2 per mil forδ18O. These results demonstrate that the isotopic water analyzer is a powerful tool that is appropriate for use in a wide range of applications and environments. Copyright © 2009 John Wiley & Sons, Ltd.
Isotopic characteristics of the Garonne River and its tributaries
Authors: Lambs Luc , Brunet Frédéric , Probst Jean‐Luc
Published: July 2009

The Garonne is the largest river in the south‐west of France, and its drainage basin stretches between the Pyrénées and the Massif Central mountains. Until now, no water stable isotope study has been performed on the whole Garonne river basin which is composed of different geological substrata, and where the water resources are limited during the dry summer period. This study focuses on the Garonne river and its tributaries from the Pyrénées foothill upstream to its confluence with the Lot River downstream. The aim of the study is to determine the origins of the surface waters using their chemical and stable isotopic compositions (18O, D and 13C), to better understand their circulation within the drainage basin and to assess the anthropogenic influences. The Garonne displays a specific 18O seasonal effect, and keeps its Pyrénean characteristics until its confluence with the Tarn River. The difference in the dissolved inorganic carbon (DIC) comes mainly from the change in lithology between the Pyrénées and the Massif Central mountains. Agriculture activity is only detected in the small tributaries. Copyright © 2009 John Wiley & Sons, Ltd.
Molecular turnover time of soil organic matter in particle‐size fractions of an arable soil
Authors: Bol Roland , Poirier Natacha , Balesdent Jérôme , Gleixner Gerd
Published: July 2009

The composition and molecular residence time of soil organic matter (SOM) in four particle‐size fractions (POM >200 µm, POM 63–200 µm, silt and clay) were determined using Curie‐point pyrolysis/gas chromatography coupled on‐line to mass spectrometry. The fractions were isolated from soils, either continuously with a C3 wheat (soil 13C value = −26.4‰), or transferred to a C4 maize (soil 13C value = −20.2‰) cropping system 23 years ago. Pyrograms contained up to 45 different pyrolysis peaks; 37 (ca. 85%) were identifiable compounds. Lignins and carbohydrates dominated the POM fractions, proteins were abundant, but lignin was (nearly) absent in the silt and clay fractions. The mean turnover time (MRT) for the pyrolysis products in particulate organic matter (POM) was generally <15 years (fast C pool) and 20–300 years (medium or slow C pools) in silt and clay fractions. Methylcyclopentenone (carbohydrate) in the clay fraction and benzene (mixed source) in the silt fraction exhibited the longest MRTs, 297 and 159 years, respectively. Plant‐derived organic matter was not stored in soils, but was transformed to microbial remains, mainly in the form of carbohydrates and proteins and held in soil by organo‐mineral interactions. Selective preservation of plant‐derived OM (i.e. lignin) based on chemical recalcitrance was not observed in these arable soils. Association/presence of C with silt or clays in soils clearly increased MRT values, but in an as yet unresolved manner (i.e. ‘truly’ stabilized, or potentially still ‘labile’ but just not accessible C). Copyright © 2009 John Wiley & Sons, Ltd.
Study of mineral water resources from the Eastern Carpathians using stable isotopes
Authors: Magdas Dana A. , Cuna Stela M. , Berdea Petre , Balas Gabriela , Cuna Cornel , Dordai Edina , Falub Mihaela C.
Published: July 2009

The Eastern Carpathians contain many mineral water springs that feed famous Romanian health resorts such as Borsec, Biborteni and Vatra Dornei. These waters have been used for their different therapeutic effects. In this work, mineral and spring waters from these Romanian regions were investigated by means of chemical and isotopic (δD and δ18O) analyses in order to understand the recharge mechanisms and also to determine their origins. Most of the investigated springs are of meteoric origin, having the average deuterium content of the local meteoric water. The higher 18O content with respect to the Meteoric Water Line (MWL) indicated an exchange reaction with crystalline igneous rocks at depth and with other rocks that the water encounters on its journey back to the surface. Copyright © 2009 John Wiley & Sons, Ltd.
A process algebraic framework for specification and validation of real-time systems
Authors: Sherif Adnan , Cavalcanti Ana , Jifeng He , Sampaio Augusto
Published: July 2009

Following the trend to combine techniques to cover several facets of the development of modern systems, an integration of Z and CSP, calledCircus, has been proposed as a refinement language; its relational model, based on the unifying theories of programming (UTP), justifies refinement in the context of both Z and CSP. In this paper, we introduceCircus Time, a timed extension ofCircus, and present a new UTP time theory, which we use to give semantics toCircus Timeand to validate some of its laws. In addition, we provide a framework for validation of timed programs based on FDR, the CSP model-checker. In this technique, a syntactic transformation strategy is used to split a timed program into two parallel components: an untimed program that uses timer events, and a collection of timers. We show that, with the timer events, it is possible to reason about time properties in the untimed language, and so, using FDR. Soundness is established using a Galois connection between the untimed UTP theory ofCircus(and CSP) and our time theory.
Generating certified code from formal proofs: a case study in homological algebra
Authors: Aransay Jesús , Ballarin Clemens , Rubio Julio
Published: July 2009

We apply current theorem proving technology to certified code in the domain of abstract algebra. More concretely, based on a formal proof of the
Basic Perturbation Lemma
(a central result in homological algebra) in the prover Isabelle/HOL, we apply various code generation techniques, which lead to certified implementations of the associated algorithm in ML. In the formal proof, algebraic structures occurring in the Basic Perturbation Lemma are represented in a way, which is not directly amenable to code generation with the available tools. Interestingly, this representation is required in the proof, while for the algorithm simpler data structures are sufficient. Our approach is to establish a link between the non-executable setting of the proof and the executable representation in the algorithm, which is to be generated. This correspondence is established within the logical framework of Isabelle/HOL—that is, it is formally proved correct. The generated code is applied to and illustrated with a number of examples.
Healing of Stoma Orifices: Multicenter, Prospective, Randomized Study Comparing Calcium Alginate Mesh and Polyvidone Iodine Mesh
Authors: Brehant Olivier , Pessaux Patrick , Regenet Nicolas , Tuech Jean Jacques , Panaro Fabrizio , Mantion Georges , Tassetti Vincent , Lehur Paul Antoine , Arnaud Jean Pierre
Published: July 2009

Background

The aim of this multicenter, randomized, prospective study was to reveal a difference in terms of a guided healing period in the case of stoma orifices after reestablishing digestive continuity by comparing an alginate mesh with a polyvidone iodine mesh.

Methods

Between April 2004 and September 2005, a total of 73 patients were randomized into two groups: A (alginate mesh) and M (polyvidone iodine mesh). The groups were comparable for demographic data, indications for and the type of stoma, and perioperative data. The main evaluation criterion was percentage healing at the 28th postoperative day (D28); and the secondary criteria were healing time, rate of infectious complications, and number of dressing changes applied.

Results

The mean percentage healing at D28 was 91% in group A and 87% in group M (p = 0.49). The mean healing time was 31 days in group A and 32 days in group M (p = 0.80). One parietal abscess (3%) occurred in group A (p = 0.37). The mean number of meshes used was 13 ± 5 in group A and 18 ± 8 in group M (p < 0.005).

Conclusion

The use of an alginate mesh for guided healing of stoma orifices after reestablishing digestive continuity allows effective healing within a normal period of time with a lower number of meshes.
An Evaluation of Morbidity and Mortality in Oncologic Gastric Surgery with the Application of POSSUM, P‐POSSUM, and O‐POSSUM
Authors: Luna Alexis , Rebasa Pere , Navarro Salvador , Montmany Sandra , Coroleu David , Cabrol Joan , Colomer Oscar
Published: July 2009

Objective

Evaluation of surgical results observed in oncologic gastric surgery with reference to estimation of risks through POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity), P‐POSSUM (Portsmouth POSSUM), and O‐POSSUM (regression model based on the POSSUM and P‐POSSUM, especially designed for gastric and esophagus surgery).

Methods

A prospective follow‐up of a cohort of 106 consecutive patients, gastrectomized because of gastric cancer. The variables studied were: age, sex, technical surgery, American Society of Anesthesiologists (ASA) score, the Charlson comorbidity index, morbidity, and mortality.

Results

From January 2004 to April 2008, 131 patients were operated on for gastric neoplasia. Of these, 28 patients were excluded: 5 because of nonstandard gastrectomy, 17 because of staging laparoscopy or unresectable cancer after laparotomy, and 3 because of palliative gastroenteroanastomosis; 106 patients were included. We performed 38 total gastrectomies, 65 distal gastrectomies, 2 esophagogastrectomies, and 1 proximal gastrectomy. The mean age was 68 years (standard deviation (SD) = 12.1; range, 34–85 years). Associated comorbidity (Charlson) was 5.4 (SD = 2.7; range, 2–16); ASA 1 at 1.9%; ASA 2 at 36.8%; ASA 3 at 43.4%; and ASA 4 at 17.9%. Expected morbidity, according to POSSUM was 46.7%; observed morbidity was 50.5%. Morbidity ratio observed/expected was 1.08. Expected mortality, according to POSSUM = 13%, according to P‐POSSUM = 4.9%, and according to O‐POSSUM = 12.1%. Observed mortality was 7.8%. Mortality ratio observed/expected according to POSSUM, P‐POSSUM, O‐POSSUM was 0.6, 1.6, and 0.6, respectively. Morbidity results were within the confidence interval of the POSSUM estimation. Our results show lower mortality than the POSSUM and the O‐POSSUM estimation (P < 0.001) and higher mortality regarding P‐POSSUM estimation (P < 0.001).

Conclusions

The control systems of risk allow us continuous evaluation of our results and objective comparison to other teams. Compared with the POSSUM scoring systems, our series showed quality improvement (morbidity and mortality) over time.
Surgical Education in Mexico
Authors: Cervantes Jorge
Published: July 2009

Surgical education in Mexico basically follows the same model as in the United States, with a selection process resembling the matching program. There is a 4‐year training period during which residents in their third year spend 4 months as the sole surgeon in a rural community. During the senior year they are entitled to an elective period in a place of their choosing. After completion of the 4 years, residents have to present a thesis and undergo an oral examination before getting a university diploma. They are then encouraged to pass the written and oral examination of the Mexican Board of Surgery before they are fully certified to enter practice in a public or private hospital.
Factors Related to Preoperative Assessment of the Circumferential Resection Margin and the Extent of Mesorectal Invasion by Magnetic Resonance Imaging in Rectal Cancer: A Prospective Comparison Study
Authors: Kim Young‐Wan , Cha Seung‐Whan , Pyo Juyon , Kim Nam‐Kyu , Min Byung‐Soh , Kim Myeong‐Jin , Kim Hoguen
Published: July 2009

Background

This study was designed to identify factors related to inaccurate prediction of circumferential resection margin (CRM) and the extent of mesorectal invasion (EMI) in T3 tumors by preoperative magnetic resonance imaging (MRI) in rectal cancer.

Methods

A total of 66 patients with rectal cancer were enrolled prospectively in this study. CRM was defined as the distance from the outer tumor margin to the mesorectal fascia, and EMI was defined as the distance from the outer surface of the muscularis propria to the outermost tumor margin. CRM and EMI measurements on MRI were compared with corresponding measurements from whole‐mount sections using 1‐mm and 5‐mm reference values, respectively, as prognostic indicators. The following variables were analyzed for relevance to preoperative staging: tumor distance from the anal verge (lower and middle), tumor location (anterior and posterior), tumor (T) and nodal (N) stage, and the thickness of the perirectal fat (anterior, left, right, and posterior positions).

Results

MRI correctly predicted CRM status in 57 of the 66 tumors and EMI status in 51 of the 58 tumors (eight T1 tumors were excluded from EMI analysis). Univariate analysis showed that T3 stage, lymph node involvement, anterior tumor location, and thin perirectal fat thickness at the anterior portion were related to incorrect prediction of CRM. Anterior tumor location and thin perirectal fat thickness at the anterior portion were related to incorrect prediction of EMI.

Conclusions

Preoperative chemoradiation can be accurately guided by preoperative MRI staging, but CRM and EMI in anterior rectal tumor should be interpreted with caution.
Rainfall extremes explain interannual shifts in timing and synchrony of calving in topi and warthog
Authors: Ogutu Joseph O. , Piepho Hans‐Peter , Dublin Holly T. , Bhola Nina , Reid Robin S.
Published: July 2009

We tested the hypothesis that ungulates time and synchronize births to match gestation and lactation with peak food availability and quality in seasonal environments, using ground counts of topi and warthog conducted over 174 months (July 1989–December 2003) in the Mara–Serengeti ecosystem. During this 15‐year period, 2,725 newborn and 45,574 adult female topi and 933 newborn and 7,831 adult warthogs were recorded. Births were distinctly synchronized in both species but far less so than in ungulates in temperate regions. Extreme droughts delayed onset and reduced synchrony of calving and natality rates but high rainfall advanced onset and increased synchrony of calving and natality rates in both species, supporting the seasonality hypothesis. Annual shifts in birth peaks were significantly negatively correlated with the preceding wet season rainfall. Varying the timing and synchrony of births and natality rates are widespread but little understood adaptations of ungulates to climatic extremes. Climate change heightens the need for advancing this understanding because increasing frequency and severity of droughts is likely to decouple phenology of breeding in seasonally breeding ungulates from that in their food plants. Similar studies of African ungulates are either extremely rare or non‐existent. New approaches to estimating the time of peak births and its confidence limits and the degree of synchrony of breeding are also presented.
Demographic and Financial Analysis of EMTALA Hand Patient Transfers
Authors: Melkun Edward T. , Ford Christian , Brundage Susan I. , Spain David A. , Chang James
Published: July 2009

In the United States, the Emergency Medical Treatment and Active Labor Act (EMTALA) effectively requires Level I trauma centers to accept hand trauma transfers for higher level of care if capacity exists. However, patient transfer for non-medical reasons, such as ability to pay, is still perceived as a common practice. We hypothesized that EMTALA would cause selective transfer of hand patients who were underinsured or uninsured, thus, effectively burdening a Level I trauma center. A dedicated transfer center documented the demographics and outcomes of all calls for hand trauma transfers from December 2003 to September 2005. This data registry was reviewed for age, gender, race, insurance status, and length of hospital stay. This data was compared with direct admissions to the emergency room for hand emergencies during that same time period. During the 2-year time period, a total of 151 calls for EMTALA transfer were received for hand emergencies. Our institution accepted 92 of these patients for transfer. Reasons for not accepting transfer included lack of bed availability and unavailability of the on-call surgeon due to other emergency operative cases. Compared with hand emergency patients brought directly to our emergency department during the same time period, transferred patients were younger and had a shorter length of stay. Interestingly, they were very similar in terms of sex, race, and insurance status. These data suggest that the primary motivations for EMTALA hand trauma transfers are truly complexity of patient care and specialist availability. Given the often urgent nature of hand trauma surgery and the limited resources available, expansion and development of hand and microsurgery regional centers will be vital to adequately meet demand without overburdening existing centers.
Bioconjugates of Glucose Oxidase and Gold Nanorods Based on Electrostatic Interaction with Enhanced Thermostability
Authors: Ma Zhanfang , Ding Teng
Published: July 2009

Bioconjugates made up of an enzyme and gold nanorods (GNRs) were fabricated by electrostatic interactions (layer-by-layer method, LBL) between anionic glucose oxidase (GOD) and positively charged GNRs. The assembled processes were monitored by UV–Vis spectra, zeta potential measurements, and transmission electron microscopy. The enzyme activity assays of the obtained bioconjugates display a relatively enhanced thermostability behavior in contrast with that of free enzyme. Free GOD in solution only retains about 22% of its relative activity at 90 °C. Unexpectedly, the immobilized GOD on GNRs still retains about 39.3% activity after the same treatment. This work will be of significance for the biologic enhancement using other kinds of anisotropic nanostructure and suggests a new way of enhancing enzyme thermostability using anisotropic metal nanomaterials.
Effect of Aspirin and Indomethacin on Prostaglandin E2 Synthesis in C6 Glioma Cells
Authors: Hwang Shiuh‐Lin , Lee Kung‐Shing , Lin Chih‐Lung , Lieu Ann‐Shung , Cheng Chi‐Yun , Loh Joon‐Khim , Hwang Yan‐Fen , Su Yu‐Feng , Howng Shen‐Long
Published: July 2009

Prostaglandin E2 (PGE2) plays an important role in immunosuppression and tumor growth. PGE2 inhibitors such as aspirin and indomethacin suppress experimental tumor growth. Little is known of the relationship between PGE2 synthesis in brain tumors and the dose of aspirin or indomethacin. The present study was undertaken to evaluate the effect of different doses of aspirin and indomethacin on PGE2 synthesis in C6 glioma cells. C6 glioma cells were incubated with different concentrations (2, 4, and 8 μM) of aspirin and indomethacin for 1, 2, 4, 6, 8, 12, and 24 hours. Intracellular PGE2 concentration was measured by enzyme immunoassay. Each concentration of aspirin and indomethacin effectively inhibited PGE2 synthesis. Concentrations of 2, 4, and 8 μM of aspirin significantly inhibited PGE2 production at 6, 4, and 1 hours, respectively, and the inhibition persisted for more than 24 hours (p < 0.05). Concentrations of 2 and 4 μM of indomethacin were effective at 4 and 2 hours (p < 0.05), respectively. However, inhibition was not observed beyond 12 hours (p > 0.05). Indomethacin 8 μM was effective at 1 hour and the inhibition persisted beyond 24 hours (p < 0.05). Our study demonstrates that aspirin and indomethacin inhibit PGE2 synthesis in C6 glioma cells and that low‐dose aspirin is as effective as high‐dose aspirin. This study may encourage future clinical use of low‐dose aspirin in the prevention or treatment of brain tumors.
Comparative Study of Early Childhood High‐Function Autism and Developmental Mixed Receptive‐Expressive Language Disorder
Authors: Yang Pinchen , Chen Cheng‐Sheng , Jong Yuh‐Jyh , Hsu Hsiu‐Yi
Published: July 2009

Verbal cognitive profile and general social functioning were compared between two groups of children aged 5 to 7 years, one with high‐function autism and the other with developmental mixed receptive‐expressive language disorders. The two groups, totaling 50 children, were matched for age and non‐verbal IQ (mean, 90). Both groups had impaired verbal cognitive profile and social adaptive functioning, with no statistically significant differences between the two groups. The implications of our findings are discussed. Current preschool and early childhood medical‐educational intervention programs in Taiwan must design and implement curricula in which children with language delay, whether autistic or not, can develop essential social skills.
Factors Related to Stress in Outpatients with Permanent Colostomies
Authors: Tseng Hui‐Chen , Wang Hsiu‐Hung , Hsu Yun‐Yun , Weng Wei‐Che
Published: July 2009

The main purpose of this study was to explore factors related to stress in outpatients with permanent colostomies, using a convenience sample. Subjects were selected from one medical center in southern Taiwan. The Stress of Colostomy Patients Scale and demographic data were collected using questionnaires either at the colorectal outpatient department or in the home of colostomy patients. Seventy‐three subjects with colostomies participated in the study. Other diseases and caregivers of colostomy patients influenced overall stress in outpatients with permanent colostomies. The five major stressors were: “I have urination problems”; “I feel tired easily owing to physical decline”; “I can't travel freely because of my colostomy”; “I worry about recurrence of the disease”; and, “I suffer from insomnia”. This study provides important information for assessing the stress level of outpatients with permanent colostomies and for developing nursing assessment tools for colostomy patients. To alleviate the overall stress of colostomy patients and to help them return to the activities of daily living before the operation, health care professionals could design individual nursing care plans based on data from assessment tools.
Significant Prognostic Factors for Vogt‐Koyanagi‐Harada Disease in the Early Stage
Authors: Sheu Shwu‐Jiuan , Kou Hsi‐Kung , Chen Jane‐Fang
Published: July 2009

This study identified possible prognostic signs in the acute stage of Vogt‐Koyanagi‐Harada (VKH) disease in a retrospective chart review of all patients diagnosed with VKH disease between 1991 and 2001. Those who were diagnosed more than 1 month after the onset of ocular symptoms were excluded. Data recorded included age, sex, clinical features, systemic manifestations, recurrence, treatment, complications, and final visual acuity. Exudative retinal detachment was ranked into 3 grades (grade 1: within peripapillary 3 disc diameters and arcade; grade 2: larger than grade 1 but no inferior retinal detachment; grade 3: inferior or total retinal detachment). Of the 31 patients, 19 were males and 12 were females. Mean age at presentation was 38.55 % 10.63 years. The mean follow‐up period was 33.09 months. Extraocular manifestations were present in 17 cases. Four patients had at least one complication, including cataract in seven eyes and glaucoma in one eye. Forty‐nine eyes (79%) had a final visual acuity of 6/12 or better. Final visual acuity was significantly better in younger patients (p = 0.023) and those who had less extensive retinal detachment (p = 0.006), no pigmentary change (p = 0.008) and no complications (p = 0.030). The visual prognosis of VKH disease is variable, though generally favorable. In the acute stage, the extent of retinal detachment may be an important risk factor for visual outcome. Further study of this factor as an indicator for treatment is necessary.
Serum Concentration of Soluble Decoy Receptor 3 in Glioma Patients Before and After Surgery
Authors: Hwang Shiuh‐Lin , Lin Chih‐Lung , Cheng Chi‐Yun , Lin Frank Art , Lieu Ann‐Shung , Howng Shen‐Long , Lee Kung‐Shing
Published: July 2009

The suppression of immune responses in malignant gliomas is thought to be involved in glioma pathogenesis. The newly identified tumor‐secreted soluble decoy receptor 3 (DcR3) can bind to the ligands CD95L and LIGHT, thereby neutralizing their pro‐apoptotic actions. Little is known of the production of DcR3 by glioma cells. This study investigated the serum concentration of DcR3 in glioma patients before and after tumor removal. Blood samples were taken from 17 glioma patients and 10 control patients. The serum DcR3 concentration was measured using a DcR3 enzyme‐linked immunosorbent assay. There was no statistically significant difference between preoperative (0.069 % 0.027 ng/mL) and postoperative DcR3 concentrations (0.068 % 0.022 ng/mL; p = 0.951). Similarly, there was no difference in preoperative DcR3 concentration between glioma patients (0.069 % 0.027 ng/mL) and controls (0.063 % 0.023 ng/mL; p = 0.106). Our study demonstrated no alteration in DcR3 concentration in glioma patients before and after tumor removal.
Pure Red Cell Aplasia After ABO Major‐Mismatched Allogeneic Peripheral Blood Stem Cell Transplantation Successfully Treated with Plasma Exchange and Low‐Dose Steroid: Two Case Reports
Authors: Tsai Hui‐Jen , Lin Sheng‐Fung , Liu Ta‐Chih , Chang Chao‐Sung , Hsiao Hui‐Hua , Chen Tyen‐Po
Published: July 2009

Pure red cell aplasia (PRCA) is a complication of ABO‐incompatible allogeneic stem cell transplantation. The mechanism is not well known, although the isoagglutinin titer before transplantation or cyclosporine use is considered to be the cause. Patients with this complication require more blood transfusions than those without it. There is no standard treatment. We report two cases of PRCA after allogeneic peripheral blood stem cell transplantation that were successfully treated with plasma exchange and low‐dose steroid.
Schwannoma of the Nasal Septum: A Case Report
Authors: Wang Ling‐Feng , Tai Chih‐Feng , Ho Kuen‐Yao , Kuo Wen‐Rei , Chai Chee‐Yin
Published: July 2009

Schwannoma is a neurogenic tumor arising from the sheath of myelinated nerves. Only 4% of schwannomas located in the head and neck region involve the sinonasal tract, and those arising from the nasal septum are exceedingly rare. We report a case of a 55‐year‐old male who presented with only right nasal obstruction. Computerized tomography and clinical examination suggested a benign tumor before the tumor was completely removed by transnasal endoscopic surgery. When encountering a mass in the nasal cavity, schwannoma should be borne in mind in the differential diagnosis. We discuss the clinical presentation, histologic features, differential diagnosis, and therapeutic options for such a rare lesion.
Perceived Enactment of Autonomy and Related Sociodemographic Factors Among Non‐Institutionalized Elders
Authors: Hwang Huei‐Lih , Lin Huey‐Shyan
Published: July 2009

The purpose of this study was to assess empirical data on the perceived enactment of autonomy (PEA), Chinese version, and to explore factors related to PEA among non‐institutionalized elderly. A purposive sample of 165 subjects older than 65 years was recruited in Kaohsiung in southern Taiwan. Five subjects failed to answer their questionnaires completely; the total effective sample was thus 160. Questionnaires and interviews were used to collect data. The structured questionnaire consisted of two parts, assessing sociodemographic information and the PEA scale, Chinese version. Subjects had a high PEA score (mean, 3.38), with the greatest score in individuality (mean, 3.54), followed by self‐direction (mean, 3.49) and freedom (mean, 3.16). Multiple regression analysis showed that the need for assistance in activities of daily living (b = −0.62), overall health status (b = 0.20), marital status (b = 0.14), and age (b = −0.13) significantly affected PEA in these elderly subjects and explained 61.9% of the total variance of PEA in this population. Based on these results, we provide substantive suggestions to practitioners and researchers. Possible future studies could expand the sample size using a random sampling method or examine factors related to PEA in order to learn more about PEA and apply it to clinical practice.
Correlates for Consistency of Contraceptive Use Among Sexually Active Female Adolescents
Authors: Wang Ruey‐Hsia , Jian Shu‐Yuan , Hsu Hsiu‐Yueh
Published: July 2009

This study explored the correlates for consistency of contraceptive use among sexually active female adolescents in Kaohsiung County, Taiwan. Overall, 164 female adolescents who had engaged in sexual behavior within the last 6 months and were not pregnant at the time of the study were selected from two vocational high schools in Kaohsiung County, Taiwan. An anonymous questionnaire was used to measure demographic data, contraceptive attitudes, contraceptive knowledge, contraceptive self‐efficacy, perception of peers' use of contraceptives, sexual history, and contraceptive use. The results showed that 45.7% of subjects had sex once or more per week, and that 39.6% of subjects always used contraceptives while 15.2% never used contraceptives. Condoms were the most popular contraceptives (51.2%) and the withdrawal method was the second most popular (23.8%). Stepwise logistic regression showed that higher contraceptive attitudes (odds ratio, OR, 1.148) and previous contraceptive education in school (OR, 3.394) increased the probability of consistently using contraceptives, correctly classifying 67.2% of the sample.
Prevalence of Pediculus Capitis Infestation Among School Children of Chinese Refugees Residing in Mountainous Areas of Northern Thailand
Authors: Fan Chia‐Kwung , Liao Chien‐Wei , Wu Ming‐Shuan , Hu Neng‐Yeou , Su Kua‐Eyre
Published: July 2009

An epidemiologic survey of Pediculus capitis infestation among Akka aboriginal and Han children of Chinese refugees living in mountainous areas at elevations of 1,100 to 1,400 m in Chiang‐Rai Province of northern Thailand was conducted during January 2003. Of the 303 children examined, 43 (14.2%) had P. capitis infestation. The overall infestation rate for P. capitis in Akka children (29.3%, 12/41) was significantly higher than that in Han children (11.8%, 31/262; c2 = 8.161, p = 0.002). The prevalence in Akka (52.2%, 12/23) and Han girls (19.7%, 31/157) was higher than that in Akka (0%) and Han boys (0%), respectively (p < 0.001), and the prevalence was higher in Akka girls than in Han girls (c2 = 10.978, p = 0.001). The high prevalence of P. capitis infestation among these girls was possibly due to poor environmental hygiene and unavailability of sufficient water.
Third Ventricle Immature Teratoma: A Case Report
Authors: Yang Jiao‐Chiao , Huang Jing‐Shan
Published: July 2009

We present the case of a 1‐year‐old girl with persistent vomiting who was found to have a disproportionately large immature teratoma in the third ventricle. Magnetic resonance imaging demonstrated a heterogeneous intracranial mass in the third ventricle, with a compressed left cerebral hemisphere and hydrocephalus. Bifrontal craniotomy via a transchiasmatic approach achieved total resection of the tumor. No significant neurologic deficit was seen except for double vision and disturbances in eye movement. Third ventricle immature teratoma, although extremely rare, may present as a suprasellar mass lesion and hydrocephalus. The prognosis after gross total resection is favorable; however, radiotherapy is usually postponed until 36 to 48 months of age in order to avoid complications such as stunted growth, endocrine disturbances and neuropsychologic problems.
Cutaneous Manifestations of Human Immunodeficiency Virus Infection in Taiwan
Authors: Tzung Tien‐Yi , Yang Chia‐Yi , Chao Sheau‐Chiou , Lee J. Yu‐Yun
Published: July 2009

Cutaneous manifestations are common and often the presenting feature of human immunodeficiency virus (HIV) infection, but a comprehensive study of HIV‐associated skin lesions is not available in Taiwan. We reviewed all skin lesions in all HIV patients diagnosed in our department between 1990 and 1998 to document the spectrum of skin manifestations, the frequency of each disorder, and their relationship with CD4 counts. A total of 64 HIV patients were studied, including 38 with acquired immunodeficiency syndrome (AIDS) (CD4 < 200 × 106 cells/L) and 26 who had not developed AIDS (non‐AIDS). There were 142 episodes of skin conditions representing 25 different skin diseases, including oral candidiasis (15% in non‐AIDS vs 71% in AIDS patients), drug eruptions, herpes simplex, seborrheic dermatitis, dermatophytosis, herpes zoster, secondary syphilis, condyloma acuminatum, Kaposi's sarcoma (16% among AIDS patients), hairy leukoplakia, and molluscum contagiosum (13% among AIDS patients), in decreasing order. Several unusual cases are briefly described, including verrucous herpes infection, condyloma‐like molluscum contagiosum, and AIDS‐associated pigmented erythroderma. In our study, 70% of all HIV patients had skin diseases, with an average of 2.2 conditions per patient (3.2 in AIDS patients vs 0.7 in non‐AIDS patients; p < 0.001). A broad spectrum of HIV‐associated skin diseases was observed in our series. The frequency of HIV‐associated skin disease was 92% in AIDS patients and 39% in non‐AIDS patients; 78% of skin lesions in AIDS patients were diagnosed when CD4 counts were below 100 × 106 cells/L.
Impact of National Health Insurance on the Survival Rate of Patients with Osteosarcoma In Taiwan: Review of 74 Patients
Authors: Poon Kein‐Boon , Chien Song‐Hsiung , Lin Gau‐Tyan , Wang Gwo‐Jaw
Published: July 2009

The 2‐year survival rate for high‐grade osteosarcoma was 46.9% before the introduction of National Health Insurance (NHI) in Taiwan on March 1, 1995, but increased to 73.8% after the implementation of NHI. The 5‐year survival rate also increased, from 37.5% to 63.6%. Between May 1990 and May 2001, 74 patients with high‐grade osteosarcoma were treated at our hospital. Median age was 17 years (range, 7‐63 years). Inadequate surgical margins, poor histologic response to chemotherapy, advanced stage of disease, and incomplete treatment were strongly associated with poor prognosis. Before NHI, 10 patients had incomplete treatment, mainly because of unaffordable medical fees. After NHI, only three patients had incomplete treatment, due to personal reasons. Patient survival improved dramatically with advances in multiagent chemotherapy, but it was the NHI that enabled patients to complete expensive treatment courses, including preoperative neoadjuvant chemotherapy, limb‐salvage surgery, and postoperative adjuvant chemotherapy. The NHI also improved the accessibility of medical care, with more patients presenting in the early stages of disease and, as a result, it not only improved survival rate but also increased the number of patients undergoing limb‐salvage surgery. We concluded that the NHI significantly improved the survival rate for patients with osteosarcoma in Taiwan.
Ventricular Septal Rupture After Early Successful Thrombolytic Therapy in Acute Myocardial Infarction: A Case Report
Authors: Su Ho‐Ming , Voon Wen‐Chol , Lin Ching‐Chang , Lin Tsung‐Hsien , Lai Wen‐Ter , Sheu Sheng‐Hsiung , Chen Ying‐Fu
Published: July 2009

Ventricular septal defect (VSD) is a severe complication of acute myocardial infarction and has a high mortality rate. This complication appears to have declined in the reperfusion era. It has mostly been reported in elderly or female patients who suffer from anterior wall infarction, patients with multivessel coronary artery disease (CAD) or occluded infarct‐related artery (IRA) without collateral circulation, or patients who have had delayed reperfusion therapy. Here, we report the case of a 60‐year‐old male patient who presented with persistent chest pain and Killip I ST‐segment‐elevation myocardial infarction. Thrombolytic therapy was started 3 hours after the onset of chest pain. Based on the subsidence of chest pain, resolution of the elevated ST segment, and early peak of cardiac enzymes, reperfusion was thought to be successful. However, on the third day of admission, the patient complained of dyspnea after defecation and was found to have new‐onset grade 3 pansystolic murmur over the left sternal border. Cardiac echography showed an apical VSD. A Swan‐Ganz catheter was inserted into the right side of the heart; analysis of blood oxygen saturation revealed a 6% step‐up of oxygen in the right ventricle. Coronary angiography showed only one‐vessel CAD and TIMI 3 flow in the IRA. The patient received intensive medical management and underwent VSD repair and internal mammary artery bypass grafting to the left anterior descending artery. His recovery was uneventful. This case illustrates that VSD can be found in patients receiving early successful reperfusion therapy, with one‐vessel CAD, and TIMI 3 flow in the IRA.
Giant Lipoma of Spermatic Cord Mimics Irreducible Inguinal Hernia: A Case Report
Authors: Chang Yu‐Tang , Huang Che‐Jen , Hsieh Jan‐Sing , Huang Tsung‐Jen
Published: July 2009

Inguinal herniorrhaphy is the most common general surgical operation performed. Although fatty protrusions are often observed along the path of the spermatic cord, true lipomas are not commonly reported. We encountered a 42‐year‐old male patient who developed a large lipoma of the right spermatic cord with indirect inguinal hernia. After herniorrhaphy and tumor excision, the patient had an uneventful convalescence. There has been no recurrence up to the time of writing (20 months).
In Vitro Activities of Antibiotic Combinations Against Clinical Isolates of Pseudomonas Aeruginosa
Authors: Chen Yen‐Hsu , Lu Po‐Liang , Tsai Jih‐Jin , Chen Tyen‐Po , Peng Chien‐Fang
Published: July 2009

Combination therapy has been recommended to treat Pseudomonas aeruginosa infections worldwide. The purpose of the present study was to determine the in vitro activities of piperacillin, cefepime, aztreonam, amikacin, and ciprofloxacin alone and in combination against 100 clinical isolates of P. aeruginosa from one medical center in southern Taiwan. The combination susceptibility assay was performed using the checkerboard technique. The percentage of resistance of P. aeruginosa to single agents in our study was relatively high for the Asia‐Pacific area, except to aztreonam. Piperacillin plus amikacin exhibited the highest potential for synergy (59/100) in this study. Moreover, a high percentage of synergism was also noted with amikacin combined with cefepime (7/100) or aztreonam (16/100). The combination of two beta‐lactams, such as cefepime with piperacillin, and aztreonam with cefepime or piperacillin, showed synergistic effects against some P. aeruginosa isolates. Although ciprofloxacin is a good anti‐pseudomonal agent, a very low potential for synergy with other antibiotics was demonstrated in this study. No antagonism was exhibited by any combination in our study. Among piperacillin‐resistant strains, there was synergy with a beta‐lactam plus amikacin, including the combination of piperacillin and amikacin. However, the combination of two beta‐lactams, such as piperacillin and cefepime or aztreonam, did not have any synergistic activity against these strains. In summary, the combinations of amikacin with the tested beta‐lactams (piperacillin, aztreonam, cefepime) had a greater synergistic effect against P. aeruginosa, even piperacillin‐resistant strains, than other combinations. Understanding the synergistic effect on clinical strains may help clinicians choose better empirical therapy in an area with high prevalence of multidrug‐resistant P. aeruginosa.
Molecular and Histopathologic Evidence for Systemic Infection by Mycobacterium Bovis in A Patient with Tuberculous Enteritis, Peritonitis, and Meningitis: A Case Report
Authors: Wei Cheng‐Yu , Chou Wen‐Jen , Hsu Yung‐Hsiang , Lee Chan Ping , Tsao Wen‐Long
Published: July 2009

Mycobacterium bovis infection has been reported in several patients with AIDS in other countries. The prevalence of tuberculosis in Taiwan is higher than the World Health Organization standard. However, reports of M. bovis infection are rare. A 47‐year‐old male had the habit of drinking uncooked fresh deer's blood and unpasteurized deer's milk. He suffered from acute abdominal pain and underwent emergency laparotomy. Pathology demonstrated tuberculosis enteritis with colon perforation. The molecular diagnosis by nested polymerase chain reaction assay and single‐strand conformation polymorphism assay showed M. bovis infection in the small intestine, mesenteric lymph nodes, and cerebrospinal fluid (CSF). Our results suggest that the most likely portal of entry of M. bovis is the gastrointestinal rather than the respiratory tract. Ingested M. bovis from unpasteurized deer's milk probably entered the mucosal macrophages of the intestine and then the draining mesenteric lymph nodes. As immunity declined, bacilli from the mesenteric lymph nodes disseminated to other organs and into the CSF.
Citalopram‐induced Serotonin Syndrome: A Case Report
Authors: Tseng Wu‐Pin , Wu Ming‐Tsang , Huang Chia‐Tsuan , Liu Hong‐Wen , Tsai Jui‐Hsiu
Published: July 2009

Serotonin syndrome is a disorder resulting from excess stimulation of serotonin and is associated with drug interaction, single‐drug therapy, and overdose. We report a case involving a 32‐year‐old man who developed sudden agitation, diaphoresis, subjective fever, tremor, and insomnia. These symptoms were related to doubling the dose of citalopram in combination antidepressant therapy. Discontinuation of the agent resulted in early notable clinical resolution after 1 week. This is a rare report of serotonin syndrome induced by citalopram polytherapy. Although serotonin syndrome is rare, clinicians need to recognize it early.
Facial Cellulitis Arising from Dens Evaginatus: A Case Report
Authors: Chen Chun‐Ming , Lee Kun‐Tsung , Chuang Fu‐Hsiung , Hong Yi‐Yuh , Chen Hsiu‐Chuan , Hsu Kun‐Rong , Wu Yi‐Min , Lee Huey‐Er
Published: July 2009

Dens evaginatus is a developmental anomaly that produces a tubercle on the occlusal surface of a tooth. It is found most frequently in the mandibular premolars. The occlusal tubercle easily causes occlusal interferences. Attrition or fracture of the tubercle can lead to pulpitis, pulp necrosis, periapical pathosis, and periapical infection. This case report illustrates the treatment of facial cellulitis arising from dens evaginatus with open apex. Calcium hydroxide was used for the apexification procedure. One year after canal obturation, radiography revealed no apical pathosis and the apical seal was evident.
Pharmacokinetics of Ketorolac Pentyl Ester, a Novel Ester Derivative of Ketorolac, in Rabbits
Authors: Tzeng Jann‐Inn , Su Wan‐Li , Chu Chin‐Chen , Shieh Ja‐Ping , Wang Jhi‐Joung , Chu Koung‐Shing , Cheng Kuang‐I
Published: July 2009

Ketorolac is a potent nonsteroidal anti‐inflammatory drug. Recently, a novel ester of ketorolac, ketorolac pentyl ester, was synthesized. When prepared in injectable oil, the new agent demonstrated a long duration of action. Ketorolac pentyl ester was synthesized using a prodrug design by esterification of ketorolac, and appeared to be a prodrug of ketorolac in vivo, which needed to be confirmed. The aim of the present study was to establish the prodrug's pharmacokinetics in vivo, and to confirm whether or not ketorolac pentyl ester was a prodrug of ketorolac. Pharmacokinetic profiles of intravenous ketorolac and its pentyl ester on an equal‐molar basis in six rabbits were evaluated. A high‐performance liquid chromatographic method was used to determine the plasma concentrations of ketorolac and its pentyl ester. We found that the plasma concentrations of ketorolac pentyl ester declined rapidly after injection and so did the conversion of ketorolac pentyl ester to ketorolac. Also, the conversion of ketorolac was proved complete when compared with intravenous ketorolac under an equi‐molar basis. In conclusion, this in vivo pharmacokinetic study confirmed that keterolac pentyl ester was a prodrug of keterolac.
Primary Intrarenal Lipoma: A Case Report
Authors: Ke Hung‐Lung , Hsiao Hsi‐Lin , Huang Chun‐Hsiung , Wu Wen‐Jeng , Guh Jinn‐Yuh , Liu Chiang‐Shin
Published: July 2009

Fat‐containing tumors of the kidneys are not uncommon, but primary intrarenal lipomas are extremely rare, with only 19 documented cases reported to date. In most cases, total nephrectomy is performed. We report on a 71‐year‐old man with the complaint of epigastralgia. Series image studies revealed a high fat‐containing tumor with low vascularity arising from the lower pole of the left kidney. We performed partial nephrectomy, and the subsequent pathology report revealed a pure lipoma.
Status Epilepticus as an Initial Presentation of Brugada Syndrome: A Case Report
Authors: Huang Chen‐Chiu , Chen Tien‐Wen , Lin Feng‐Chen , Huang Mao‐Hsiung
Published: July 2009

Patients presenting with convulsions are sometimes incorrectly treated for epilepsy, as these symptoms may be manifestations of underlying cardiac disease. Brugada syndrome, associated with an elevated risk of developing fatal arrhythmic events, is a rare disorder characterized by a unique electrocardiographic pattern. The typical clinical presentation mainly involves syncope of unclear cause or sudden death. Seizures are uncommon clinical manifestations of Brugada syndrome, and reports of status epilepticus as initial presentation of Brugada syndrome are extremely rare. In this case report, we present a male patient with a typical pattern on 12‐lead electrocardiography, following resuscitation for generalized convulsive status epilepticus.
Initial Intravenous γ‐Globulin Treatment Failure in Iranian Children with Kawasaki Disease
Authors: Kashef Sara , Safari Mojgan , Amin Reza
Published: July 2009

The purpose of this study was to determine the initial rates of intravenous ?‐globulin treatment (IVIG) failure in Kawasaki disease (KD) and their predisposing factors. This study was a retrospective analysis of the initial response to IVIG (2 g/kg), assessed from the medical reports of all patients admitted to Namazee Hospital pediatric ward, from March 1998 to March 2002, and who fulfilled the criteria for KD. Data were available for 64 patients, 58 of whom (90.6%) became afebrile 48 hours after completion of the initial dose of IVIG (Group I) and six (9.4%) who remained febrile (Group II). Two patients had a prompt response to a second dose of IVIG. In Group I, five patients (8.6%) developed coronary artery disease, seen on echocardiography. In Group II, two patients (33.3%) developed coronary artery disease. No significant difference was found in the prevalence of coronary artery disease between the two groups (p = 0.12), or in age or gender. The rate of initial treatment failure was 9.4% in this cohort of patients, which is comparable with previous reports. No predictive factors such as coronary artery disease, age or gender were found for initial treatment failure in KD.