Appropriateness of hysterectomy in Taiwan.

BACKGROUND AND PURPOSE: Hysterectomy is among the most frequently performed surgical procedures in developed countries, but few studies from the Asia-Pacific region have assessed the appropriateness of hysterectomy. The purpose of this study was to examine the rate of inappropriate hysterectomy in Taiwan and its association with patient characteristics and indications for the procedure. METHODS: A random sample of hysterectomies for which claims were submitted to the Taiwan Bureau of National Health Insurance from July 1, 1997 to June 30, 1998 was selected. A total of 658 charts were reviewed by an expert panel composed of 5 senior gynecologists. RESULTS: Overall, 74.2% of patients underwent hysterectomy for appropriate reasons, 5.6% for uncertain reasons, and 20.2% for inappropriate reasons. Inappropriate procedures were positively associated with younger age and premenopausal status. Primary indications that accounted for over 25% of inappropriate procedures were chronic pelvic pain (42.9%), abnormal uterine bleeding (37.5%), and endometriosis (27.7%). CONCLUSIONS: This study found a high rate of inappropriate hysterectomy in Taiwan. Gynecologists and physician organizations should take action to improve physician agreement on the use of hysterectomy, especially for indications associated with high rates of inappropriate procedures.     

Immunocytochemical and electrophysiological differentiation of rat cerebellar granule cells in explant cultures

We have used a combination of immunocytochemical and electrophysiological measurements to monitor the differentiation of cerebellar granule cells in vitro. We present immunocytochemical evidence showing that several characteristic features of developing rat cerebellar tissue were retained in postnatal explant cultures. Most notably the cultures expressed radiating GFAP-positive (Bergmann) glia processes, proliferating NSE-negative neuroblasts, and migrating NSE-positive granule cells. The latter were subdivided into 3 developmental stages--i.e., immature, intermediate, and mature granule cells, based upon cell differences in location from the explant, intensity of NSE staining, excitability, and the amplitude of voltage-dependent conductances. Immature cells were identifiable during the first week in culture and were located up to 140 micron from the explant. These cells stained lightly for NSE and displayed conductances of insufficient magnitude to generate action potentials. Intermediate cells were present after 1-2 weeks in culture and were located up to 500 micron from the explant. These cells were also NSE positive and were characterized by the presence of soma action potentials. Intermediate cells displayed 3 large voltage-dependent conductances: a transient, TTX-sensitive inward current; a delayed, TEA-sensitive outward current; and a transient, 4AP-sensitive outward current. Mature cells were present after 1 month in culture and, like intermediate cells, were no more than 500 micron from the explant. However, mature cells stained more intensely for NSE, and the somata of these cells were devoid of voltage-dependent conductances (although axonal currents were usually present). These results indicate that granule cells undergo a stereotypic sequence of differentiation in postnatal explant cultures. These stages may correspond to developmental changes in granule cells during migration into the (internal) granular cell layer in vivo.     

Isolation of human complement subcomponents C1r and C1s in their unactivated, proenzyme forms

We have modified a standard isolation procedure for C1r and C1s, which employs IgG-Sepharose affinity chromatography followed by DEAE chromatography. As usual, all steps were performed at low temperature and two proteolytic inhibitors, PMSF and NPGB, were added during affinity chromatography on IgG-Sepharose. The novel condition was to keep the pH at pH 6.1 during the entire procedure, where activation was markedly depressed. In addition, purification was improved by washing the IgG-Sepharose column with a buffer free of added divalent cations immediately prior to elution of the C1r and C1s with EDTA. The final yields of highly purified C1r and C1s were about 20%; little or no activated material was detected in these highly purified fractions.     

Lack of STK11 gene expression in homozygous twins with Peutz-Jeghers syndrome

Clinical features of Peutz-Jeghers syndrome (PJS), an autosomal dominant disorder, include clusters of melanotic spots on the lips and limbs, polyposis of the gastrointestinal (GI) tract, and propensity to develop neoplasms of the GI tract, ovaries, testes, and other sites. We report twin sisters with PJS who were found to be homozygous, based on analyses of 9 DNA markers containing short tandem repeats (STR). Aberrant expression of a putative tumor suppressor gene, STK11, which encodes a serine threonine kinase, has been suggested as the etiologic factor in PJS. In both of the twin sisters with PJS, mRNA analyses by RT-PCR demonstrated a complete lack of STK11 gene expression. These results provide direct evidence that STK11 gene expression is abnormal in PJS. Detecting abnormal expression of the STK11 gene may serve as a molecular approach to the diagnosis of PJS and may facilitate genotype-phenotype correlations in PJS patients.     

Comparison of different PCR approaches for characterization of Burkholderia (Pseudomonas) cepacia isolates.

In this study, we evaluated three PCR methods for epidemiological typing of Burkholderia (Pseudomonas) cepacia--PCR-ribotyping, arbitrarily primed PCR (AP-PCR) and enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR)--and compared them with pulsed-field gel electrophoresis. The analysis was performed with 31 isolates of B. cepacia, comprising 23 epidemiologically unrelated isolates and 8 isolates collected from the same patient during two episodes of bacteremia. Pulsed-field gel electrophoresis, ERIC-PCR, and AP-PCR identified 23 distinct types among the 23 unrelated isolates, while PCR-ribotyping only identified 12 strain types, even after AluI digestion of the amplification products. Among the eight isolates collected from the same patient, all typing techniques revealed two clones of strains. The day-to-day reproducibilities of PCR-ribotyping and ERIC-PCR were good, while greater day-to-day variations were noted in the fingerprints obtained by AP-PCR. We conclude that all three PCR techniques are useful for rapid epidemiological typing of B. cepacia, but ERIC-PCR seems to be more reproducible and discriminative.     

Seroprevalence of hepatitis E virus infection among institutionalized psychiatric patients in Taiwan.

BACKGROUND: Hepatitis E virus infection (HEV) remains unclear in institutionalized psychiatric patients. OBJECTIVES: To investigate the prevalence and risk factors of HEV infection in a psychiatric institution in Taiwan. STUDY DESIGN: A total of 754 patients with psychiatric disorders were enrolled in the study. Clinical features, review of patient charts, and interviews with families were recorded for analysis. Antibody to HEV was tested using a commercial enzyme-linked immunosorbent assays. RESULTS: The prevalence of HEV infection in institutionalized patients was as high as 14.5%. Males had higher prevalence than females. It was also found prevalence increased significantly by age group. When compared with patients 30 years old or less, those in the 31-40 year old age group had an odds ratio of 4.89 [95% confidence interval (CI), 1.15-20.82], 41-50 years old of 6.30 (95% CI, 1.48-26.83), and 50 years or older of 6.20 (95% CI, 1.44-26.74). In multivariate logistic regression analysis, age and male gender were the independent risk factors. CONCLUSIONS: Institutionalized psychiatric patients had higher prevalence of HEV infection. In addition, there was an age-related increase in exposure to HEV with males that had a higher HEV seropositivity.     

Effect of accuracy constraint on joint coordination during pointing movements

Given the number of muscles and joints of the arm, more ways are available to produce an identical hand movement when pointing to a target than are strictly necessary. How the nervous system manages these abundant degrees of freedom was the focus of this study of pointing to targets of low and high indices of difficulty (ID). Two essential features of movement synergies were examined. The first reflects the preferred relations among the outputs of each movement element and was studied through principal component analysis. The second feature of synergy reflects the flexibility of those relationships evidenced by the use of multiple, goal-equivalent solutions to joint coordination. This second feature, which is the main focus of this report, was studied using the uncontrolled manifold approach. Motor abundance was defined operationally as the component of variance of joint combinations that left unchanged the value of important performance variables (goal-equivalent variability, GEV). This variance component was contrasted with the component of variance leading to a change in the value of these variables (non-goal-equivalent variability, NGEV). The difference between GEV and NGEV was evaluated with respect to the performance variables movement extent, movement direction, and path of the arm's center of mass. More than 90% of the variance of joint motions across the pointing trial were accounted for by one principal component, indicating a consistent temporal coupling among most joint motions in a single functional synergy. The flexible nature of this synergy was revealed by the variability analysis. All subjects had significantly higher GEV than NGEV for most of the movement path. Thus, variable patterns of joint coordination did not represent noise but the use of equivalent coordinative solutions related to stabilizing important performance variables. Higher GEV than NGEV was present regardless of the task's ID. One exception was at the time of peak velocity, leading to poorer control of movement extent than movement direction. Increasing the task's ID led to an overall reduction of joint configuraion variance, particularly GEV. These results support earlier work indicating that the use of goal-equivalent solutions to joint coordination is a common feature of the control of this and many other motor tasks. Functionally important performance variables appear to be controlled through flexible but task-specific coordination among the motor elements Electronic Publication     

Specular microscopy of hard contact lens wearers

Wide-field specular microscopy, slit-lamp examination, and pachometry were performed on 22 successful hard contact lens wearers and 22 controls matched for age, race, sex, and refractive error. A minimum of 600 cells per control and 1200 per contact lens wearer were manually digitized from the specular photomicrographs. Frequency distributions of cell areas were compared between the two groups using the parameters of mean, median, standard deviation, coefficient of variation, skewness and kurtosis. Slit-lamp examination was normal and there was no significant difference in corneal thickness between the patient group and the control group. Comparison of mean, median, and standard deviation also revealed no significant difference, but skewness (P less than .001), kurtosis (P less than .001) and coefficient of variation (P less than .004) were greater in the hard contact lens wear group. Hard contact lens wearing time correlated with increasing pleomorphism (P less than .05). Specular microscopy also revealed morphologic changes including deep stromal striae, intra- and extracellular "blackout" areas, and clustering of extremely small and large cells. The possible relationship between endothelial hypoxia and structural stromal changes are discussed.