Long-term arsenic exposure and incidence of non-insulin-dependent diabetes mellitus: a cohort study in arseniasis-hyperendemic villages in Taiwan

Diabetes prevalence in arseniasis-hyperendemic villages in Taiwan has been reported to be significantly higher than in the general population. The aim of this cohort study was to further evaluate the association between ingested inorganic arsenic and the incidence of non-insulin-dependent diabetes mellitus in these villages. A total of 446 nondiabetic residents in these villages were followed biannually by oral glucose tolerance test. Diabetes is defined as a fasting plasma glucose level > or = 7.8 mmol/L and/or a 2-hr post-load glucose level > or = 11.1 mmol/L. During the follow-up period of 1499.5 person-years, 41 cases developed diabetes, showing an overall incidence of 27.4/1,000 person-years. The incidence of diabetes correlated with age, body mass index, and cumulative arsenic exposure. The multivariate-adjusted relative risks were 1.6, 2.3, and 2.1 for age > or = 55 versus < 55 years, a body mass index ¿Greater/Equal to] 25 versus < 25 kg/m(2), and a cumulative arsenic exposure > or = 17 versus < 17 mg/L-years, respectively. The incidence density ratios (95% confidence intervals) between the hyperendemic villages and the two nonendemic control townships were 3.6 (3.5-3.6), 2.3 (1.1-4.9), 4.3 (2.4-7.7), and 5.5 (2.2-13.5), respectively, for the age groups of 35-44, 45-54, 55-64, and 65-74 years. The findings are consistent with our previous cross-sectional observation that ingested inorganic arsenic is diabetogenic in human beings.     

Hepatotoxicity caused by Breynia officinalis

Breynia officinalis has the Chinese proprietary name, Chi R Yun, which means dizziness or vertigo for 7 d. In daily practice, it has been used to treat venereal diseases, contusion, heart failure, growth retardation and conjunctivitis in combination with other traditional Chinese medicines. Two hospital-based cases of Breynia officinalis poisoning have been reported to the Poison Control Center. Case 1 was a 43-y-old female who consumed a mixture of 1500 g lower stem and root of Ji Mu Ju in boiled water in a suicide attempt. Her AST reached 264 and ALT reached 2443. Case 2 was a 51-y-old female who consumed 20 pieces of lower stem and root of Ji Mu Ju stewed with meat and 100 ml of wine to treat chronic contact dermatitis. Her AST reached 3815 and ALT reached 6625. In both cases Breynia officinalis was identified as the cause of poisoning. Poisoning in humans involves the neurologic, gastrointestinal, hepatic, urinary and respiratory systems. Hepatotoxic effects have been reported for some Chinese herbal medicines, but not Breynia officinalis: Breynia officinalis poisoning causes hepatocellular liver injury rather than cholestatic liver injury.     

Tuberculin skin test and anergy in dialysis patients of a tuberculosis-endemic area

BACKGROUND/AIM: Uremic patients are at an increased risk of being affected by tuberculosis (TB). Periodical tuberculin skin tests were suggested to detect TB-infected patients. These were replaced by chest radiographs in endemic areas like Taiwan. However, almost 50% of the TB incidence in dialysis patients was extrapulmonary. In this study, we tried to investigate the value of tuberculin tests in dialysis patients in endemic areas. METHODS: The patients were recruited from our dialysis unit. Purified protein derivative (PPD) and control tests with antigens for Candida and toxoid were performed using the Mantoux method. PPD with >10-mm induration will be considered positive. Skin anergy meant that the indurations of all antigens were less than 5 mm. A follow-up was done 12 months after the tests. RESULTS: A total of 177 patients were evaluated. Anergy was found in 40 patients (22.6%). A positive predictor of anergy was age >45 years (p = 0.03), while a negative predictor was prealbumin >20 mg/dl (p = 0.04). Fifty-three patients (30%) had positive PPD tests. Seven of the positive PPD patients (13.2%) developed active TB during the following years. Among the 40 patients with skin anergy, 6 (15%) were found to have active TB. Of the 48 patients (21.1%) with indurations of the PPD tests between 5 and 10 mm, none was found to have active TB. CONCLUSION: Although anergy will influence the sensitivity of PPD tests, these tests in combination with anergy tests could help to establish the diagnosis of TB in uremic patients, even in TB-endemic areas.     

Do the elderly benefit from annual physical examination? An example from Kaohsiung City,Taiwan

BACKGROUND: This study evaluates the impact of free annual health examinations on survival of elderly (> or =65 years of age) residents in Kaohsiung City, Taiwan. METHODS: A stratified random sample scheme was used in each of the 11 districts of Kaohsiung City. A total of 1,193 elderly people were selected and interviewed in 1993; deaths and results of health check-ups were recorded through 1998. RESULTS: While over 50% of the subjects received at least one health examination between 1993 and 1998, only 18% received three or more. Most (60%) subjects who received examinations in a given year also received examinations the subsequent year; most (over 70%) who did not receive examinations in a given year did not receive check-ups the following year. Cox proportional hazards model showed that those who utilized the examination service had better survival probability than those who did not, given the same age, sex, education, marital status, living arrangements, and number of chronic diseases at baseline: The relative risk (RR) of mortality for those who ever utilized the health examination service was 0.50 (P < 0.0001). CONCLUSIONS: Elderly subjects who received annual health examinations had lower mortality than those who did not. This finding should be interpreted cautiously, however, as the difference in survival may reflect better general health behaviors among those who participated in the program.     

Synthesis and vasorelaxant activity of 4-(cyclic amido)-2H-naphtho[1,2-b]pyrans

A series of 4-(cyclic amido)-2H-naphtho[1,2-b]pyrans related to cromakalim (1) has been prepared and their vasorelaxant activities on isolated rat thoracic aorta precontracted with phenylephrine have been evaluated. The relaxant mechanism of 3a was found not through ATP-sensitive K(+) channels as cromakalim, but through opening voltage-sensitive K(+) channels.     

Comparison of three-dimensional anthropometric body surface scanning to waist-hip ratio and body mass index in correlation with metabolic risk factors

In this study, we used a three-dimensional (3D) body scanner to evaluate subjects with central obesity. These measurements were correlated with blood pressure, blood glucose, lipid, and uric acid levels. We randomly selected 1,204 subjects who visited the Department of Health Management at Chang Gung Medical Center in Linkou. The health index (HI) was calculated as HI = (body weight x 2 x waist profile area)/[body height(2) x (breast profile area + hip profile area)]. Among the 1,204 subjects, body mass index (BMI) equal to or greater than 30 kg/m(2) was found in 8.3% of the subjects. Pearson correlation coefficient studies revealed that HI was a better index for correlating metabolic parameters than BMI and waist-to-hips girth ratio. Of the 1,204 subjects, 9.5% (114) had diabetes mellitus, according to American Diabetes Association criteria. The percentages of men and women with total cholesterol greater than or equal to 245 mg/dL were almost the same (11.0% vs. 11.1%). Elevated low-density lipoprotein (> or =130 mg/dL) was found in 36.9% (444) of subjects. In conclusion, HI as determined by 3D scanning, is another method to predict these metabolic abnormalities. Further prospective long-term follow-up study is needed to determine the relationships of 3D body scanning data and HI to blood pressure, blood glucose, lipid, and uric acid levels.     

The concentration of serum transforming growth factor beta-1 (TGF-beta1) is decreased in cervical carcinoma patients

Transforming growth factor beta-1 (TGF-beta1) is a multifunctional growth factor and known to inhibit the proliferation of epithelial cell. The relationship between serum TGF-beta1 level and the presence of cervical cancer was investigated in this study. The patients with cervical squamous cell carcinoma (SCC) had significantly lower level of serum TGF-beta1 (39.14 +/- 9.03 ng/mL; mean +/- SD) than those with myoma (49.17 +/- 9.38 ng/mL) and normal subjects (49.13 +/- 8.81 ng/mL), (p < 0.007 and p < 0.001, respectively). TGF-beta1 level was also lower in the patients with cervical intraepithelial neoplasia (CIN3) (42.07 +/- 9.38 ng/mL) than in normal controls (49.13 +/- 8.81 ng/mL) (p < 0.04). It suggested that diminution of the production of TGF-beta1 has close association with the neoplastic transformation of cervical epithelium.     

A new device for measuring density of jaw bones

OBJECTIVES: The purpose of this project was to develop a lightweight, simple device to evaluate alveolar process bone density using normal intraoral and extraoral imaging procedures. METHODS: A simple lightweight device was constructed using barium sulfate as the major radiopaque component. The 5 x 32 x 12 mm(3) resin block has eight segments with known densities ranging from 1.304 (g/cm(3)) to 1.982 (g/cm(3)). The device was integrated into an XCP unit for standard intraoral radiographs and placed between the jaws for computer aided tomographic imaging. The relationship between the device segment densities and the optical densities of the exposed film was plotted. RESULTS: A linear inverse relationship was found between the device segment densities and optical densities when segment densities were between 1.304 (g/cm(3)) to 1.882 (g/cm(3)). However, the relationship was non-linear for segment densities above 1.882 (g/cm(3)). CONCLUSIONS: Normal human bone density is 1.85 (g/cm(3)), and this densitometer is useful for determination of material densities from 1.304 (g/cm(3)) to 1.882 (g/cm(3)). The device may be useful for precise bone density assessment.