Subthalamotomy for advanced Parkinson disease

OBJECT: The aim of this study was to determine if subthalamotomy is effective in treating advanced Parkinson disease (PD). METHODS: The authors performed microelectrode mapping-guided stereotactic surgery on the subthalamic nucleus in eight patients with PD. Lesioning was performed using radiofrequency heat coagulation and confirmed with magnetic resonance imaging. Three patients who underwent unilateral and four with bilateral subthalamotomy were evaluated for up to 18 months according to the Unified PD Rating Scale (UPDRS). One patient who underwent unilateral subthalamotomy died 6 months postsurgery. At 3 months into the "off" period after surgery, there were significant improvements in contralateral bradykinesia (p < 0.0002), rigidity (p < 0.0001), tremor (p < 0.01), axial motor features (p < 0.02), gait (p < 0.03), postural stability (p < 0.03), total UPDRS scores (p < 0.03), and Schwab and England scores (p < 0.04). The benefits were sustained at 6, 12, and 18 months, except for the improvement in tremor. At 12 months into the "on" period, significant benefits were present for motor fluctuation (p < 0.04), on dyskinesia (p < 0.006), off duration (p < 0.05), total UPDRS score (p < 0.02), and contralateral tremor (p < 0.05). Benefits for motor fluctuation, off duration, and off-period tremor were lost after the 18-month follow-up period. The levodopa requirement was reduced by 66% for the unilateral and 38% for the bilaterally treated group. Bilateral subthalamotomy offered more benefits than did unilateral surgery for various parkinsonian features in both the on and off periods. Three patients suffered hemiballismus, two recovered spontaneously, and one died of aspiration pneumonia after discontinuation of levodopa. CONCLUSIONS: These findings indicate that subthalamotomy can ameliorate the cardinal symptoms of PD, reduce the dosage of levodopa, diminish complications of the drug therapy, and improve the quality of life.     

Blood lead levels of primary-school children in Penghu County,Taiwan: distribution and influencing factors

OBJECTIVES: The purpose of this study was to investigate the blood lead levels (BLLs) of primary-school children aged 7 to 12 in Penghu island and to determine the factors affecting their BLLs. METHODS: A total of 1,885 participants were recruited and BLLs were measured with a flameless atomic absorption spectrophotometer. A questionnaire was used to collect personal information. RESULTS: The results indicated that the mean BLL of primary-school children in Penghu was 6.0+/-2.4 microg/dl (1.0 approximately 29.3 microg/dl). The mean BLL of schoolboys ( n=1,046) was 6.3+/-2.6 microg/dl, with a maximum of 29.3 microg/dl, while the mean BLL of schoolgirls ( n=839) was 5.7+/-2.2 microg/dl, with a maximum of 23.4 microg/dl. Risk-factor analysis showed that personal characteristics (i.e., gender, frequency of milk consumption, grade levels) and geographic factors (i.e., levels of urbanization) significantly influence the BLLs. However, there was no significant impact on BLLs from drinking water, residential distance from a major road, and living close to lead-emitting sources. CONCLUSIONS: Geographical factors were highly associated with BLLs. The BLLs of the primary-school children living in the main Penghu island were lower than those in the other small islands.     

Characterization of human UMP/CMP kinase and its phosphorylation of D- and L-form deoxycytidine analogue monophosphates

Pyrimidine nucleoside monophosphate kinase [UMP/CMP kinase (UMP/CMPK);EC 2.7.4.14] plays a crucial role in the formation of UDP, CDP, and dCDP, which are required for cellular nucleic acid synthesis. Several cytidine and deoxycytidine analogues are important anticancer and antiviral drugs. These drugs require stepwise phosphorylation to their triphosphate forms to exert their therapeutic effects. The role of UMP/CMPK for the phosphorylation of nucleoside analogues has been indicated. Thus, we cloned the human UMP/CMPK gene, expressed it in Escherichia coli, and purified it to homogeneity. Its kinetic properties were determined. UMP and CMP proved to be far better substrates than dCMP. UMP/CMPK used all of the nucleoside triphosphates as phosphate donors, with ATP and dATP being the best donors and CTP being the poorest. Furthermore, UMP/CMPK was able to phosphorylate all of the deoxycytidine analogue monophosphates that we tested. The relative efficiency was as follows: arabinofuranosyl-CMP > dCMP > beta-L-2',3'-dideoxy-3'-thia-CMP > Gemcitabine monophosphate > beta-D-2',3'-dideoxy-CMP; beta-L-2',3'-dideoxy-2',3'-didehydro-5-fluoro-CMP; beta-L-2',3'-dideoxy-5-fluoro-3'-thia-CMP > beta-L-2',3'-dideoxy-CMP > beta-L-dioxolane-CMP. By comparing the relative V(max)/K(m) values of D- and L-form dideoxy-CMP, we showed that this kinase lacked stereoselectivity. Reducing agents, such as DTT, 2-mercaptoethanol, and thioredoxin, were able to activate this enzyme, suggesting that its activity may be regulated by redox potential in vivo. UMP/CMPK localized predominantly to the cytoplasm. In addition, 196-amino acid UMP/CMPK was the actual form of UMP/CMPK, rather than the 228-amino acid form as suggested before.     

Human herpesvirus-8 infection in hemodialysis patients from eastern Taiwan--Hualien

Human herpesvirus-8 (HHV-8) is the causative agent in Kaposi's sarcoma (KS). Uremic or hemodialysis patients are known to be highly susceptible to viral infection, and may be at increased risk of developing KS from the increased risk of exposure to HHV-8 infection. We collected 77 serum samples from hemodialysis patients and 207 serum samples from blood donors. Serum samples were tested for HHV-8-specific immunoglobulin G by immunofluorescence assay. Fifteen of 77 hemodialysis patients (19.5%) had HHV-8 antibodies. The ages of these 15 patients ranged from 43 to 89 years (mean, 62 yr). Six of 207 (3.0%) blood donors had HHV-8 antibodies. Thus, the prevalence of HHV-8 antibodies in hemodialysis patients in Hualien is higher than that in normal blood donors. The transmission route should be surveyed in detail.     

腹腔CT影像学检查在腹膜透析相关非感染性腹腔并发症中的诊断价值

目的：初步探讨腹腔CT影像学检查在诊断持续性非卧床腹膜透析（continuous ambulatory peritoneal dialysis，CAPD）患者非感染性腹腔并发症中的应用价值。 方法：前瞻性地对2005年至2007年间在我院进行CAPD治疗且临床高度怀疑为透析相关非感染性腹腔并发症的患者进行腹腔CT影像学检查。结合临床资料，综合分析患者是否存在腹腔渗漏、疝气、局部腹透液的聚集和大网膜包裹等情况，评估腹腔CT影像学检查的应用价值。 结果：腹腔CT造影检查发现，11例CAPD患者中有9例出现异常情况，其中包括腹股沟疝气3例，睾丸鞘膜积液1倒，脐疝1例，导管出口处渗漏2例，大网膜包裹2例；其中8例（腹股沟疝气2例，睾丸鞘膜积液1例，脐疝1例，导管出口处渗漏2例，大网膜包裹2例）有手术条件的患者经过手术均得到证实。 结论：在一些存在可疑腹膜透析相关非感染性腹腔并发症的CAPD患者中，腹腔CT影像学检查可能是一种无刨、可靠且灵敏度较高的检查技术，操作简便易行，有助于明确诊断，值得进一步研究。     

Effects of lead and noise exposures on hearing ability

Lead and noise, via different mechanisms, may damage hearing ability, and, in some cases, cause severe and irreversible damage. To explore possible independent and synergistic effects of lead and noise on auditory function, the authors conducted a cross-sectional study in two lead-battery manufacturing factories. Lead and noise were the two most common sources of occupational exposures in the factories. Blood lead level, ambient lead concentration, noise exposure level, and hearing thresholds of 339 lead-battery workers-including clerical and managerial staffs-were measured. The authors obtained demographics and working histories via an interview-based structured questionnaire. A total of 220 lead-battery workers were exposed to high levels of lead and noise; their average blood lead concentration was 56.9 microg/dl, and their average noise exposure level was 86.0 dBALeq. Multivariate analysis, in which possible risk factors of hearing ability were considered, demonstrated a significant correlation between a high, long-term lead exposure index (defined by duration of employment and ambient lead concentration) and decreased hearing ability. In contrast, such a correlation between short-term lead exposure (defined by blood lead level) and hearing ability was not significant. Furthermore, neither noise exposure level alone nor the interaction between noise exposure level and short- or long-term lead exposure was correlated significantly with hearing ability. The present study raises an important, but typically ignored, issue: lead exposure might precipitate a more severe auditory than noise-exposure effect. The preservation of workers' hearing ability requires that preventive measures be taken against noise exposure, which is as essential as measures taken against lead exposure.     

Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography of Carotid Artery after Stenting

PURPOSE: This study presents 3-dimensional, contrast-enhanced, magnetic resonance (MR) angiographic appearances of the carotid artery after stenting. METHODS: The authors reviewed contrast-enhanced MR angiograms of 18 carotid arteries in 13 patients. These arteries were not stenotic or occluded in the stented segment, as shown on carotid angio-grams (11 patients) or carotid Doppler images (2 patients) obtained later. RESULTS: Five patients had 1 stent in each of their bilateral carotid arteries. One patient with 1 stent in 1 artery underwent the examination twice with different MR coils. Different artifact patterns were found in 19 carotid-stent examinations. Type 1a involved short segments of false narrowing or false focal occlusion at both ends of the stent (n = 12); the carotid artery in the stented segment between the ends was normal. Types 2a and 2b occurred along the stented segment of the artery between the 2 ends of the stent. Type 2a was milder, with segmental faint signal intensity or luminal stenosis in the entire length of the stented segment (n = 5). Type 2b was total loss of luminal signal intensity over the whole length of the stented segment (n = 2). Last, type 1b was a band of hyperintensity at the ends of type 2a or 2b artifacts. Types 1a and 1b were due to susceptibility effect, and types 2a and 2b were from radio-frequency shielding effect. Both of these effects were identified in MR angiogram of nitinol stents and stainless steel stents. CONCLUSION: Awareness of these artifacts is essential to prevent misdiagnosis.