Adult ; Aged ; Cohort Studies ; Dust ; analysis ; Female ; Humans ; Male ; Manganese ; analysis ; Manganese Poisoning ; diagnosis ; Middle Aged ; Occupational Exposure ; analysis ; Retrospective Studies ; Young Adult

This paper describes the administrative structure of the health system and its basic characters in Tai-wan province, and focus on the analysis of the main approaches and characteristics of the health system planning and management:“Taiwan’s health care network plan” was used to allocate the health resources reasonably; the health insurance system and “The Hospital Accreditation” were combined to regulate the behavior of the medical institu-tions;the form of public/government hosted and private running” was used to improve the efficiency of the public hospitals;the public and private hospitals were treated equally by the government to promote the private to invest in the hospital;and the public hospitals were managed strictly. Then we proposed several implications from the practices of Taiwan for our country in strengthening health care system planning and management.

Aim To investigate the relationship between the clinical actions and the serum concentrations of the enantiomers of (?)-trans tramadol and its active metabolite. Methods 20 postoperative patients were divided into two groups and given multiple intravenous doses of (?)-trans tramadol hydrochloride injection, 400 mg?d-1 (group A) or 300 mg?d-1 (group B). The blood samples were taken at 38 h after the initial dose. The concentrations of the enantiomers of (?)-trans tramadol and its active metabolite, (?)-trans O-demethyltramadal were determined with high performance capillary electrophoresis(HPCE). Results The concentrations of the enantiomers of (?)-trans tramadol, the frequency and serious level of adverse reactions were higher in group A than in group B. The concentrations of the enantiomers of (?)-trans O-demethyltramadal, the analgesic effect were similar between group A and group B. Conclusion There is much closer relation between the analgesic effect and the concentration of (+)-O-demethyltramadal. The frequency and serious level of adverse reactions may be attributed to the higher concentrations of the enantiomers of (?)-trans tramadol, which are caused by the saturated metabolism.

Objective To study the interaction of BDNF gene C270T polymorphism and estrogen receptor alpha (ERα)gene Xba Ⅰ loci and Pvu Ⅱ loci polymorphism in late-onset Alzheimer's disease(LOAD)pathogenesis in southern Chinese Han population.Methods BNDF gene C270T locus,ERα gene Xba Ⅰ site and Pvu Ⅱ site polymorphisms were examined in 203 LOAD patients and normal controls using PCR-RFLP technique.Results There was an interaction be-tween BDNF gene and ERα gene,and BDNF gene C270T locus CC genotype and the ERa gene Xba Ⅰ locus xx genotype increased the LOAD incidance risk(OR=2.38,95%CI:1.02～5.53).Conclusions BDNF gene and ERα gene are in-teracted each other in the pathogenesis of LOAD.Patients carrying both BDNF gene C270T locus CC genotype and the ERα gene Xba Ⅰ locus xx genotypes might have an increased risk for LOAD.

AIMTo simultaneously determine three unconjugated neurosteroids, dehydroepiandrosterone (DHEA) , pregnenolone (PREG), allopregnenolone (AP), from several brain regions of the rat.

METHODSNeurosteroids were isolated separately in a two steps procedure by using ethyl acetate-n-hexane (90:10) as the first step to extract the unconjugated steroids, then the steroid fractions were further purified by SPE. All steroids were derivatized with 2-nitro-4-trifluoromethylphenylhydrazine (2-NFPH) and analyzed by HPLC-MS ( APCI) using selected-ion monitoring. Methyltestosterone was chosen as the internal standard. Results The linear calibration curve of DHEA was obtained in the concentration range of 0.030-2.00 microg x L(-1). The linear calibration curves of PREG and AP were obtained in the concentration range of 0.025-2.00 microg x L(-1). The concentrations of DHEA, PREG and AP in male rat brain regions were (0.70 +/- 0.23), (4.8 +/- 1.9), (1.1 +/- 0.6) ng x g(-1) for frontal cortex, (0.57 +/- 0.28), (6 +/- 3), (0.5 +/- 0.3) ng x g(-1) for hippocampus, (1.5 +/- 1.0), (9 +/- 5), (1.4 +/- 0.9) ng x g(-1) for amygdale, (0.52 +/- 0.14), (7.7 +/- 2.8), (0.5 +/- 0.6) ng x g(-1) for striatum, (2.9 +/- 1.6), (18 +/- 9), (1.6 +/- 1.3) ng x g(-1) for nucleus accumbens, (4.0 +/- 2.0), (27 +/- 12), (0.8 +/- 0.5) ng x g(-1) for pituitary gland, (1.7 +/- 1.2), ( 16 +/- 10), and (0. 8 +/- 0.7) ng x g(-1) for hypothalamus, respectively.

CONCLUSIONGood linearity and accuracy were observed for each steroid. The procedure was suitable for measuring concentrations of the unconjugated steroids in rat brain simultaneously.

Amygdala ; chemistry ; Animals ; Brain Chemistry ; Chromatography, High Pressure Liquid ; Corpus Striatum ; chemistry ; Dehydroepiandrosterone ; analysis ; Hippocampus ; chemistry ; Hypothalamus ; chemistry ; Male ; Mass Spectrometry ; methods ; Nucleus Accumbens ; chemistry ; Prefrontal Cortex ; chemistry ; Pregnenolone ; analogs & derivatives ; analysis ; Rats ; Rats, Sprague-Dawley ; Sensitivity and Specificity

AIMTo establish the rat model of morphine-induced conditioned place preference (CPP) and to investigate the effects of morphine psychical dependence on the levels of neurosteroids in rat brain.

METHODSRats were ip administered morphine 5 mg x kg(-1) for 10 days to induce CPP in morphine group. The concentrations of dehydroepiandrosterone (DHEA), pregnenolone (PREG), allopregnanolone (AP), dehydroepiandrosterone sulfate (DS) and pregnenolone sulfate (PS) in nucleus accumbens (Nac), hypothalamus (Ht), amygdale (A) and plasma of rats were determined with liquid chromatography-negative atmospheric pressure ionization mass spectrometry (LC-MS).

RESULTSTrained with morphine for 10 days resulted in the acquisition of CPP in morphine group with the time that the rats spent in drug-pairing room was longer than that of control group. Compared with control group, morphine treatment could significantly decrease the contents of DHEA in Nac and plasma, decrease that of PREG in Ht.

CONCLUSIONMorphine could induce the CPP in rats and affected the contents of some neurosteroids in rat brain, which suggests that endogenous neurosteroids might he related to the development of morphine dependence.

Amygdala ; metabolism ; Animals ; Brain ; metabolism ; Conditioning, Operant ; physiology ; Dehydroepiandrosterone ; blood ; metabolism ; Dehydroepiandrosterone Sulfate ; blood ; metabolism ; Hypothalamus ; metabolism ; Male ; Morphine Dependence ; metabolism ; Nucleus Accumbens ; metabolism ; Pregnanolone ; blood ; metabolism ; Pregnenolone ; blood ; metabolism ; Rats ; Rats, Sprague-Dawley

Objective To investigate the clinical characteristics of laminar shelling decompression for the treatment of thoracic spinal stenosis.Methods One hundred and twenty-one patients with thoracic spinal stenosis were reviewed.Ages of these 51 male and 70 female patients ranged from 45 to 71 years (mean 54.8 years).There were 72 patients with thoracic ossification of ligamentum flavum(OLF),21 patients with thoracic ossification of posterior longimental ligament(OPLL)and 28 patients with thoracic OLF and OPLL.The lesion segmentum,kyphosis angle of thoracic vertebra and residual area of vertebral canal(RAVC)were measured.All these patients were treated with laminar shelling decompression.Preoperative and postoperative functional statuses were evaluated using a Japanese Orthopaedic Association(JOA)score.Results Thoracic OLF were found between T7 to T12 in 77.0% of the lesions;thoracic OPLL were found between T1 to T6 in 81.1% of the lesions.Of the 121 patients,the mean kyphosis angle was 31.5°±6.8° in upper thoracic spine and,9.4°±3.5° in lower thoracic spine.In patients whose RAVC were more than 80%,the pre- and postoperative mean JOA score was 7.7±1.4 and 9.5±1.6 respectively;RAVC more than 50%,5.2±1.8 and 8.6±2.1 respectively;RAVC less than 5%,4.8±1.4,and 5.6±1.3 respectively.Conclusion Thoracic OLF mostly occurred in lower thoracic spine,while thoracic OPLL mostly occurred in upper thoracic spine.The RAVC is a significant factor to the prognosis of thoracic spinal stenosis.As long as the clinical symptoms correspond with imaging findings,it is better to resect the whole ossification part as much as possible.Thoracic spinal stenosis often recurs after surgery.More attention to decompression ranges and decompression skills shoud be paied during revision surgery.

Objective To investigate the prognostic value of CDKN2A mRNA in glioblastoma (GBM).Methods CDKN2A gene mRNA data were obtained from three different GBM database online (TCGA,REMBARNDT and GSE16011).The correlations between overall survival (OS) and CDKN2A expression were analyzed by Kaplan-Meier method and multivariate Cox regression analysis.Results In the TCGA database (n =358),patients with high CDKN2A mRNA level got longer OS than those with low expression level [median OS:18.0 months (95 ％ CI 15.0-21.0 months) vs 13.9 months (95 ％ CI 12.4-15.4 months),P =0.001].In another two validation datasets,patients with high CDKN2A mRNA level had longer OS than those with low expression level [median OS in REMBRANT:16.6 months (95 ％ CI 13.3-19.8 months) vs 11.8 months (95 ％ CI 7.3-16.4 months),P =0.019; in GSE16011:11.9 months (95 ％ CI 8.3-15.6 months) vs 8.4 months (95 ％ CI 6.2-10.5 months),P =0.005].CDKN2A mRNA level was an independent prognostic factor for GBM.The combination of CDKN2A mRNA expression with MGMT promoter methylation status or G-CIMP status/IDH1 mutations provided an optimized prognostic factor in GBM patients.Conclusion The CDKN2A mRNA has prognostic value in GBM patients,which provided an optimized stratification strategy based on multiple biomarkers.

Objective To investigate clinical relevance of U1-nuclear ribonucleoprotein antibody (anti-U1 RNP) in Chinese patients with systemic sclerosis (SSc). Methods In total, 131 Chinese patients with SSc were prospectively and consecutively recruited into Scleroderma Trials and Research Group sponsored by European League Against Rheumatism (EUSTAR) from clinical database of Peking Union Medical College Hospital ( PUMCH). Their clinical features, visceral lesions and laboratory findings including detection of anti- U1 RNP were recorded. Relevance between existing anti-U1 RNP and clinical characteristics and other laboratory indicators of SSc was analyzed statistically. Results Eighty-seven of the 131 patients presented as diffused SSc (dSSc) , 36 limited SSc ( lSSc) and eight SSc/systemic lupus erythematosus (SLE) overlap syndrome, with positive rate of anti-U, RNP of 28. 2 (37/131) percent in patients with SSc. Positive rate of anti-U1 RNP in dSSc was similar to that in lSSc groups [28. 7% (25/87) and 25. 0% ( 9/36 ) , respectively, P = 0. 673]. But significantly higher prevalence of pulmonary arterial hypertension and cardiac involvement, and less white blood cell and platelets counts were observed in the patients with positive anti-U1 RNP than in those with negative anti-U1 RNP (all P < 0. 05 ). There was no statistically significant difference in skin sclerosis score and prevalence of arthritis, myositis and interstitial lung disease was observed between those with positive and negative anti-U1 RNP ( P > 0. 05 ) . Detection rate of anti-DNA topoisomerase I ( Scl-70 antibody) was higher in SSc patients with negative anti-U, RNP. Conclusions U1 RNP antibody is a common antibody in Chinese patients with SSc, and detection for it combined with other autoantibodies will be helpful for diagnosing of SSc and predicting development of pulmonary arterial hypertension, cardiac and hematological involvements in them.

OBJECTIVETo discuss diagnosis and treatment of iatrogenic purulent lumbar spinal infection.

METHODSFrom December 2006 to January 2010, 4 patients with iatrogenic purulent lumbar spinal infection were treated with posterior debridement. There were 2 males and 2 females, ranging in age from 50 to 66 years (respectively in 52, 66, 58, 50 years); in course of disease from 2 weeks to 2.5 months (respectively in 21, 14, 60, 75 days ). All patients had fever, lumbago, local tenderness and limited lumbar activity before operation. White blood cell count (WBC), erythrocyte sedimentation rate (ESR) were abnormal. The clinical effects were evaluated by symptoms and laboratory examination.

RESULTSSymptoms of lumbago and fever vanished in 4 patients, of which wounds were primary healing without complications. The patients were followed up for 3 months, no infection (WBC, C-reactive protein and ESR were normal) and lumbar instability were found.

CONCLUSIONIatrogenic purulent lumbar spinal infection can be diagnosed according to course of disease, clinical symptoms and signs, imaging finding. In the items, magnetic resonance imaging finding have necessarily specificity, once finding abscess-formation, will promptly operate.

Aged ; Debridement ; methods ; Diagnosis, Differential ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spondylitis ; diagnosis ; surgery ; Suppuration