Search

Copyright of Journal of Nursing is the property of Taiwan Nurses Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Nursing is the property of Taiwan Nurses Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: To explore the efficacy of gefitinib to non small cell lung cancer (NSCLC) patients irrespective of their performance status, number of prior treatment regimens and the presence of brain metastasis., Methods: A total of 76 patients were enrolled., Results: For all enrolled patients, the disease control rate was 63.2% (95% CI, 52.1%-74.3%) with a median progression-free survival of 5.0 months (95% CI, 3.5-6.6 months) and median overall survival of 9.9 months (95% CI, 4.9-14.8 months). Fifty seven patients had measurable lesions and the objective response rate was 33.3% (95% CI, 20.7%-46.0%). Twenty one patients had simultaneously assessable intracranial and extracranial lesions, 17 of them (81.0%) showed comparable tumor response. There was no survival difference between the patients with and without metastatic brain disease. Most drug-related adverse events were mild. Intolerable toxicities happened in 5 patients, 4 of them were interstitial pneumonia (5.8%), Conclusions: Gefitinib is active in patients with brain metastasis from NSCLC. It is feasible to conduct randomized trials to identify the role of gefitinib alone or in combination with other modality in the treatment of NSCLC patients who have metastatic brain lesion(s).

TGF-beta 1 is a multifunctional molecule which has unique and potent effects on many target cells and tissues. TGF-beta 1 may promote inflammatory reaction by certain intercellular interaction. TGF-beta 1 at extremely low concentrations shows strong chemotatic activity for mononuclear phagocytes and stimulates bone resorption by enhancing production of PGE2. On the other hand, TGF-beta 1 plays a very important role in the regulation of extracellular matrix turnover presumably by modulating the action of other growth factors on matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) expression. TGF-beta 1 was identified intra- and extracellularly in the inflamed gingival tissues and the distribution was associated with areas of inflammation. Sixteen miniature swines were used in this experimental gingivitis/periodontitis study. The ligatures were placed in situ for periods of 3, 5, 8 and 13 weeks and peroral innoculations of Porphyromonas gingivalis/Actinomyces viscosus into the ligatures were carried out only in the experimental group. ELISA was used to measure the levels of TGF-beta 1 in gingival tissues from the experimental and control groups. Recording of the clinical periodontal parameters was performed and the proportion of black-pigmented Bacteroides in the ligature (plaques) removed immediately prior to the biopsies was recorded. The results revealed that the concentration of TGF-beta 1 of the experimental group was higher and significantly different in statistics on the period of third week than that of the control group. The concentration of TGF-beta 1 was significantly different between the third week and the thirteenth week in the experimental group, and was negatively related to the time-length of ligatures. Furthermore, the concentration of TGF-beta 1 was negatively related to the changes of the calculus index and gingival index. These data indicated that the concentration of TGF-beta 1 of gingival tissue exhibited dynamic changes associated with the progression of experimental periodontal inflammation. The levels of TGF-beta 1 in gingival tissue may be valuable in detecting the inflammatory reaction of periodontal tissues.

The attention deficit hyperactive disorder (hereinafter ADHD, children with this disease usually are named hyperactive children) is often one of the most frequent diagnosis of psychiatric outpatients for children. Though there are still some disputes in diagnosis, child psychiatrists can diagnose individual cases through interview, observation and the information provided by their parents and teachers. Besides the diagnosis and treatment, the result of long-term follow-up studies of hyperactive children also gradually indicate the most extreme signification. According to the long-term outcome studies of hyperactive children conducted in foreign countries for the past 20 to 30 years, symptoms of hyperactive children will not disappear completely as they grew up; instead, the residual symptoms can cause adaptive impairment in their adolescent and adult period. The core symptoms of ADHD (inattention, hyperactivity, impulsive behavior) can be satisfactorily managed if they can be diagnosed as earlier as possible, through medicine and behavioral therapy, plus medical staff and cooperation from family, school and society. If there is no early diagnosis or intervention, and let symptoms continue, after growing up, associated conduct problem or disorder, antisocial behavior, substance abuse and antisocial personality disorder, even criminal behavior will have higher opportunity to develop into adolescence and adulthood. These behavioral problems will cause very serious social problems. We have became more clearly aware of the accurate recognition of hyperactive children and have emphasized its importance in recent years. Unfortunately, there are still no long-term follow-up study reports regarding these children in our country; therefore we could not discover the effective predictors and higher risk groups for early intervention and prevention. This paper aims at reviewing long-term outcome studies of hyperactive children and trying to organize its adaptive problems and associated mental disorders after growing up. We also expect that the long-term follow-up studies on hyperactive children can be seen in the very near future at our country.

The main purpose of this study was to understand the influence of school administrator's and teacher's participation in oral hygiene promotion, and dental health education intervention on the oral hygiene status of the elementary school children. Questionnaires designed to evaluate the school staff's willingness to emphasize and proceed the oral hygiene programs were answered by the school administrators (principals, deans of pupils' affair, chiefs of physical education and hygiene departments, and nurses) in 75 public elementary schools of the Kaohsiung City, Taiwan. Two of the most, and of the least cooperative schools were randomly selected. The fifth grade teachers of those four schools were asked to answer the questionnaires. Pupils of the two classes whose teachers who had the greatest and the least willingness to participate were selected for further investigation. Pupils were asked to answer questionnaires, receive oral examinations and tooth-brushing instructions every other two weeks for a total of two times. The results were as follows: 1. Before active oral hygiene instruction, there is no significant difference in plaque scores among groups. However, DMFT scores are influenced by school administrators. 2. The oral hygiene education intervention actually significantly improved the school children's plaque scores. 3. The cooperation of school administrators and teachers has a positive influence on keeping (forming) school children's good oral hygiene habits. Furthermore, the influence from school administrators is more than that from teachers. 4. School children's knowledge of oral hygiene is influenced by school' administrators and teachers while teachers' attitude of oral hygiene is influenced by school administrators.

Actinobacillus actinomycetemcomitans(Aa), elaborating a multiplicity of virulence factor and tissue-damaging products, is considered an etiological agent in periodontal disease. Serotype b is the most frequently isolated serotype in localized juvenile periodontitis patients, suggesting a particularly high periodontopathic potential for serotype b strains. Interleukin-6(IL-6) plays an important role in the mediation of inflammatory and immune responses as well as in the osteoclastic bone resorption. However, there is little information regarding the effect of the different serotypes of Aa on IL-6 production by human gingival fibroblasts (HGF). Therefore, the purpose of this study was to compare the ability of the three serotypes (a, b, and c) of Aa sonicates to induce the production of IL-6 by HGF. In fibroblast cultures, confluent monolayers of HGF were incubated with sonic extracts of Aa-511 (serotype a), Aa-Y4 (serotype b), and Aa-652 (serotype c) at various concentrations for 48 h at 37 degrees C in 5% CO2 and air. At the end of the culture period, supernatants were collected and analysed for IL-6 content by using EIA and bioassay. In order to compare the effects of non-lipopolysaccharide (LPS) activation of Aa sonicates on IL-6 production by HGF, we added polymyxin B in cultures with Aa sonicates to bind LPS. The results were summarized as follows. (1) All three serotypes of Aa sonicates had similar dose-dependent stimulant effects on IL-6 production by HGF, and the biological activities of IL-6 correlated with their immunoreactivities. (2) The maximum releases of IL-6 by HGF were achieved at concentrations of 10 to 100 micrograms protein/mL of Aa sonicates, and the ability of Aa-Y4 to induce the release of IL-6 was higher than that of Aa-511 and Aa-652 at these concentrations. (3) Polymyxin B (50 micrograms/mL) effectively decreased the amounts of IL-6 produced by stimulation of the HGF with 10 micrograms protein/mL of Aa sonicates. However, the polymyxin B-treated Aa-Y4 sonicate showed a higher ability to induce the release of IL-6 than the other two strains. These results indicate that Aa-Y4 (serotype b) has a higher potency to induce HGF secretion of IL-6; thus contributing to a comparatively stronger efficacy to the destruction of periodontal tissue in periodontitis.

The purposes of this study were to investigate the furcation entrance angle (FEA) and the distance between cemento-enamel junction (CEJ) and furcation entrance (FE) of the extracted maxillary and mandibular molars. Assay teeth comprised 89 maxillary molars and 93 mandibular molars. All the FEAs and CEJ-FEs of the molars were measured by a stereomicroscope at 2.5 x equipped with a Bioscan OPTIMAS Image Analyzer (BOIA). The results were summarized as follows: (1) The mean FEAs in the buccal, mesial and distal furcations were 96.3 +/- 10.0, 103.8 +/- 9.7, and 107.2 +/- 12.2 degrees in the maxillary molars, and 91.6 +/- 11.7, 101.7 +/- 11.5, and 97.1 +/- 10.7 degrees in the maxillary second molars, respectively. At the buccal and lingual furcations of mandibular first and second molars, they measured 100.5 +/- 9.7/102.7 +/- 8.5, and 93.3 +/- 11.5/91.7 +/- 10.8 degrees, respectively. (2) The mean distance of CEJ-FEs at the buccal, mesial and distal furcations of maxillary molars were 3.42 +/- 1.5mm, 3.55 +/- 0.97 mm, and 3.69 +/- 0.98mm for the first molars, and 3.01 +/- 1.04mm, 4.04 +/- 1.58mm and 3.00 +/- 1.14mm for the second molars. At the buccal and lingual furcations of the mandibular first and second molars, they were recorded as 1.90 +/- 0.08mm and 2.90 +/- 0.07mm, and 2.82 +/- 1.34mm and 3.46 +/- 1.03mm, respectively. It was concluded that buccal FEA of maxillary 2nd molar was the smallest (91.56 +/- 9.68 degrees) as compared to the mesial and distal FEAs; whereas the mean distance of CEJ-FEs at the buccal surface was the smallest (1.90mm +/- 0.08mm) when compared to the others.

Multiple myeloma is a neoplastic disorder of bone that originates from cells of bone marrow. It is most commonly seen within the age range of 50-80 years, cases under the age of 40 being rare. Men are affected more frequently than are women. Bone pain is the cardinal clinical symptom in multiple myeloma. Because of the destruction of bone, pathologic fracture is fairly common. In the oral manifestations, the mandible is involved far more frequently than the maxilla, especially the most active hematopoietic areas-the remus, angle and molar region of the mandible. Other signs and symptoms of jaw involvement include swelling, pain, and increased tooth mobility. Extraosseous lesions may result in paresthesia of soft tissue and gingival enlargement with bleeding tendency. Roentgenographic examination will usually reveal numerous punched-out lesions in a variety of bones. In addition, blood examination will reveal hyperglobulinemia and Bence-Jones protein may be present in the urine of myeloma patients. The histological features of myeloma are closely packed cells resembling plasma cells. Case 1 in this report is a 64-year-old female, who has been diagnosed as having multiple myeloma (IgG, lambda). She was referred to our hospital because of gingival swelling, bleeding and pain. Case 2 is a 60-year-old female suffering from spontaneous gingival bleeding. After blood, urine examination and bone marrow biopsy, multiple myeloma was diagnosed (IgG, lambda). This paper reports the clinical manifestations and treatment courses of these two cases, and the concerns of treatment of multiple myeloma are also discussed.

In previous studies we have investigated the furcation entrance dimension (FED), furcation entrance angle (FEA) and the distance between cementoenamel junction and furcation entrance (CEJ-FE) of the first and second molars and compared the Chinese with the Caucasians. The aim of the present study was to relate the FED, FEA, and distance of CEJ-FE to the clinical significance of periodontal therapy of molar furcations. All the FEDs, FEAs, and distance of CEJ-FEs of the molars were measured by a stereomicroscope equipped with a Bioscan OPTIMAS Image Analyzer and statistically analyzed by Student's paired t-test, multiple regression of ANOVA and correlation analysis. The results are summarized below. (1) There is a significant relationship between FEA and location of buccal, mesial, and distal furcations of maxillary first and second molars (16& 26, p < 0.001; 17&27, p < 0.01). (2) There exists a significant relationship between FEA and FED in the mandibular first and second molars. (3) There exists a significant relationship between FED and FEA in the mandibular second molar (r = 0.370, p < 0.05). (4) The prevalence of mean FED and FEA (type D, FED < or = 0.75 mm and FEA < or = 90 degree) of the maxillary first molar (45%) is twice as high as the maxillary first molar (24%). (5) The prevalence of type D of the buccal (32%) and lingual (37%) furcations on the mandibular second molar is markedly higher than the first molar (buccal = 12%; lingual = 4%, respectively). These results reveal that those topographics of the FED, FEA, and distance of CEJ-FE in second molars have poor prognosis in periodontal therapy when compared with first molars.

The purpose of the present study was to document the mean proximal alveolar bone loss of molars. The samples consisted of 219 subjects receiving of full mouth radiographs by standardized paralleling technique from Jan, 1992 to Jun, 1994. All the radiographs of 219 individuals suffered from adult periodontitis at age between 20 and 65 years old were measured, and were assessed mean proximal alveolar bone loss of molars and associated contributing factors. The main results indicated that (1) the mean proximal alveolar bone loss of the maxillary first and second molars accounted for 38. 4% and 33.5%, respectively, whereas the mandibular first and second molars were 34.8% and 31.6%, respectively; (2) within the same dental arch, mean proximal alveolar bone loss of the first molars was significant greater than that of the second molars, while the bone loss in the maxillary first molars was significant greater than that of the mandibular first molars. There was no difference between mean proximal bone loss of the maxillary and mandibular second molars; (3) mean alveolar bone loss of the first molars was significant greater than second molars in the same side of the dental arch. There was no significant difference in the mean proximal alveolar bone loss between right and left side molars. (4) average bone loss was the greatest (39.4%) at the mesial surfaces of maxillary first molars, whereas the least mean alveolar bone loss appeared at the distal surfaces of mandibular second molars. A significant difference of mean proximal alveolar bone loss was found between mesial and distal surfaces in mandibular first molars.

Gingivitis is one of the most common oral diseases. It is caused by dental plaque and by the factors produced/released from it. The black pigmented bacteria in subgingival dental plaque are thought to be the periodontopathogens. Prevotella intermedia and Porphyromonas gingivalis have been shown to be closely associated with human gingivitis. Prevetella intermedia can use female sex hormones such as progesterone or estradiol as a source of nutrients. In pregnant women, the concentrations of progesterone and estradiol are markedly increased in serum and both are accumulated and found in the gingival tissue. The purpose of this study was to test levels of female sex hormones in gingival crevicular fluid and to observe the relationship between hormones and black pigmented bacteria in subgingival plaque. The results showed that the amount of progesterone found in the gingival crevicular fluid and percentage of black pigmented bacteria in subgingival plaque of pregnant women were markedly higher than in the postpartum stage. The percentage of black pigmented bacteria was positively correlated with the progesterone level, pregnancy and the severity of the gingivitis. Severity of the gingivitis was positively correlated with both the plaque index and the percentage of black pigmented bacteria in subgingival plaque.

We performed a sequential neuropsychological tests before and after neurosurgical intervention on a 69-year-old patient with left hemineglect syndrome caused by metastatic right temporal papillary carcinoma. The tests performed before operation and computer tomography revealed marked impairment in visuospatial reasoning, spatial orientation, visual perception, visuoconstructional praxis, effort emory, as well as block design in Wechsler Adult Intellectual Scale-Revised, all of which suggested right temporo-parietal lesion. Left spatial neglect was obviously demonstrated by the Line Cancellation Test, Watch Test, and clinical observation. After surgical debulking of the tumor, his performances on most of the tests were improved. Our study demonstrated that the conventional neuropsychological test is not only useful for localizing the cerebral lesion but also valid for the assessment of functional recovery after treatment, a role that can never be replaced by any other modern technique.

The purpose of this study was to explore the difference in postpartum adjustment between women who were at home for there "doing the month" and those who stayed in a maternity care center. A repeated measures design was conducted, with data collected at 1 and 4 weeks postpartum. A total of 120 postpartum women participated in this study. Data were analyzed by factor analysis to determine the relationships within categories of postpartum strssors and depression. Then, the data were analyzed by 2 x 2 repeated measure MANOVA to determine the variations among groups and time. The results indicated that women who were in maternity centers for the "doing the month" perceived significantly higher stress than did the home group, and that women perceived higher stress at 4 weeks postpartum than at 1 week postpartum. Factor analysis of the data defined four categories of postpartum stress. It was found that women at maternity care centers perceived significantly higher stress from factors named, "stress from lacking of support system" and "stress from identifying maternal role". In addition, women doing the month at maternity care centers showed significantly higher depression level than women doing the month at home. However, there is no significant difference in postpartum stress and postpartum depression between time 1 (1 week postpartum) and time 2 (4 weeks postpartum).

Vibrio vulnificus is a halophilic Vibrio that has been isolated repeatedly from sea-water and shellfish during the warm months of the year. It's a virulent pathogen for men and is frequently associated with overwhelming infections including sepsis, gangrene of extremities and high mortality rate. We encountered a 13-year-old boy who had a history of beta-thalassemia major with secondary hemochromatosis, suffering from vomiting, diarrhea, fever and hypotension. Physical examination revealed that ecchymosis, bullae and ulceration were noted over the left leg. Vibrio vulnificus was isolated from the blood. Initially, the patient did not respond to the appropriate antibiotics treatment, subsequently surgical debridement was performed. After that, the patient recovered gradually, and discharged home after 17 days of admission. In conclusion, when patients present with sepsis and/or characteristic skin lesion-hemorrhagic bullae, particularly those with thalassemia major, hemochromatosis or underlying liver disease and a history of marine exposure, clinicians should be alerted to this potentially fatal infection and should commence appropriate assessment and treatment immediately.

Conducted a survey at Veterans General Hospital in Taichung, to compile a statistical analysis on the usage of fresh frozen plasma (FFP) transfusions. The investigation was conducted from July 1st to September 30, 1991. According to the distribution of usage of FFP, we investigated 726 transfusions (4,216 units) based on our grouping criteria. We found the following: 532 units were used for clotting support which accounts for 12.6% of total, 815 units (19.3%) for blood pressure support, 148 units (3.5%) for combination of clotting and blood pressure support, 681 units (16.2%) for albumin replacement, 436 units (10.3%) for therapeutic pheresis, 396 units (9.4%) for packed red cell concurrently, 819 units (19.4%) for burn cases, and the remaining (9.2%) for other or unidentified reasons. If it was classified by the departments applying FFP; 76% (3,200 units) were used by surgery, 22.4% (947 units) by internal medicine, and 1.6% (69 units) by other departments. Having classified all the reasons for FFP transfusion, we found that FFP was commonly used as a volume expander, for nutrition support, and reconstituted whole blood. These reasons are out of the range of indications for FFP transfusion. This misuse of FFP transfusion increases the chance of transmission infections therefore, we will thoroughly investigate these treatment modalities in order to ensure our blood source is being used in an appropriate manner. This will allow patients the best possible treatment available.

We diagnosed 627 cases of SCLC from 1971 to 1985 in VGH-Taipei. Sixty-nine cases received no treatment, while 558 cases received treatment including chemotherapy, radiotherapy, surgical intervention or combined modality. The median survival time of the treated group and untreated group was 6 and 1 months respectively (p less than 0.001). Female sex was a positive prognostic factor (p less than 0.05) and median survival time of female and male were 7 and 5 months respectively. Age (older or younger than 65 y/o) was not a significant prognostic factor in our series (p = 0.13). Thirteen cases (2.33%) of patients in the treated group survived longer than 5 years. Among them, 11 cases were limited disease and 2 cases were extensive disease. The characteristics of these 13 patients were analysed to find them in relatively good performance status, less body weight loss, less biochemical abnormality and more limited disease. In them, no secondary tumor was noted during the follow-up period.

It is well recognized that meniscal tear in the avascular portion is difficult to heal. The purpose of this study is to evaluate the ability of periosteum and fibrin adhesive system (FAS) in promoting the meniscal repair in the avascular zone. Full-thickness defects of 1 x 3 mm were created in the avascular portion of lateral menisci in adult mongrels. The control menisci were left without any treatment. The experimental defects were either repaired with autogenous periosteum or the combination of periosteum and FAS. Histologic and ultrastructural evaluation of the reparative tissue were compared at 4, 8, and 16 weeks postoperatively. The reparative tissue in the control group remained fibrous even at week 16, whereas that in the grafted and graft/FAS groups resembled normal adjacent fibrocartilage. Moreover, the regenerated chondrocytes in the graft/FAS group appeared more mature than those in the grafted group. Our results suggest that periosteum is a potential source of primitive cells from which chondrocytes could be differentiated and developed during the reparative process of meniscal fibrocartilage. As to FAS, it not only acted as a hemostatic agent and a fixant, but also could indirectly accelerate the chondrogenesis of periosteum in the meniscal defects. It is sufficient to conclude that the combination of periosteum and FAS in promoting meniscal defects or severe tears in the avascular portion bears its potential in future clinical application.

The purpose of the present research was to develop child abuse potential inventories as a screening tool. The sample was 248 families who were all financially supported by Chinese Children's Fund. Kaohsiung Family Helper. One of the inventories selected, that was translated into Chinese by the expert committee, was the Child Abuse Potential Inventory developed by Milner. The internal consistency and test-retest reliabilities obtained by this research were as good as Milner's and basic interpretation of four factors was found to be was consistent with Milner's data. The other inventory developed by the expert committee was the Child Abuse Potential Interview used by social workers to interview caretakers. Having completed the questionnaire social workers rated 15 items, i.e. immaturity, lack of parenting skills, unrealistic expectancy, social isolation, unresolved affective needs, abused experiences, crisis, substance abuse etc. The coefficients of correlation between these two inventories were 0.20-0.37, respectively, which indicated that these inventories assessed abuse potential trait and uniqueness. Therefore, these inventories were considered both highly applicable.

Congenital atrioventricular block is a congenital disorder of the cardiac conducting system. Pacemaker implantation is the treatment of choice for patients with congenital A-V block if prior medical treatment fails. The criteria for pacemaker implantation in infants and children are (1) frequent syncope (2) heart failure (3) ventricular rate below 55 beats/min (4) ventricular arrhythmia (5) QRS widening in the ECG (6) moderate to severe exercise intolerance. Our experience with a 15-month-old male child is herein presented. The patient suffered from frequent attacks of upper respiratory tract infection, bradycardia and complete A-V block as found on electrocardiograms. At 15 months old, he was admitted again due to respiratory tract infection and several attacks of syncope. Stokes-Adams syndrome was noted several times despite medical treatment. Following implantation of a VVI mode epicardiac pacemaker, the patient's condition, including resistance to heart failure and respiration, were improved dramatically. He was followed up regularly for 4 years, his heart beat remaining stable.

From July 1987 to December 1988, 19,625 children in Taiwan were measured for their body weights and heights. They were 9,564 boys and 10,061 girls and were seen either in a well baby clinic of a large community hospital or in the local kindergartens. We divided these children into 64 groups according to their sex and ages. The mean values and standard deviation of body weight and height were tried to correlate with those from children of school age reported for 1987 by the Ministry of Education. Furthermore, body weight and height growth curves were drawn for these children, aged from 1 month to 18 years.

A retrospective study of the clinical features and management of 27 newborns with meningitis is presented. All were treated in the China Medical College Hospital between July 1981 and July 1988. Seven were premature and twenty were full term. There were 11 males and 16 females. Five infants had low birth weight (less than 2500 g) and 12 cases were diagnosed in the first week of life (early onset). E.coli was the predominant pathogen. The most common presenting manifestations were nonspecific in nature-fever, poor feeding, respiratory distress and poor activity, etc... Six patients died during the period of acute illness and the case fatality rate was 22.2%. Of the 21 patients who survived, six had sequelae (four hydrocephalus, one subdural effusion, one microcephaly), giving an over-all rate of 19 percent in the survivors. The presence of gram-negative bacterial infection and high protein content in CSF correlated significantly with the higher mortality rate.