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Niemann-Pick disease type C (NP-C) is a rare inherited neurovisceral disease characterized by progressive neurological manifestations. Oral miglustat was first approved for the treatment of children and adults with NP-C in Europe in 2009. There are still relatively few published data on the long-term efficacy and safety of miglustat in patients with NP-C in clinical practice. We report the effects of up to 6 years of treatment with miglustat 100 mg t.i.d. in five children. Overall, 3/5 patients displayed progressive dysphagia before starting miglustat, and 4/5 showed marked cognitive and/or motor impairment. The mean age at treatment start was 11.6 years, and the median (range) duration of therapy so far is 4 (4.1 to 6.1) years. No treatment dose alterations were required, but therapy was interrupted for 1–3 months at least once in all patients due to supply issues. Swallowing function was stabilised during miglustat therapy, with no significant increase in Han dysphagia scale or aspiration-penetration index scores among four evaluable patients (p > 0.05). Scores on the mini-mental state examination indicated an improvement in cognitive function during the first 3–6 months of miglustat therapy, followed by stabilisation up to 5 years. Ambulatory function remained stable for at least the first 2 years of treatment in most patients, but there was a trend towards deterioration thereafter, possibly related to treatment interruptions. The safety/tolerability profile of miglustat was similar to previous clinical studies, although reports of gastrointestinal disturbances were rare. Overall, miglustat appeared to stabilise key parameters of neurological disease progression.

Background/aims: In the present study, we attempted to develop a simulated model to explore the causal effects of periodontal pathogens on skeletal homeostasis in postmenopausal osteoporosis. Methods: Fifty-three female adult ICR mice were randomly assigned to an experimental group (ovariectomized) or a control group. A single injection of Porphyromonas gingivalis lipopolysaccharide (P. gingivalis-LPS, ATCC 33277) or Escherichia coli lipopolysaccharide (E. coli-LPS) was administered intraperitoneally 4 weeks after an ovariectomy. Concentrations of interleukin-6 (IL-6), osteoprotegerin (OPG), and the receptor activator of nuclear factor-κB ligand (RANKL) in serum were subsequently analyzed using an enzyme-linked immunosorbent assay (ELISA). Results: Under stimulation with P. gingivalis-LPS or E. coli-LPS, the concentration of OPG rose in both groups. The serum level of RANKL showed a decreasing trend 24 h after the injection in both groups. After injection of P. gingivalis-LPS in both the experimental and control animals, the OPG : RANKL ratio increased 24 h after the booster (22.26–620.99, P

The water extract of Anoectochilus formosanus Hayata showed a potent tumor inhibitory activity in BALB/c mice after subcutaneous transplantation of CT-26 murine colon cancer cells. The tumor-inhibition ratios of mice pre-administered with A. formosanus for 2 days before tumor transplantation, and treated further for 12 consecutive days, were 55.4% and 58.9% at the oral dose of 50 and 10 mg/mouse per day, respectively. Even for the tumor-bearing mice, after oral administration of the water extract of A. formosanus for 12 consecutive days, the tumor inhibition ratios were still 23.8% and 40.5% at doses of 50 and 10 mg/mouse, respectively. Because the low-concentration water extract of A. formosanus does not show direct cytotoxicity in CT-26 tumor cells, we observed further that oral administration of the water extract of A. formosanus may activate murine immune responses, such as stimulating the proliferation of lymphoid tissues and activating the phagocytosis of peritoneal macrophages against Staphylococcus aureus. This study suggests that the antitumor activity of A. formosanus may be associated with its potent immunostimulating effect. It is worth further analyzing the immunomodulating component purified from A. formosanus, and evaluating its potential value for the treatment of human cancers.

Lu H-K, Tseng C-C, Lee Y-H, Li C-L, Wang L-F. Flutamide inhibits nifedipine- and interleukin-1β-induced collagen overproduction in gingival fibroblasts. J Periodont Res 2010; 45: 451–457. © 2010 John Wiley & Sons A/S Background and Objective: To understand the role of the androgen receptor in gingival overgrowth, the effects of flutamide on interleukin-1β- and nifedipine-induced gene expression of connective tissue growth factor (CTGF/CCN2) and collagen production in gingival fibroblasts were examined. Material and Methods: Gingival fibroblasts from healthy subjects and patients with dihydropyridine-induced gingival overgrowth (DIGO) were used. Confluent cells were treated with nifedipine, interleukin-1β or both. The mRNA expression was examined using real-time polymerase chain reaction, and the concentration of total soluble collagen in conditioned media was analysed by Sircol Collagen Assay. In addition, the protein expressions of androgen receptor, CTGF/CCN2 and type I collagen in gingival tissue were determined by western blot. Results: Interleukin-1β was more potent than nifedipine in stimulating CTGF/CCN2 and procollagen α1(I) mRNA expression, and there was an additive effect of the two drugs. Healthy cells exhibited an equal or stronger response of procollagen α1(I) than those with DIGO, but DIGO cells displayed a stronger response in the secretion of soluble collagen in the same conditions. Flutamide, an androgen receptor antagonist, inhibited stimulation by nifedipine or interleukin-1β. Additionally, the protein expressions of androgen receptor and type I collagen were higher in DIGO gingival tissue than those in healthy gingival tissue. Conclusion: The data suggest that both nifedipine and interleukin-1β play an important role in DIGO via androgen receptor upregulation and that gingival overgrowth is mainly due to collagen accumulation. Flutamide decreases the gene expression and protein production of collagen from dihydropyridine-induced overgrowth cells.

Actinobacillus actinomycetemcomitans (Aa) has been implicated as the putative micro-organism for localized juvenile periodontitis (LJP). The most distinct clinical features of LJP include severe angular bony defects of the mesial sides of permanent first molars and the onset of disease during puberty. Currently, no large-scale studies have been performed which address the change in detection rates of Aa on the mesial sides of permanent 1st molars following eruption and up to puberty.In this study, subgingival plaque samples were taken from the mesial pockets of 2 randomly selected permanent 1st molars from 328 primary school children and 50 adult staff, and analyzed by polymerase chain reaction (PCR) to detect Aa.The results showed a 5.5% prevalence rate of Aa which increased after the eruption of 1st molars and peaked near puberty. There were no significant differences in the detection rates of Aa among different groups in terms of gender, plaque index (PII), and gingival index (GI); however, the higher detection rates of Aa were significantly associated with increased probing depths at p0.05.PCR analysis of the subgingival plaques demonstrated a prevalence of Aa which peaked near puberty, suggesting that Aa may be important for LJP in Taiwan.

To examine the relation between the results of ambulatory 24-hour blood pressure monitoring (ABPM) and left ventricular mass index (LVMI), then to find the independent determinant for left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients. Finally, to evaluate the differences in the clinical and cardiovascular characteristics between patients on continuous ambulatory PD (CAPD) and continuous cyclic PD (CCPD).An open, nonrandomized, cross-sectional study.Divisions of nephrology and cardiology in a medical center.Thirty-two uremic patients on maintenance PD therapy (22 patients on CAPD, and 10 on CCPD) without anatomical heart disease or history of receiving long-term hemodialysis.Home blood pressure (BP) and office BP were measured using the Korotkoff sound technique by sphygmomanometer. ABPM was employed for continuous measurement of BP. Echocardiography was performed for measurement of cardiac parameters and calculation of LVMI.Multivariate logistic regression analysis was performed for independent determinant of LVH in PD patients. The differences in clinical and cardiovascular characteristics between CAPD and CCPD patients were compared.Simple regression analysis showed positive correlations between LVMI and the duration of hypertension, ambulatory nighttime BP/BP load/BP load30%, serum phosphate, calcium-phosphate product, ultrafiltration (UF) volume, and percentage of UF volume during the nighttime. A negative correlation was noted between LVMI and dipping. In multiple regression analysis, the duration of hypertension was the only variable linked to LVMI. In multivariate logistic regression analysis, only ambulatory nighttime systolic BP load30% had an independent association with LVH. There were correlations between office/home BP and ambulatory 24-hour BP. In addition, CCPD patients had higher LVMI, UF volume during the nighttime, and percentage of UF volume during the nighttime than those of CAPD patients.In this study, ambulatory nighttime systolic BP load30% had an independent association with LVH. Office and home BP measurements were correlated with ABPM in PD patients. The result that CCPD patients had a higher LVMI than CAPD patients may be due to a relative volume overload during the daytime in CCPD patients.

There are some racial differences in the prevalence and prognosis of idiopathic nephrotic syndrome; however, reports about minimal change disease (MCD) in Chinese were rare. We retrospectively analyzed 123 Chinese adults with idiopathic nephrotic syndrome, who received percutaneous renal biopsy in our institution within the last 10 years. In total, 46 patients (37.4%) were compatible with the pathological diagnosis of MCD. The male to female ratio was 1.2:1. The mean age of onset was 30.9 years, and 80% of the patients with MCD were less than 40 years. The mean daily proteinuria was 10.2 g, and serum albumin was 1.8 mg/dl. Azotemia occurred in 16 (35%) of 46 cases; hypertension, 13%; and microscopic hematuria, 13%. High selectivity index for proteinuria (SI0.1) was noted in 12 (39%) of 31 cases; and high IgE level was found in 83.7% of the study subjects, although only one case had allergic history. Complete remission in 36 MCD patients treated with corticosteroid was achieved by 42% (15/36), 80% (29/36), and 94% (34/36) within 4, 8, and 12 weeks, respectively. The time interval to remission was similar between the younger group (40 years old, 1.7 months) and older group (40 years old, 1.6 months). Nineteen (56%) of 34 cases with steroid response did not relapse, and the other cases (44%) had a mean relapse rate of 1.5 times per patient within a period of 45 months. The age of onset in MCD cases was not significantly correlated with steroid-responsive rate, and the time interval to remission. However, a tendency existed between the onset in the young age and the sequentially relapsing rate (p = 0.06). Two cases with primary steroid resistance and 5 cases with frequent relapse or steroid dependence responded well to intravenous pulse therapy of cyclophosphamide, except one refractory case. No thrombotic episode was ever noted in our group. Regarding infectious complications, primary peritonitis occurred in one, pneumonia in one, and cellulitis in 6 cases during active nephrotic stage. Two mortality cases, one with E. coli-related necrotizing fasciitis and one from pneumonia, were noted. In brief, compared with children, adult patients with MCD had lesser high selectivity index for proteinuria, the same steroid-responsive rate (94%), but slower response, and significantly lesser relapsing rate. The intravenous pulse therapy of cyclophosphamide may be an alternative regimen for adult patients with steroid resistance or dependency. In addition, the Asian adult-onset MCD had younger age, male predominance, and lesser relapsing rate in comparison to those of the Western population.

It has been assumed that there is a relationship between periodontal diseases and diabetes mellitus, however the putative periodontal microorganisms in non-diabetes mellitus (non-DM) individuals and non-insulin-dependent diabetes mellitus (NIDDM) patients have not been well studied. In this study, the detection rates of 5 putative periodontal pathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Eikenella corrodens, Treponema denticola, and Candida albicans by polymerase chain reaction (PCR) between NIDDM and non-DM adults were compared. A total of 246 adults were randomly recruited and periodontal parameters including: plaque index (P1I), gingival index (GI), probing depth (PD) and attachment level (AL) were recorded. Subgingival plaque samples were collected by sterile curettes from the most diseased and healthy sites based on PD and AL. The differences in periodontal parameters and microbiological data in healthy and diseased sites between non-DM and NIDDM patients were compared by chi-square analysis. The results showed no significant differences in age, gender, GI, P1I, PD, and prevalence of the 5 microorganisms between the NIDDM and the non-diabetic groups. However, except for A. actinomycetemcomitans, the prevalence of the periodontal microorganisms tested was significantly higher (p0.001) in diseased sites than in the healthy sites in both groups. The P1I, GI, PD and AL were significantly higher in T. denticola positive sites than in negative sites. The results suggested that P. gingivalis, T. denticola, E. corrodens and C. albicans may play important roles in the periodontitis of both NIDDM and non-DM individuals, however the etiology of periodontitis in both groups may not be different from each other.

To characterize phenotypic and genotypic changes in gastric cancer (GC), DNA copy number aberrations (CNAs) were assessed in 53 tumors using comparative genomic hybridization (CGH) and correlated with clinicopathologic characteristics and status of TP53 and replication error (RER). The number of CNAs per tumor was 6.8 (gain 5.3, loss 1.5), and the number of changes was significantly higher in tumors with advanced stage, TP53 mutation, and without RER than in those with early stage (7.7 vs. 3.0), no TP53 mutations (12.4 vs. 4.8) or RER phenotype (8.2 vs. 2.6). Frequent abnormalities included gains on chromosomal arms 8q (43%), 6q (26%), 11q (26%), 13q (24%), 7p (23%), 17q (23%), and 20q (23%), and losses on chromosomal arms 16q (26%), 19p (23%), 5q (19%), 3p (15%), 4q(15%), and 1p (15%). Advanced GC demonstrated a higher prevalence of gains of 8q (51% vs. 10%, P0.05) and loss of 16q (33% vs. 0%, P0.05) than early GC. Gains on 8q (64% vs. 20%, P0.05), 17q (39% vs. 4%, P0.05) and losses on 3p (25% vs. 4%, P = 0.05) and 5q (32% vs. 4%, P0.05) were higher in intestinal GC than in diffuse GC. On the other hand, gains on 13q were more common in the diffuse type (40% vs. 11%, P0.05). As compared with noncardia cancer, cardia cancer showed more gains on 7p (58% vs. 12%, P0.05) and 20q (58% vs. 12%, P0.05) and more losses on 4q (50% vs. 5%, P0.05). The finding of histology-related aberrations and the combination of CGH and molecular data thus provide additional evidence suggesting genetic heterogeneity of GC.

The frequent association of gastric atrophy and intestinal metaplasia in gastric cancer (GC) might preclude serologic detection of Helicobacter pylori (H. pylori) infection in GC. By using polymerase chain reaction (PCR) for detection, we would like to determine whether there exists a subset of genuinely H. pylori-negative GC patients, and whether they have distinct clinicopathologic features or not.IgG antibodies against H. pylori were determined by ELISA in sera, and H. pylori DNA was detected by PCR in resected gastric specimens from 160 GC patients. Clinicopathologic characteristics were then compared among group A: seropositive, group B: seronegative but PCR-positive, and group C: seronegative and PCR-negative.Among 160 patients, 105 (65.6%) were classified as group A, 25 (15.6%) as group B, and 30 (18.8%) as group C. Group B patients were older and had more infiltrative tumor growth than group A. Group C had a significantly higher frequency of female predominance, and their cancers were of a more cardiac location and of the diffuse histologic subtype than those of groups A and B.A significant portion (15.6%) was negative to ELISA but positive to PCR, suggesting that older ages and infiltrative tumor growth might preclude serologic detection of H. pylori infection by impairing humoral responses. Although the majority (81.2%) has a strong association with H. pylori infection, an H. pylori-negative subset indeed exists and has distinct clinicopathologic features, supporting that causes other than H. pylori infection are involved in GC carcinogenesis.

Oligodontia is defined as the congenital absence of six or more teeth, excluding the third molars. Genetic factors play an important role in oligodontia, which can occur as an isolated finding or as part of a syndrome. Characteristic dental symptoms are a reduced number of teeth, a reduction in tooth size, anomalies of tooth form, and delayed eruption. This article describes treatment of a 6-year-old girl with congenital absence of 16 permanent teeth. Her malocclusion was corrected by orthodontic therapy, and removable partial dentures were made to improve esthetics and chewing function.

The aim of this study is to determine the diagnostic value of 24-hour ambulatory esophageal manometry and pH-metry for patients with noncardiac chest pain (NCCP), but no reflux symptoms. Twenty-four hour ambulatory esophageal manometry and pH-metry was performed on 34 patients with NCCP, but no reflux symptoms. The pressure transducers were located 3, 8, and 13 cm above the lower esophageal sphincter (LES) and the pH probes were located 5 and 20 cm above the LES. An event marker was triggered by the patient for chest pain. Only 17 patients (50%) had at least one pain episode (total 81 episodes, range 1-19 episodes per person) during a 24-hour recording. Twenty-one chest pain episodes (26%) occurred during abnormal motility, whereas 4 episodes (5%) were associated with pH4, and 10 episodes (12%) had both abnormalities. The majority of chest pain episodes, 46 out of 81 events (57%), did not have any association with motility or pH abnormalities. Five of 7 patients (71%) with reflux-related chest pain and 8 of 11 patients (73%) with dysmotility-related chest pain had symptom association probability95%, indicating a significant association between chest pain and esophageal dysfunction. Our conclusion is that ambulatory esophageal manometry and pH-metry is a useful tool in the evaluation of NCCP, but only a few additional patients with reflux-related chest pain could be found in patients without reflux symptoms.

Traditionally, crown-lengthening procedures to expose subgingival caries for operative restorative work are carried out in a two-stage approach. A disadvantage of this procedure is that the gingival margin associated with the treated tooth moves apically; this may create an esthetic problem. Resin-modified glass-ionomer cement has been demonstrated to have good biocompatibility with dental hard and soft tissues. Surgical and restorative procedures were combined at the same appointment in an effort to achieve a restoration with minimal change in the gingival margin. Four patients have been treated with this one-stage team approach and followed for 8 to 13 months. The clinical results demonstrated this team approach procedure is excellent for the dentition when esthetics is a consideration.

A randomised trial was undertaken to compare the effect of three oral care protocols in delaying the onset of stomatitis and reducing oral injury in nasopharyngeal cancer patients undergoing radiotherapy, 30 eligible patients with a mean age of 56.2 years were recruited and evenly allocated to one of the three groups using a randomly permuted blocks method. Patients allocated to group E1 and group E2 were given the same instructions on oral care at 1 day, and 1 week before radiotherapy, respectively, while those allocated to the control group were given no instructions. We use the Oral Assessment Guide to assess the oral physical conditions of these patients daily. Our findings revealed that the patients in the E2 group not only had later onset of stomatitis than those in the control and the E1 groups, but also had lesser degree of oral injury measured by the overall assessment score. We thereby recommend the use of the E2 protocol for delaying the onset of stomatitis and reducing oral injury in nasopharyngeal cancer patients undergoing radiotherapy.

One-lung ventilation during anesthesia (one-lung anesthesia) in patients under lateral decubitus position to help performing intra-thoracic surgical procedures was well known to have larger alveolar-to-arterial oxygen tension difference and lower arterial oxygen tension (PaO2) as compared to two-lung ventilation. In the present study, we investigate the changes of arterial oxygen tension in the supine position during one-lung anesthesia.Forty-two patients of palmar hyperhidrosis, ASA class I-II, scheduled to receive bilateral transthoracic endoscopic sympathectomy were studied. After anesthetic induction (fentanyl, thiopental, and succinylcholine), a 35 (for female) or 37 (for male) French left-sided Robertshaw double-lumen endobronchial tube was intubated. Anesthesia was maintained with isoflurane 1.0-1.5% and 50% O2-N2O. They were changed to isoflurane 1.5-2.0% and 100% O2 during one-lung ventilation. Once the surgical operation is completed, they were changed to 100% O2 and two-lung ventilation. Arterial blood gases were measured at 4 phases: 5 min after endobronchial intubation (two-lung ventilation), 5 min after left one-lung ventilation, 5 min after right one-lung ventilation, and 5 min after accomplishing operation (two-lung ventilation).The results showed PaO2 were significantly lower in left and right one-lung ventilation with 100% O2 as compared with that obtained from two-lung ventilation with 50% O2 5 min after endobronchial intubation (p0.05). Furthermore, right one-lung ventilation had a lower PaO2 than left one-lung ventilation (p0.05).We conclude that arterial oxygen tension can be safely maintained during one-lung anesthesia with pure oxygen in healthy patients lying in a supine position.

Patients with liver cirrhosis usually die of hepatic failure and variceal bleeding. Successful treatment of the latter can reduce mortality. Sclerotherapy is one method often used. This study compared (a) the successful rate of acute bleeding control; (b) short- and long-term survival rate between those with and without treatment with sclerotherapy to evaluate the clinical benefit of sclerotherapy for liver cirrhosis patients with esophageal variceal bleeding.Between August 1983 and December 1991, 183 cirrhotic patients with esophageal variceal bleeding receiving endoscopic injection sclerotherapy (EIS) was compared with 123 patients without sclerotherapy treatment retrospectively. The severity of underlying liver disease was classified using a modified Child's classification. Sclerotherapy was done within 48 hours after active bleeding in the sclerotherapy-treated group, while the medical treatment group received Sengstaken-Blakemore (SB) tube or pitressin infusion only.Successful rate of acute bleeding control was 81.63% (120/147) in the EIS group and 59.35% (73/123) in the medical treatment group. The worse the hepatic function of the patients, the lower the success of acute bleeding control in both groups. Fifty subjects (74.63%) had varices eradicated in 67 sclerotherapy treatment patients with regular follow-up. Patients receiving EIS had a better long-term survival than those without treatment. Benefit of EIS on long-term survival was more significant in Child B patients and less in Child C and Child A patients. Death from variceal bleeding was lower in the EIS group than in the medical treatment group (32% vs 62.6%). Complications of EIS were rare. Eight patients died of aspiration pneumonia, spontaneous bacterial peritonitis or acute renal failure after sclerotherapy, and most were Child B and C patients. Sixteen patients had esophageal stricture. Four needed dilatation treatment.The sclerotherapy-treated group had a higher control rate of acute bleeding and lower mortality rate from esophageal variceal bleeding compared with the medical-treated group. The procedure prolonged long-term survival in Child B patients but did so less frequently in Child A and Child C patients. The incidence of complications was low. As a whole, EIS is a safe and efficient method for control of esophageal variceal bleeding.

The purpose of this study was to evaluate the oral health conditions of subjects in a southern Taiwan health checkup program. One half of the examinees were selected randomly for oral examination during a two-year period. There were 537 subjects, including 286 men and 251 women with mean ages of 49.7 +/- 13.5 years and 50.2 +/- 12.1 years, respectively. Oral examinations included periodontal condition and existence of dental caries. The periodontal treatment needs of all examinees were evaluated using the Community Periodontal Index of Treatment Needs system and the World Health Organization periodontal probe. Dental caries examination was performed by the visual-tactile method with a mouth mirror and explorer. No radiographs were taken. All clinical evaluations were performed by the first author, who has experience in all of the indices. The results showed that only 0.7% of the subjects had no need of periodontal treatment, 6.7% had bleeding after gentle probing, and 75.2% presented with calculus, overhanging restorations, or pockets of 4 or 5 mm. The remaining 17.3% had pocket depths of 6 mm or deeper. There was no statistically significant difference between males and females in periodontal treatment needs and the mean number of decayed teeth (D). According to this hospital-based observation, most of the people in the health checkup program were in need of periodontal treatment, including oral hygiene instruction, prophylaxis and root planing. Approximately one-fifth of the subjects needed complex periodontal treatment; there were no differences in the treatment needs of males and females.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to evaluate the incidence of clinical infection after routine periodontal surgery. The population studied comprised patients in need of periodontal surgery at the Periodontal Division, Dental Department, National Cheng Kung University Hospital, during the period from January 1989 to June 1990. A total of 207 patients including 103 males and 104 females were involved, and 220 surgical procedures were carried out under aseptic conditions. Patients allergic to antibiotics or with any systemic problems were excluded from this study. Following surgery, 82 surgical cases were prescribed antibiotics (group 1), and 138 surgical cases were not prescribed antibiotics (group 2). Periodontal surgical techniques employed included flap surgery, osseous surgery, gingivectomy/gingivoplasty, soft tissue grafting, and tooth resection. Postoperative infection was defined as progressively severe pain, pus exudate, local swelling, and lymphadenopathy. The degree of wound redness and swelling was also recorded. The mean age in group 1 was 38.3 +/- 13.8 and was 38.9 +/- 14.6 years in group 2 (p = 0.78). The total occurrence of postoperative infection was 3.6% (8/220), including 3.7% (3/82) in the group with antibiotics and 3.6% (5/138) in the group without antibiotics. There was no statistical difference in the incidence of postoperative infection between the two groups (Zc = -0.36, p = 0.72). Based on the results of this prospective study, we conclude that the routine prescription of antibiotics is not necessary following periodontal surgery using aseptic surgical techniques.

It was retrospectively analyzed whether intravesical instillation of bacillus Calmette-Guerin (BCG) or anti-cancer agents had prophylactic effect or not after removal of superficial bladder tumors. The results over a follow-up period ranging from 6 to 40 months showed 23.8 per cent recurrence in group 1 patients treated with BCG (21 patients), 46.7 per cent recurrence in group 2 treated with anti-cancer agents (45 patients) and 52.3 per cent recurrence in the group 3 (127 patients) which were not received any intravesical drugs. Long-term results among the 3 groups calculated with Kaplan-Meier method demonstrated that the instillation of BCG or of anti-cancer agents was more useful for prophylaxis, compared with the actuarial non-recurrence rates of group 3. The instillation of BCG showed good prophylactic effects especially in recurrent, grade 2 and pTa bladder tumors. The instillation of anti-cancer agents showed to provide prolonged protection from recurrence, but the instillation of BCG did not.

To investigate the relationship between "systemic" antitumor immunity and "local" antitumor immunity with respect to the histopathological stage of gastric cancer, interleukin-2 stimulated mixed lymphocyte tumor extract reactions (ILS-MLTR) of peripheral blood lymphocytes (PBL) and regional node lymphocytes (RNL) were evaluated in 59 gastric cancer patients. ILS-MLTRs of both PBL and RNL decreased with the advance of cancer stage, but ILS-MLTRs of PBL were always lower than those of RNL. Positive correlations in MLTR between PBL and RNL were found in patients with depth of invasion to muscularis propria and serosa and peritoneal dissemination. Inverse correlations between PBL and RNL were noted in patients with stage IV and distant nodal involvement. These results suggest that variations in the anticancer immunities might be effectively managed by an immunotherapy which is designed according to the responsiveness in the immune parameter ILS-MLTR.

To investigate the association between pre-walking locomotor strategies and psychomotor developments in children with mental retardation (MR), 50 children with non-specific MR were included in this study. There were 29 boys and 21 girls, 96% of whom had moderate to severe MR. They were followed from 4-53 months to 25-99 months of age, and their follow-up periods ranged from 10 to 48 months (mean 30 months). According to the pre-walking locomotor strategies, these children were categorized into three groups: the crawling group (n = 34) who used crawling or creeping as their main locomotion pattern before independent walking; the shuffling group (n = 9) who used shuffling prior to independent walking; and the direct-walking group (n = 7) who did not have any other locomotor strategies except rolling. In almost all motor developmental milestones, children in the direct-walking group developed earlier than those in the crawling and shuffling groups. Children in the crawling group had more advanced developments than those in the shuffling group. The difference in the mean ratio developmental quotients of the Bayley Mental Scale among the three groups was not significant. The present study showed that crawling may not be a necessary prerequisite for early ambulation or better cognitive function in MR children.

High-dose fentanyl has become a popular anesthetic agent for cardiac anesthesia because of its cardiac stability. Little attention has yet been paid to the relationship between the dose and problems during the early postoperative period. This study was designed to investigate whether higher doses of fentanyl combined with diazepam would influence the early-stage of postoperative conditions. Sixteen patients scheduled for elective coronary artery bypass graft (CABG) surgery were studied. All of them had adequate cardiac performance, and were randomly divided into two groups, 9 in Group I and 7 in Group II. Group I received fentanyl (less than 100 micrograms/kg) combined with diazepam (less than 0.2 mg/kg). In Group II the doses of both drugs were greater than that used in Group I. The cardiovascular changes, the maximal infusion rates of dopamine, nitroglycerin (NTG), and sodium nitroprusside (Nipride) were observed. Meanwhile, the awakening time from anesthesia, the time of extubation, and the duration of stay in the intensive care unit (ICU) were also recorded. The results showed that there were no significant differences between both groups regarding the factors studied except the maximal infusion rate of Nipride and the awakening time of post-anesthesia. We suggest that higher doses of fentanyl combined with diazepam can reduce the dosage of vasodilator but do not prolong the time of extubation and stay in ICU.

The in vivo function of NK cells is still uncertain, and there are various contradictory reports on NK cells in gastrointestinal cancer. In the present study the activity and proportion of NK cells (Leu 11 + cells) in peripheral blood were assessed in 71 patients with gastric cancer, and analysed with respect to the clinical and histopathological factors, such as the clinical stage, tumor size, degree of invasion, metastasis, histology, etc. There were no differences in the proportions and activities of NK cells between normal volunteers and gastric cancer patients. A low NK cell activity was associated with early gastric cancers (carcinoma in the mucosa or submucosa) less than 2 cm in diameter, large advanced tumors (invasion beyond the muscularis propria) greater than 8 cm in diameter, and metastasis of adjacent regional (perigastric) nodes. Liver metastasis did not affect the NK cell activity, however a high NK activity was found in patients with peritoneal dissemination. The NK activity did not correlate with the proportion of Leu 11 + cells in normal volunteers or in patients with early gastric cancer, however the activity and proportion of NK cells correlated with each other in patients with advanced gastric cancer. These results suggest that the preoperative evaluation of circulating NK cells in gastric cancer patients may be beneficial to assess the extent of nodal metastasis, the degree of tumor invasion, and peritoneal dissemination.

Sjögren's Syndrome (SS) is a chronic inflammatory disease characterized by xerostomia. Although it is confirmed that a common observation in SS is increased susceptibility to caries, the degree of influence of SS on periodontal disease has not been well-described. The purpose of this study was to determine the periodontal status of 14 SS female subjects and 14 age-matched females, who did not exhibit SS (controls). The mean age of the SS and control subjects were 52.9 +/- 11.6 and 53.7 +/- 8.9, respectively. The plaque (PI), gingival (GI), bleeding (BI) and calculus (CI) indexes, as well as probing depth (PD) and attachment level (AL), were estimated on 7 index teeth. Data were analyzed by means of the Student t-test. The results indicated that there were no statistically significant differences between the SS and control groups: PI, PD and GI (p greater than 0.05); AL and CI (p greater than 0.1); and BI (p greater than 0.01). Thus, it may be concluded from this study that Sjögren's syndrome has no observable influence upon the indices measured in evaluating periodontal disease.

The present study was designed to investigate the mechanisms responsible for suppressed T-cell immunity in gastric cancer patients. The peripheral blood T-cell functions in gastric cancer patients were evaluated by measuring responses to PHA and IL-2, and T-cell subpopulations were assessed by flow cytometry. Both the PHA and IL-2 responses decreased in patients with gastric cancer, although the proportions of CD3+ and CD25+ cells were the same for gastric cancer patients and healthy volunteers. The PHA response, but not that of IL-2, was lower in patients with liver metastasis or peritoneal dissemination than in patients without these conditions. Single regression analysis showed that with lymph node involvement in the disease the IL-2 response was more strongly suppressed than PHA response. The serum level of IAP did not correlate with the response to either PHA or IL-2. The proportion of CD4+ cells was not affected by any factor related to gastric cancer, although CD4+/CD8+ and CD8+11b-/CD8+11b+ ratios did decrease in patients with distant lymph node involvement. These changes may be due to a comparative increase in suppressor cells. These results suggest that gastric cancer patients exhibit impaired IL-2 mediated T-cell function and that the number of suppressor cells may increase with progressive lymph node involvement. These two serial effects may be indeed responsible for the impaired blood T-cell function in patients with gastric cancer.

A biological response modifier, OK-432 (Picibanil) administered by injection has been used for cancer immunotherapy. The present study was designed to determine the optimal dose and frequency of oral administration of OK-432. Ninety-one stomach cancer patients were randomly assigned into 7 groups and were administered a placebo or OK-432 at a dose of 5, 20 or 40 KE, once or 3 times a week before their operation (5 KE X 1/W, 20 KE X 1/W, 40 KE X 1/W, or X3/W). ++Missregistration excluded 3 patients and the data of 88 patients were analysed. There was no significant difference in the background status of the patients in each group. The NK activity of PBL was augmented by the administration of 40 KE X 1/W or 20 KE X 3/W and that of RNL was augmented by the administration of 5 KE X 3/W or 40 KE X 1/W, in conjunction with an increase in the number of % positive cells of leu 11a+ or leu 19+ analysed by flow cytometry. The killing activity of PBL, RNL, or MNL against allogeneic lined gastric cancer cells (KATO III) was not augmented by the oral administration of OK-432 for one week. The skin reactivity to Su-PS or PPD, serum levels of tumor markers, or serum levels of immunoglobulins did not help in determining the optimal dose or its frequency. These results suggest that 5 KE X 3/W may be the optimal regimen to augment the antitumor immunity of RNL.

Sjögren's syndrome (SS) is a chronic inflammatory disease characterized by xerostomia. Although a common observation in SS is increased susceptibility to caries, the level of periodontal disease has not been described in these individuals. The purpose of this study was to determine the periodontal status of 14 SS female subjects who had a mean age of 52.9 +/- 11.6 years. Plaque, gingival, and calculus indices as well as probing depth (PD) and attachment level (AL) were determined on 7 index teeth in each subject. Result indicated that individuals with Sjögren's Syndrome did not exhibit significant periodontal disease.

Along with an evaluation of the effects of 12 years' water fluoridation in the prevention of caries, the present study was conducted to explore the influence of water fluoridation on the eruption of permanent teeth. The survey was carried out in fluoridated Chung-Hsing New Village and the control town of Tsao-Tun from October to December, 1984. Dental examinations were performed on 3,459 children Chung-Hsing New Village and 4,610 in Tsao-Tun, at ages ranging from 3 to 15 years. The results showed that in general, the mean tooth eruption time of girls was earlier than that of boys, and that teeth in the lower jaw emerge sooner than their homologues in the upper jaw, except for premolars. In both fluoridated and control areas the order of tooth eruption was very similar except for the teeth of girls in the upper jaw. The eruption sequence was first premolar, canine then second premolar in the girls of Chung-Hsing New Village, while first premolar, second premolar then canine in those of Tsao-Tun. By comparing the eruption time of permanent teeth in the children of fluoridated and control areas, it was found that they were very alike in general, the only difference being observed in the premolars of the sexes. The premolars of the children in the fluoridated area emerged in the oral cavity 2.5 to 4.5 months later than did their counterparts in the control area.(ABSTRACT TRUNCATED AT 250 WORDS)