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As a part of the CAREBeijing-2008 campaign, observations of O3, oxides of nitrogen (NOx and NOy), CO, and hydrocarbons (NMHCs) were carried out at the air quality observatory of the Peking University in Beijing, China during August 2008, including the period of the 29th Summer Olympic Games. The measurements were compared with those of the CAREBeijing-2006 campaign to evaluate the effectiveness of the air pollution control measures, which were conducted for improving the air quality in Beijing during the Olympics. The results indicate that significant reduction in the emissions of primary air pollutants had been achieved; the monthly averaged mixing ratios of NOx, NOy, CO, and NMHCs decreased by 42.2, 56.5, 27.8, and 49.7%, respectively. In contrast to the primary pollutants, the averaged mixing ratio of O3 increased by 42.2 %. Nevertheless, it was revealed that the ambient levels of total oxidant (Ox = O3+NO2+1.5NOz) and NOz were reduced by 21.3 and 77.4%, respectively. The contradictions between O3 and Ox were further examined in two case studies. Ozone production rates of 30-70 ppbv h-1 and OPEx of ~8 mole mole-1 were observed on a clear-sky day in spite of the reduced levels of precursors. In that case, it was found that the mixing ratio of O3 increased with the increasing NO2/NO ratio, whereas the NOz mixing ratio leveled off when NO2/NO>8. Consequently, the ratio of O3 to NOz increased to above 10, indicating the shift from VOC-sensitive regime to NOx-sensitive regime. However, in the other case, it was found that the O3 production was inhibited significantly due to substantial reduction in the NMHCs. According to the observations, it was suggested that the O3 and/or Ox production rates in Beijing should have been reduced as a result of the reduction in the emissions of precursors during the Olympic period. However, the nighttime O3 levels increased due to a decline in the NO-O3 titration, and the midday O3 peak levels were elevated because of the shift in the photochemical regime and the inhibition of NOz formation. [ABSTRACT FROM AUTHOR]

Objective: To define the nature and incidence of minor anomalies in Chinese newborn infants and to evaluate the validity of the hypothesis that infants with three or more minor surface anomalies will also have a major malformation. Methods: A total of 3,345 Chinese newborn infants were examined based on a list of 67 items of minor anomalies. Results: About 44.9% of the newborn infants had at least one minor anomaly that was unrelated to gender, maternal age, or gestational age, but significantly associated with fetal presentation. Breech-presented newborn infants had double the risk of minor anomalies. Simian crease, upward slant and frontal bossing could be considered normal variants for Chinese newborn infants, because the incidence of each was higher than 4%. Conclusions: Although some studies have shown that approximately 90% of infants having three or more minor anomalies are associated with a major malformation, we found only a 10.1% predictive value based on this study. Nevertheless, we suggest that infants with three or more minor anomalies be carefully evaluated for the possibility of major malformation in order to provide early management. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the effects of self-paced cycling at an active workstation on executive functions and cortical activity., Methods: In a crossover study design, 37 young adults (45.9% females) were randomly assigned to the following two task conditions: (1) performing cognitive tests during sitting, (2) performing cognitive tests while cycling at an active workstation. Executive functions were assessed by the Stroop color and word test and the task-switching paradigm. Cortical activity was monitored using a multi-channel functional near-infrared spectroscopy (fNIRS) system., Results: The behavioral results showed that there were no significant differences on the Stroop interference effects ( P = 0.66) between the sitting and the cycling conditions. In all probability, no differences on the global switch costs ( P = 0.90) and local switch costs ( P = 0.67) were observed between the sitting and the cycling conditions. For the fNIRS results, the oxygenated hemoglobin (oxy-Hb) in response to the Stroop interference in channels 5, 10, and 12 were decreased during the cycling condition (all Ps < 0.05, FDR-corrected). Conversely, the oxy-Hb associated with the global switch costs in channels 3, 29, and 31 were increased during the cycling condition (all Ps < 0.05, FDR-corrected)., Conclusions: The findings indicated that behavioral performances on executive functions were not affected by cycling at an active workstation, while cognitive resources were reallocated during cycling at an active workstation.

Background and Objective: The interleukin-13 (IL-13) -1112 C/T polymorphisms have been analyzed previously in a North European population of patients with aggressive periodontitis. The present study was carried out to investigate the association of polymorphisms in the IL-13 gene with susceptibility to periodontitis in a Taiwanese population., Material and Methods: The genotyping of IL-13 -1112 C/T polymorphisms in 60 patients with aggressive periodontitis, 204 patients with chronic periodontitis and 95 healthy controls was carried out using the polymerase chain reaction-restriction fragment length polymorphism technique. Genotypes and allele frequencies among study groups were compared using Fisher's exact test (p < 0.05). Pearson's chi-square test was used for analysis of the Hardy-Weinberg equilibrium., Results: The distributions of CC genotypes and C alleles between patients with aggressive periodontitis and healthy controls were significantly different (p = 0.034 and 0.046). After adjustment for age, gender, betel nut chewing and smoking status using logistic regression analysis, the odds ratio (OR) was 6.45 [95% confidence interval (CI) = 1.99-23.72, p = 0.003] for aggressive periodontitis. However, the CC genotype was only significantly associated with the risk of aggressive periodontitis in the nonsmoking group (OR = 4.48, 95% CI = 1.31-16.93, p = 0.020)., Conclusion: The CC genotype or C allele appears to increase the risk of developing aggressive periodontitis in Taiwanese subjects., ((c) 2010 John Wiley & Sons A/S.)

Objectives: To estimate the prevalence of spondyloarthritis (SpA) and the clinical features of human leucocyte antigen (HLA)-B27-associated acute anterior uveitis (HLA-B27 uveitis) in Chinese patients., Methods: We conducted a retrospective cohort study using a structured chart review to record the complete ocular history, including the onset of uveitis, month of uveitis attack, specific eye involvement, the time of first attack, and rheumatic manifestations from 1987 to 2004. A total of 504 patients with HLA-B27 uveitis were consequently enrolled consecutively from the uveitis clinic of Taipei Veterans General Hospital., Results: In total, 1719 attacks of uveitis in 504 patients were recorded. Females tended to have a higher frequency of attack than males, and those with a disease course of less than 5 years showed more uveitis recurrence. The same eye attacks were observed in 156 of 332 patients (47%), more than the expected percentage compared with attacks with random-eye occurrence (p < 0.001). A significantly higher number of uveitis attacks occurred in winter. SpA-related acute anterior uveitis (AAU) was found in 387 patients (76.8%). Ankylosing spondylitis (AS) occurred in 214 patients (42.5%), with a significantly higher prevalence in males than in females (p < 0.001). Undifferentiated SpA (USpA)-related AAU occurred in 150 patients (29.8%), with a significantly higher prevalence in females than in males (p < 0.001). Patients with SpA had an earlier onset of uveitis (p = 0.01) and a greater number (> or = 6) of attacks (p = 0.03)., Conclusions: The prevalence of SpA was high in the Chinese population with HLA-B27-associated uveitis. The association with SpA indicated an earlier age of uveitis onset and a greater likelihood of having a higher number of uveitis attacks.

Objective: The purpose of this study was to examine whether polymorphisms of interleukin-4 (IL-4) (promoter-590 and intron 3) and tumor necrosis factor-alpha (TNF-alpha) promoter-308 genes are markers of susceptibility to or clinical manifestations of gout in Taiwanese patients., Methods: The study included 196 Taiwanese patients with gout and 103 unrelated healthy control subjects living in central Taiwan. Polymorphisms of the IL-4 (promoter-590 and intron 3) and TNF-alpha (promoter-308) genes were typed from genomic DNA. Allelic frequencies and carriage rates were then compared between gout patients and control subjects. The correlation between allelic frequencies, carriage rates and clinical manifestations of gout were evaluated., Results: No significant differences were observed in the allelic frequencies and carriage rates of the IL-4 (promoter-590 and intron 3) and TNF-alpha gene polymorphisms between patients with gout and healthy control subjects. Furthermore, the IL-4 (promoter-590 and intron 3) and TNF-alpha genotypes were not found to be associated with the clinical and laboratory profiles in gout patients. However, there was a significant difference in the TNF-alphapolymorphism genotype between patients with and without hypertriglyceridemia (P=0.001, xi2=11.47, OR=10.3, 95%CI=3.57-29.7)., Conclusion: The results of our study suggest that polymorphisms of the IL-4 (promoter-590 and intron 3) and TNF-alpha promoter-308 genes are not related to gout in Chinese patients in Taiwan.

Mutations of the telomeric survival motor neuron gene (SMN1) are related to spinal muscular atrophy (SMA). However, no phenotype-genotype correlation has been observed since the SMN1 gene is lacking in the majority of patients affected with either the severe form (type I) or the milder forms (types II and III). Here, we analyze the SMN, NAIP and P44 genes in 132 Chinese SMA patients and their families. At least three types of normal allele, and four types of mutant allele were found in this study. The combination of one normal allele with one mutant allele resulted in carriers of different types, and the combination of different mutant alleles accounted for the different genotypes among different types of SMA. Deletions of mutant alleles can be further subgrouped into four types, which includes involving SMN1, SMN1 and NAIP(T) (telomeric portion of NAIP gene), SMN1 and NAIP(T) and P44(T) (telomeric portion of P44 gene), and SMN1 and SMN2 (centromeric portion of SMN gene). Some of the severe (type I) SMA cases correlated with the extent of deletions in the SMN, NAIP and P44 genes or the dosage of SMN gene when both SMN1 and SMN2 are deleted. We also found two novel point mutations, an A insertion at codon 8 (AGT-->AAGT) and an A substitution at codon 228 (TTA-->TAA).

Objective: To demonstrate the association of minor anomalies and breech-presenting newborns with breech deformation complex., Study Design: A total of 3,345 newborns with singleton, term delivery were examined based on a list of 67 items of major and minor anomalies. All infants were divided into two groups: group 1, vertex presentation (3,107 infants); group 2, breech presentation (224 infants). The prevalence of anomalies between both groups was compared., Results: There were 1,495 (44.9%) infants with one or more minor anomalies, which included 1,313 infants (42.3%) in group 1 and 182 (81.3%) in group 2 (P < .005). The prevalence of anomalies in groups 1 and 2 were: frontal bossing (1.8% vs. 51%), prominent occiput (0.8% vs. 42%), upward slant (11.6% vs. 23.7%) and low-set ears (0.3% vs. 20.5%). Torticollis (0.3% vs. 1.78%) and congenital dislocation of the hip (CDH) (0.06% vs. 0.9%) (all P < .005) were related to breech presentation., Conclusion: Breech-presenting newborns had a higher risk of combining breech deformation complex, torticollis and CDH. The criteria for breech deformation complex included frontal bossing, prominent occiput, upward slant and low-set ears. The prevalence of breech deformation complex, torticollis and CDH was not related to the delivery method.

The protein tyrosine kinase activity of c-src proto-oncogene product, pp60(c-src), is elevated in a number of human cancers, including colon cancer. Phosphorylation of human pp60(c-src) carboxy-terminal tyrosine 530 suppresses its kinase activity. A recent report suggested that the risk of colon cancer is higher for those who carry a C-->T transition mutation on codon 531 (Gln-531-->Amber-531) of src gene. This mutation caused a prematured translation termination and up-regulated the kinase activity. To examine whether this mutation could be a risk factor for colon carcinoma in the Chinese population, we used the same PCR-based assay to analyze src genotypes of 131 colon cancers and other various types of carcinoma. No mutation was detected in all specimens that were screened in this study. Thus, mutation at Gln-531 of src gene does not seem to be involved in the development of colon cancer in Chinese ethnicity.

Background: Non-ulcer dyspepsia (NUD) accounts for the majority of dyspeptic patients and studies on the epidemiology of Helicobacter pylori infection in NUD depend on a non-invasive and rapid diagnostic test. This study was performed to determine the sensitivity and specificity of a 15-min simplified protocol of the [13C]-urea breath test ([13C]-UBT) for the diagnosis of H. pylori infection in patients with NUD., Methods: One hundred and thirty-six patients with a clinical and endoscopic diagnosis of NUD were included. The [13C]-UBT was modified from the European standard protocol. The baseline breath sample was collected 5 min after the patient took a test meal and the 13CO2 was collected 15 min after the patient drank 100 mg [13C]-urea. The gold standard used for comparison was either a positive culture or positive histology + positive rapid urease test sampled on upper gastrointestinal endoscopy., Results: The prevalence of H. pylori infection in NUD by the gold standard was 59.6%, whereas that calculated by the [13C]-UBT was 60.3%. The sensitivity and specificity of [13C]-UBT was 93.8 and 89.1% compared with the gold standard. The shortened collection time and simplification of the procedure may have led to a decline in specificity., Conclusion: The 15-min [13C]-UBT is a rapid but less specific protocol for detecting the presence of H. pylori infection in patients with NUD.

Congenital adrenal hyperplasia (CAH) is a common autosomal recessive disorder mainly caused by defects in the steroid 21-hydroxylase (CYP21) gene. We screened 1,000 healthy people, using a previously developed differential PCR method combined with single-strand conformation polymorphism and amplification-created restriction site methods for the carrier detection of the CYP21 gene deficiency. Our results indicated that the rate of occurrence of the heterozygous CAH carrier was about 12 in 1,000, with a gene frequency of 0.0060 and an incidence frequency of 1 in 28,000 in the Chinese population. In addition, 9 cases of CAH families were performed with prenatal diagnosis. Among them, 3 cases were diagnosed as the severe form, 4 cases carried the heterozygous mutation, and 2 were normal. This is the first report of carrier frequency analysis and prenatal diagnosis of 21-hydroxylase deficiency in Chinese.

Glutathione S-transferase (GST) enzymes are involved in detoxification of many potentially carcinogenic compounds. The homozygous deletions or null genotypes of GSTT1 (theta class) and GSTM1 (mu class) genes may be associated with an increased risk of cancer. Few studies have evaluated the relationship between GSTT1, GSTM1 and the risk of gastric cancer, as well as the potential interactions between these genetic markers and other risk factors of gastric cancer in the Chinese population. We conducted a case-control study with 143 cases with gastric cancer, 166 chronic gastritis (CG) cases and 433 cancer-free population controls from Yangzhong County, China. The epidemiological data were collected by a standard questionnaire for all of the subjects, and blood samples were obtained from 91 gastric cancer cases, 146 CG cases, and 429 controls. GSTT1 and GSTM1 genotypes were assayed by the PCR method, and Helicobacter pylori infection was measured by the ELISA method. Using logistic regression model in SAS, we assessed the independent effects of GSTT1 and GSTM1 null genotypes on the risk of gastric cancer and their potential interactions with other factors. The prevalence of GSTM1 null genotype was 48% in gastric cancer cases, 60% in CG patients, and 51% in controls. The prevalence of GSTT1 null genotype was 54% in gastric cancer cases, 48% in CG patients, and 46% in controls. After controlling for age, gender, education, pack-years of smoking, alcohol drinking, body mass index, H. pylori infection, and fruit and salt intake, the adjusted odds ratio (OR) for GSTT1 and gastric cancer was 2.50 (95% confidence interval (CI), 1.01-6.22). When gastric cancer cases were compared with CG patients, the adjusted OR for GSTT1 was 2.33 (95% CI, 0.75-7.25). However, GSTT1 null genotype was not associated with the risk of CG when using population controls. No obvious association was found between GSTM1 and the risk of both gastric cancer and CG. Our results suggest that GSTT1 null genotype may be associated with an increased risk of gastric cancer in a Chinese population.

Type I oculocutaneous albinism (OCA1) is an autosomal recessive disorder, which is caused by the reduction or the absence of tyrosinase activity in melanocytes of the skin, hair and eyes. Although tyrosinase mutations of OCA1 have been extensively analyzed in most populations worldwide, there is no systemic study of OCA1 mutation in Chinese patients. By use of single strand conformation polymorphism and direct sequencing, we had detected 21 mutant alleles out of 24 OCA1 chromosomes screened (87.5%). Detected mutant alleles include one splicing site, three insertion/deletion and five missense mutations, of which the splicing site nucleotide alteration (IVS 1-3C>G) and two each of the insertion/deletion (232-233 ins GGG and 861-862 del TT) and missense mutations (Cys 289 Gly and Trp 400 Leu) are novel. The ins/del mutations accounts for about 37.5% in Chinese OCA1 alleles. The 232-233 ins GGG, one of the novel mutations, was found to be most frequent (25%) among the OCA1 alleles in Chinese. Through this study, we found that while some of the OCA mutant alleles were identified in other populations, ethnic difference still exists. Hum Mutat 14:542, 1999., (Copyright 1999 Wiley-Liss, Inc.)

The potential association of distinct polymorphism of the tumor suppressor gene p53, with an increased susceptibility to malignant transformation has been reported for various cancers. A polymorphism at codon 72 of p53 results in translation to either arginine (p53Arg) or proline (p53Pro), and recent study showed that Caucasian women with arginine form of p53 are more susceptible to HPV-associated carcinoma of the cervix. To examine whether arginine 72 could be a significant risk factor for tumor development, we used a PCR-based assay to analyze p53 genotypes of patients for several types of carcinoma. No significant difference in the frequency of p53Arg was found between normal and cancer patients, the results showed that the individuals homozygous for arginine variant were not at increased risk for cancer.

Background: The human Lewis histo-blood group system belongs to a family of structurally related oligosaccharides. The mutations of fucosyltransferase genes alpha(1,2)-fucosyltransferase (FUT2 or Se) and alpha(1,3/1,4)-fucosyltransferase (FUT3 or Le), are responsible for the polymorphism of Lewis blood group phenotypes. However, a population study of the FUT2 mutation in Chinese and Thais has not yet been done, and there is some controversy about the phenotypes of Le(a+b+) and Le(a+b-)., Study Design and Methods: One hundred twentyfour Chinese and 70 Thais were phenotyped for Lea and Le(b). DNA samples were studied by polymerase chain reaction and then by a restriction enzyme digestion method to distinguish wild-type and six known mutations. Direct sequencing was done for controls and some uncertain cases., Results: A new mutation, C302T mutation, was found in 2 of 136 chromosomes in the Thai population; none were discovered in Chinese. The frequencies of the normal and six mutant alleles among Chinese and Thais, respectively, were as follows: 134 (54.0%) of 248 and 58 (41.4%) of 140 were wild-type (Se); 0 of 248 and 2 of 140 (both 1.4%) had the G428A mutation; 120 (48.4%) of 248 and 75 (53.6%) of 140 had the A385T mutation; 2 (0.81%) of 248 and 0 of 140 had the C571T mutation; and 1 (0.4%) of 248 and 3 (2.2%) of 140 had the G849A mutation. Only 1 Chinese (0.4%) of 248 had the C628T mutation, and none had fusion gene mutation., Conclusion: The FUT2 genes encoding for the phenotypes Le(a+b+) and Le(a+b-) are the same. The function and character of the mutant enzyme may play an important role in the phenotype. The methods used in this study are clinically applicable in population studies of the FUT2 gene polymorphism to explore relationships among different ethnic groups and correlations between phenotype and genotype.

Polymerase chain reaction (PCR) amplification was used to detect cytomegalovirus (CMV) in 1000 urine specimens from Chinese newborns for defining the incidence of congenital CMV infection in the Chinese population. The major immediate-early and the late antigen genes of CMV were amplified and detected by gel electrophoresis. There were 18 congenitally infected infants found when tests were performed with one or both primer pairs. Comparing with tissue culture, PCR of both primer sets provided a sensitivity of 94%, a specificity of 100% and a predictive value of positive result of 100%.

The purpose of the present study was to document the furcation entrance dimensions (FEDs) of the maxillary and mandibular 1st and 2nd molars and relate them to the choice of periodontal therapy. Study samples consisted of 89 maxillary molars (49 1st and 40 2nd molars) and 93 mandibular molars (50 1st and 43 2nd molars). All the FEDs of the molars were examined and measured under a stereomicroscope at 2.5 x equipped with a Bioscan OPTIMAS Image Analyzer (BOIA). The results may be summarized as follows. (1) The mean FEDs in the buccal, distal and mesial furcations of maxillary 1st and 2nd molars were 0.74 mm, 0.99 mm and 1.04 mm in the 1st molars, and 0.63 mm, 0.67 mm, 0.90 mm in the 2nd molars, respectively. In the buccal and lingual furcations of mandibular 1st and 2nd molars, they measured 0.88 mm and 0.81 mm, and 0.73 mm and 0.71 mm, respectively. (2) The %s of FEDs of 0.56 mm or less (the tip width of a Cavitron tip being 0.56 mm) in the buccal, distal and mesial furcations of maxillary 1st and 2nd molars, accounted for 32%, 8% and 6% of 1st molars, and 40%, 40% and 18% of 2nd molars. In the buccal and lingual areas of mandibular 1st and 2nd molars, they accounted for 16% and 26%, and 35% and 33% of the furcations, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of the present study was to investigate the morphology, extent, and distribution of root fusions in 1st and 2nd permanent molars in a Chinese population. The sample consisted of 158 maxillary and 151 mandibular extracted 1st and 2nd molars. Root fusion in molars was assessed by direct viewing and measuring the length of the root and root trunk with stereoscopic microscopy. Root fusion was graded by the extent of fusion and the number of affected surfaces. The main results were as follows: (1) the majority of root fusions affected upper and lower 2nd molars (39.7% and 28.1%, respectively); (2) the prevalence of maxillary roots with 1, 2 and 3 fusions was 55.2%, 31.3% and 13.4% respectively, and most of the root fusions affected the maxillary 2nd molars (65.7%); (3) the majority of mandibular root fusions affected the 2nd molars (89.2%), and were of grade III (48.7%); (4) in order of decreased prevalence, the grades of root fusion in 2nd molars were grades III, II and I; whereas in 1st molars they were grades I, II and III; (5) there were 44 (41.5%) and 19 (51.4%) complete root fusions (grade III) among 106 fused roots in maxillary molars and 37 fused roots in mandibular molars, respectively.

A total of 404 maxillary lateral and central incisors were examined in a group of 101 individuals comprising 64 males and 37 females for the presence of palato-radicular groove (PRG). The methods used to document the presence of PRG situated at or apical to the cemento-enamel junction (CEJ) included clinical probing, flap operation and inspection with the aid of an enlarging oral mirror. PRGs were classified by location in the mesial, distal and midpalatal areas of affected teeth. The plaque index (P1I), gingival index (GI) and probing pocket depth (PPD) were recorded on the lingual aspect of the teeth examined. Those PRG with initial PPDs of > or = 4 mm and located at or apical to the CEJ were counted as PRG with PPD. The difference in the PRG location for teeth with and without PPDs was analyzed via the chi 2 test. The relationship between the presence of a PRG and the patients periodontal health and plaque accumulation were analyzed using the t-test.(ABSTRACT TRUNCATED AT 250 WORDS)

The presence of various types of birthmarks was determined in 3,345 Chinese infants under 48 hours of age. Mongolian spots were present in 86.3% of the studied infants. Vascular lesions included salmon patch (22.6%), port-wine stain (0.4%), and strawberry marks (0.7%). Nevocellular nevi (1%), sebaceous nevi (0.1%), and café au lait spots (0.4%) were also found. The following non-birthmark skin changes were observed: erythema toxicum neonatorum (33.7%), preauricular tags (1.3%), preauricular pits (2.5%) and a hyperpigmented scrotum (31.3%; in 1,727 male infants), which was related to the presence of mongolian spots.

Hirsutism is rare in oriental women. In order to define the androgen metabolism in these women, plasma levels of androstanediol glucuronide (AG) along with testosterone (T), androstenedione (delta 4A), dehydroepiandrosterone sulfate (DHAS) and sex hormone binding globulin (SHBG) were determined in samples collected from 22 normally menstruating Chinese women. Their ages were 37.7 +/- 7.2 years (mean +/- S. D.) with a range of 27 to 46 years. All were born of Chinese parents. None were on any hormonal medication for at least one year. Compared to our local controls, no significant differences were observed in plasma androgens and SHBG concentrations. Comparable levels of AG, delta 4A and T in these two groups suggest that in Chinese women, under basal conditions, the androgen metabolism is comparable to their north american counterparts.

We describe the clinical features of parkinsonism in 25 patients whose age of onset was under 40 years. Among them, 17 patients, whose age of onset was after their 21st birthday, were classified as young onset Parkinson's disease (YOPD), and the remaining 8 whose age of onset was before their 21st birthday were classified as juvenile parkinsonism (JP). Rigidity and akinesia were revealed in all 25 patients. Resting tremor was observed in only 5 patients; 3 in the YOPD group and 2 in the JP group. There were 8 of the 25 patients (32%) who experienced an aching sensation in the leg before or at the onset of the parkinsonian features. In 6 of these 8 cases, the sensory symptoms were on the same side where the clinical manifestations of parkinsonism later developed. In the JP group, 2 patients had right foot dystonia, which improved with levodopa. Diurnal fluctuations in parkinsonian symptoms were found in 9 of the 25 cases. The familial incidence of parkinsonism was higher in the JP group. The parkinsonian disabilities in all 25 cases responded dramatically to levodopa therapy. Unfortunately, 10 cases, 5 in the YOPD group and 5 in the JP group, developed dyskinesia. The longer they took levodopa, the greater the chance of developing dyskinesia. The cumulative percentage of dyskinesia was 100% in the YOPD group and 83% in the JP group by the seventh and fourth year of treatment, respectively. A positive correlation was found between the prevalence of dyskinesia and the duration of treatment in both groups.

The composition and location of gallstones differ in Western and Eastern people. This has been documented in the literature. The difference in the clinical manifestations of biliary calculous disease has been postulated to be based on ethnic or environmental factors. In an effort to improve our management of patients with gallbladder perforations, a combined hospital study in a Chinese population during 11 years was conducted to study the clinical profiles at risk. Seventy-one patients were studied. The perforations were categorized as either acute (type I) in 14 (19.7%), subacute (type II) in 25 (35.2%), or chronic (type III) in 32 (45.1%). The incidence of severe underlying disease was significantly greater (p = 0.02) in patients with acute and subacute perforation as compared with chronic perforation. Multiple stones in the biliary tree and the gallbladder are very common and may mask the presentation of gallbladder perforation when patients with either biliary colic or biliary tract infection. A history suggestive of chronic gallstone disease is common, especially in patients with chronic perforation. The clinical manifestations of gallbladder perforation are similar to those of acute cholecystitis without perforation. On the basis of these data, clinical profiles have been developed for patients at risk of developing acute versus chronic gallbladder perforation. Awareness of these groupings forms the basis for early recognition and treatment of acute gallbladder perforation.

Between 1964 and 1987, a total of 57 cases of ruptured aneurysm of the sinus of Valsalva underwent surgical correction at the National Taiwan University Hospital. This represents 0.96% of all cardiac operations. The origin of ruptured aneurysm of the sinus of Valsalva was the right coronary sinus in 46, the noncoronary sinus in nine, and the left coronary sinus in two. The aneurysms ruptured into the right ventricle in 44, into the right atrium in 11, into the left ventricle in one, and into both the right ventricle and right atrium in one. Associated congenital cardiac anomalies included ventricular septal defect in 30 patients, aortic regurgitation in 20, and infundibular pulmonic stenosis and coarctation of the aorta in one each. Operative death occurred in two patients (3.5%) and one patient had a successful reoperation. The remainder did well following surgery. To compare the differences between Oriental and Western countries in ruptured aneurysm of the sinus of Valsalva, 361 cases (195 Oriental patients versus 166 Western) were collected from the literature. Analyses of these cases revealed that ruptured aneurysm of the sinus of Valsalva in Oriental patients compared with Western series is characterized by a higher incidence (5 times), more aneurysms originating from the right coronary sinus (87.9% versus 63.6%), more aneurysm rupturing into the right ventricle (84.2% versus 56.6%), a higher incidence of association with ventricular septal defect (mainly supracristal) (59.0% versus 34.6%), less incidence of association with other congenital cardiac abnormalities (4.1% versus 21.5%), very few instances of rupturing into cardiac chambers other than the right ventricle and right atrium, and less incidence of occurrence in the extremities of ages (the youngest was 7 years in Oriental patients versus 11 months in the Western series). In other words, ruptured aneurysm of the sinus of Valsalva in Oriental patients is more or less a simple and uniform disease entity in contrast to the more diverse and protean pathologic profiles encountered in Western series. However, both Oriental patient and Western patient series have similar incidences of combination with aortic regurgitation (24.6% versus 20.0%), with 40.4% of Oriental patients and 60.6% of Western patients presenting with intact ventricular septum. Therefore the pathogenetic mechanisms of ruptured aneurysm of the sinus of Valsalva may at the same time contribute to the development of aortic regurgitation.

Seventy-six patients less than 40 years of age were diagnosed from 1970 to 1983 as having lung cancer. We compared the smoking history, clinical features, cell types, and treatments in this series with those of 804 patients with primary lung cancer aged 40 or more. In the present study the association between smoking and lung cancer in young Chinese was substantially weaker (only 41.1% were smokers). The high incidences of adenocarcinoma (59.2%) and poorly differentiated carcinoma (11.8%) and the small number of epidermoid carcinoma (13.2%) in the young contrasted with those in the older patients. Though the young patients had relatively delayed diagnosis and more advanced disease, they did not have significantly poorer resectability and worse prognosis. But the 19 patients (25%) aged 30 or less ran a more virulent course.