Journal of the Formosan Medical Association RSS feed: Current Issue. The Journal of the Formosan Medical Association is the peer-reviewed publication of the Formosan Medical Association , based in Taipei, Taiwan. The JFMA invites original contributions relating to all fields of medicine and related disciplines that are of interest to the medical profession. http://www.jfma-online.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Journal of the Formosan Medical Association0929-66461092February 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jfma-online.com/article/PIIS0929664610600289/abstract?rss=yesPyrrole-Imidazole Polyamide: A Novel Gene Silencer and its Potential Use in Drug-eluting StentsZi-Wen Zhao, En-Hui Yao, Liang-Long Chen10.1016/S0929-6646(10)60028-9Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-19193http://www.jfma-online.com/article/PIIS0929664610600290/abstract?rss=yes Human immunodeficiency virus (HIV)-1 infection is initiated by the binding of gp120 envelope glyco-protein to its cell receptor (CD4) and a coreceptor (CXCR4 or CCR5), followed by a series of conformational changes in the gp41 transmembrane subunit. These changes include insertion of fusion peptide into the target cell membrane and association of C-heptad repeat (CHR) peptide with the N-heptad repeat (NHR) trimer, a pre-hairpin fusion intermediate. A stable six-helix bundle core is then formed, bringing the viral envelope and target cell membrane into close proximity for fusion. Peptides derived from the CHR region, such as T20 and C34, inhibit HIV-1 fusion by interacting with the gp41 fusion intermediate. A number of anti-HIV-1 peptides and small molecule compounds targeting the gp41 NHR-trimer have been identified. By combining HIV fusion/entry inhibitors targeting different sites in the gp41 fusion intermediate, a potent synergistic effect takes place, resulting in a potential new therapeutic strategy for the HIV infection/AIDS. Here, we present an overview of the current development of anti-HIV drugs, particularly those targeting the gp41 fusion intermediate. HIV-1 gp41 Fusion Intermediate: A Target for HIV TherapeuticsChungen Pan, Shuwen Liu, Shibo Jiang10.1016/S0929-6646(10)60029-0Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-194105http://www.jfma-online.com/article/PIIS0929664610600307/abstract?rss=yes Background/Purpose: Betel quid (BQ) chewing is a popular oral masticatory activity, and there are approximately 600 million BQ chewers worldwide. Although chewing BQ has been linked to the patho-genesis of oral cancer, leukoplakia, and oral submucous fibrosis. The question whether the mixed constituents present in areca nut, which may exert cytotoxic effects on red blood cells (RBCs), has never been addressed. Methods: Heparinized blood specimens were obtained with informed consent from healthy laboratory personnel. RBCs were separated with the standard procedure and adjusted to 10% hematocrit with PBS. Various concentrations of areca nut extract (ANE; 100–800 μg/mL) were added to these RBC preparations and incubated at 37°C for 4 hours. Two portions (0.4 mL each) of the incubated RBCs were then used for measuring osmotic deformability index and for observing RBC morphology with scanning electron microscopy. The remaining RBCs were used for determining membrane sulfhydryl groups and protein profiles by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Results: Blood incubated with various concentrations of ANE showed concentration-dependent decreases in osmotic deformability index and membrane sulfhydryl groups. Membrane protein profiles revealed a significant loss of the band 3 fraction, with the concomitant appearance of several new protein bands in the electropheretogram. Finally, drastic morphological changes of ANE-treated RBCs were observed. Conclusion: We suggest that to assure the quality of transfusion, the blood donated by a habitual BQ chewer should be used with caution because of its possible contamination with areca nut ingredients that may be cytotoxic to RBCs. Is the Blood Donated by Habitual Nut Quid Chewers Suitable for Use in Transfusion?Kuang-Ping Peng, Jeng-Fong Chiou, Yen-Tsun Chen, Tsan-Zon Liu10.1016/S0929-6646(10)60030-7Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-1106112http://www.jfma-online.com/article/PIIS0929664610600319/abstract?rss=yes Background/Purpose: Thiazolidinediones have anti-atherothrombotic effects in diabetic patients. However, the effects of rosiglitazone on inflammatory and hemostatic markers, as well as global endothelial function in non-diabetic smokers are unknown. Methods: Twenty-seven healthy male heavy smokers without metabolic syndrome were enrolled in this double-blind, controlled study. Fourteen subjects received 4 mg/day rosiglitazone for 8 weeks (group R) and 13 subjects received placebo (group C). Changes in the reflection index (ΔRI) of β-agonist-induced endothelium-dependent vasodilatation by photoplethysmography and plasma biomarkers were measured before and after treatment. Results: Matrix metalloproteinase-9, fibrinogen, and high-sensitivity C-reactive protein were reduced significantly in group R after treatment as compared with the baseline [84.1 (45.6 139.0) vs. 123.9 (58.4 141.8) ng/mL, p = 0.03; 2914 (2400-3553) vs. 3220 (2542-3940) mg/L, p = 0.04; and 3.4 (2.2 5.1) vs. 5.5 (4.1 6.8) mg/L, p = 0.009, respectively]. ΔRI was improved markedly in group R as compared with the baseline [13.5 (4.2 65.1) vs. 2.5 (−10.6 to 9.3)%; p = 0.024]. These biomarkers and ΔRI did not differ significantly in the group C. There were no significant changes in fasting plasma glucose, insulin, homeostasis model assessment index, and lipid profile in both groups R and group C. Conclusion: Rosiglitazone significantly reduces plasma levels of inflammatory and hemostatic biomarkers, and restores global endothelial dysfunction, independently from insulin sensitization, in healthy smokers. Rosiglitazone Reduces Plasma Levels of Inflammatory and Hemostatic Biomarkers and Improves Global Endothelial Function in Habitual Heavy Smokers Without Diabetes Mellitus or Metabolic SyndromeI-Chih Chen, Ting-Hsing Chao, Wei-Chuan Tsai, Yi-Heng Li10.1016/S0929-6646(10)60031-9Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-1113119http://www.jfma-online.com/article/PIIS0929664610600320/abstract?rss=yes Background/Purpose: The emergence of multidrug-resistant Neisseria gonorrhoeae is a great challenge in controlling gonorrhea. This study was conducted to survey the prevalence of molecular mechanisms of antimicrobial resistance among 45 clinical isolates of N. gonorrhoeae collected at a university hospital in Southern Taiwan during 1999-2004. Methods: Mutations in mtrR loci and quinolone-resistance-determining regions (QRDRs) were examined by gene sequencing. Polymerase chain reactions with specific primers were performed to detect ermA, ermB, ermC, and ermF. Serogroups and serovars were determined by commercial kits. Results: The percentage of multidrug resistance, that is, resistance to penicillin, tetracycline, erythromycin, and ciprofloxacin, among the 45 isolates was 40%. Ceftriaxone and spectinomycin were active against all isolates in vitro. The frequency of mutations in the QRDR and mtrR promoter was 82.2% and 93.3%, respectively. Eighty-two percent of the isolates carried mutations both in the QRDR and mtrR loci. Of nine mutation profiles with QRDR mutations (n =37), gyrA-Ser91Phe/gyrA-Asp95Gly/parC-Ser87Arg was the most common type (56.8%). Acquired genes for rRNA methylase were detected in 11 isolates (10 ermB and 1 ermA). Twenty-seven serovars were identified and all belonged to serogroup B, which suggested that multiple clones of N. gonorrhoeae were circulating in the community in the Tainan area. Conclusion: The high prevalence of multidrug resistance caused by varied resistance mechanisms in N. gonorrhoeae limits the drug choice. Ongoing surveillance of antimicrobial resistance and discovery of new effective antibiotic therapy are warranted in endemic areas. High Prevalence of Mutations in Quinolone-resistance-determining Regions and mtrR Loci in Polyclonal Neisseria gonorrhoeae Isolates at a Tertiary Hospital in Southern TaiwanPo-Lin Chen, Hsin-Chun Lee, Jing-Jou Yan, Yu-Hsiang Hsieh, Nan-Yao Lee, Nai-Ying Ko, Chia-Wei Lin, Chia-Ming Chang, Chi-Jung Wu, Ching-Chi Lee, Wen-Chien Ko10.1016/S0929-6646(10)60032-0Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-1120127http://www.jfma-online.com/article/PIIS0929664610600332/abstract?rss=yes Background/Purpose: Despite widespread recognition of the occurrence of antisocial behavior and depression in adolescents, the specifics of the relationship between them have not been clarified. The purpose of this study was to investigate the role of expressed emotion as a proximal factor for depression and antisocial behavior among adolescents, by looking at direct and indirect relationships. Methods: Secondary data analysis using path analysis was carried out on 2004 data from the Child and Adolescent Behaviors in Long-term Evaluation project. The study sample consisted of 1599 seventh-grade students in Northern Taiwan. Variables included family factors, personal factors (sex and academic performance), expressed emotion [emotional involvement (EI) and perceived criticism (PC)], depression, and antisocial behavior. Results: We found that one dimension of expressed emotion, PC, directly influenced student depression and related indirectly to antisocial behavior. Depression was an important mediator between PC and antisocial behavior. Another dimension, EI, did not influence either depression or antisocial behavior. Sex was related directly to expressed emotion, depression, and antisocial behavior, and also indirectly to antisocial behavior through PC and depression. Academic performance was related directly to expressed emotion and indirectly to antisocial behavior through PC and depression. Conclusion: Greater PC from parents directly contributed to higher levels of student depression and was related indirectly to more student antisocial behavior. It is suggested that parents should decrease overly critical parenting styles to promote adolescent mental health and avoid the development of antisocial behavior. Expressed Emotion and its Relationship to Adolescent Depression and Antisocial Behavior in Northern TaiwanBee-Horng Lue, Wen-Chi Wu, Lee-Lan Yen10.1016/S0929-6646(10)60033-2Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-1128137http://www.jfma-online.com/article/PIIS0929664610600344/abstract?rss=yes Background/Purpose: Suicide is an important public health problem and one of the leading causes of death worldwide. The present study investigated the prevalence of suicidal ideation (SI) and its associated risk factors in the general population. Methods: A nationwide community survey was conducted using a computer-aided telephone interview system with residents aged ≥ 15 years, who were selected by a stratified, proportional randomization method. The questionnaire comprised demographic variables, five items of psychopathology selected from the Brief Symptom Rating Scale (BSRS-5) and questions about personal experience with suicide. In total, 2054 respondents, 1002 male (48.8%), and 1052 female (51.2%), completed the survey. Results: The weighted prevalence of SI was 2.84% in the past week, 5.50% in the past year, and 18.49% during a lifetime. Significant risk factors for SI in the last week included presence of SI over the past year [odds ratio (OR) =1763.6], SI during the lifetime (OR =267.6), psychiatric morbidity (OR = 30.3), depression (OR =26.1), inferiority (OR =11.2), hostility (OR = 10.9), anxiety (OR = 10.5), insomnia (OR =6.7), history of seeking help for psychological distress (OR = 7.9), divorce (OR =6.4), unemployment (OR = 5.0) and having suicidal behavior in relatives or friends (OR =3.8). Stepwise multiple regression analysis demonstrated that the five symptom items of BSRS-5 and unemployment significantly predicted 25.3% of the variance of SI. Using the BSRS-5 score 3 or 4 as a cut-off to predict SI, the rate of accurate classification was 85.88%, with sensitivity of 0.83 and specificity of 0.86. Conclusion: A telephone interview survey containing the BSRS-5 items is an efficient way to identify determinants of SI in the general population. Prevalence of Suicidal Ideation and Associated Risk Factors in the General PopulationJia-In Lee, Ming-Been Lee, Shih-Cheng Liao, Chia-Ming Chang, Suz-Chieh Sung, Hung-Chi Chiang, Chuan-Wan Tai10.1016/S0929-6646(10)60034-4Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-1138147http://www.jfma-online.com/article/PIIS0929664610600356/abstract?rss=yes Background/Purpose: Data about the clinical manifestations of congenital adrenal hyperplasia caused by 21-hydroxylase deficiency (21-OHD) are lacking in Taiwan. Therefore, this study analyzed the clinical features of 21-OHD in Taiwanese children to improve the diagnosis of this disorder, and to provide background information regarding the ongoing neonatal screening program for 21-OHD in Taiwan. Methods: Eighty children with 21-OHD, 39 with the salt-wasting (SW) type and 41 with the simple-virilizing (SV) type, were evaluated by a review of their medical records. Their clinical symptoms and signs, laboratory findings, and genetic mutations were analyzed. Results: The most frequent features in 21-OHD patients were hyperpigmentation and signs of androgen excess. Clinical manifestations related to hyponatremia such as poor feeding, poor weight gain, and dehydration were noted most frequently in patients with SW-type 21-OHD. Five patients had low serum cortisol with elevated plasma adrenocorticotropic hormone levels, and 22 patients had elevated dehydroepiandros-terone sulfate levels. All had elevated blood levels of 17-hydroxyprogesterone, androstenedione and testosterone. Hyponatremia and hyperkalemia were detected in 29 patients with SW-type 21-OHD. In terms of molecular diagnosis, mutations at IVS2-12A/C → G and gene deletion were the most frequent mutations detected in SW-type 21-OHD, while I172N and mutation at IVS2-12A/C → G were most frequent in SV type. Conclusion: Taiwanese children with 21-OHD have characteristic clinical findings such as hyperpigmentation, androgen excess, and failure to thrive. There is a good correlation between genotype and pheno-type. Laboratory tests, including serum 17-hydroxyprogesterone, androstenedione, and testosterone levels are more sensitive than serum cortisol or dehydroepiandrosterone sulfate levels for diagnosing 21-OHD in prepubertal children. Clinical Characteristics of Taiwanese Children With Congenital Adrenal Hyperplasia Caused by 21-Hydroxylase Deficiency in the Pre-screening EraCheng-Ting Lee, Yi-Ching Tung, Pei-Hung Hsiao, Jing-Sheng Lee, Wen-Yu Tsai10.1016/S0929-6646(10)60035-6Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-1148155http://www.jfma-online.com/article/PIIS0929664610600368/abstract?rss=yes Background/Purpose: To describe the clinical characteristics and imaging findings of craniocervical dissection in childhood ischemic stroke, in a tertiary medical center. Methods: In this retrospective study, we investigated children (aged 1 month to 18 years) with symptoms and radiographic confirmation of ischemic stroke from January 1996 to January 2007. Stroke work-up included neuroimaging (magnetic resonance imaging, computed tomography, conventional angiography, and magnetic resonance angiography), cardiac assessment, prothrombotic assays, immunoassays, infection screening, and metabolic screening. Results: Among 95 children with arterial ischemic stroke, arterial dissection was identified as the underlying risk factor in nine patients (7 boys and 2 girls; age range, 1.9 17.2 years). All the patients had focal neurological signs and two had warning symptoms. A history of trauma was noted in two patients and another two had stroke during physical exertion. The other five patients had spontaneous dissection. Six patients had anterior circulation arterial dissection. Three patients had posterior circulation arterial dissection, and the most common location was in the vertebral artery. Antiplatelet treatment was given to five patients and anticoagulants to one. Endovascular treatment was given to one patient with dissecting aneurysm. One patient died at the acute stage and another seven had neurological deficits after 9 months to 8 years follow-up. The ninth patient had no residual neurological impairment. No patients had recurrent stroke. Conclusion: Arterial dissection should be considered in childhood ischemic stroke. Spontaneous arterial dissection is an important factor in this group. Early investigation and treatment can improve the outcome. Craniocervical Arterial Dissection: A Cause of Childhood Arterial Ischemic Stroke in TaiwanYing-Ying Lee, Kuang-Lin Lin, Huei-Shyong Wang, Min-Liang Chou, Po-Cheng Hung, Meng-Ying Hsieh, Jainn-Jim Lin, Alex Mun-Ching Wong10.1016/S0929-6646(10)60036-8Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-1156162http://www.jfma-online.com/article/PIIS092966461060037X/abstract?rss=yes Oral appliances are a range of devices that are designed to alter upper airway patency. The efficiency of these appliances for treatment of obstructive sleep apnea (OSA) has been rarely discussed. This case report describes two designs of mandibular repositioning appliances used to treat OSA. A 36-year-old man was diagnosed with mild OSA by his physician. A single-piece, soft oral appliance and a two-piece, acrylic appliance were used in this patient. Polysomnography was performed three times (baseline, and with the single-piece, and two-piece appliances). The apnea/hypopnea index was improved significantly with both appliances, but to a greater degree with the single-piece soft appliance. Our study concluded that oral appliances may assist in the management of OSA. The Difference Between Two Oral Appliances in Treating Obstructive Sleep Apnea: A Case ReportJu-Hui Wu, Chung-Yao Hsu, Chau-Hsiang Wang, Huey-Er Lee, Ting-Hsun Lan, Je-Kang Du10.1016/S0929-6646(10)60037-XJournal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-1163166http://www.jfma-online.com/article/PIIS0929664610600381/abstract?rss=yes The purpose was to determine whether there was a breakdown of the blood-aqueous barrier in a patient with choroideremia. A 27-year-old man with typical choroideremia underwent standardized ophthalmo-logical evaluation, including quantitative measurement of aqueous flare intensity, by a laser flare-cell meter. The results showed areas of atrophy of the choriocapillaries and retinal pigment epithelium in the mid-periphery and posterior pole, although not in the macula. Fluorescein angiography showed areas of loss of the choriocapillaries and retinal pigment epithelium. The fovea was spared with a surrounding zone of hy-perfluorescence. Electroretinography showed a subnormal photopic amplitude and extinguished scotopic response. Electrooculography revealed that the light peak/dark trough ratio was reduced. Goldmann perimetry showed constricted peripheral fields. Laser photometry showed an increase in the aqueous flare intensity in both eyes, as compared with normal subjects. We conclude that the function of the blood-aqueous barrier might be affected in patients with choroideremia. Blood-aqueous Barrier Function in a Patient With ChoroideremiaMuh-Shy Chen, Ching-Chung Chang, Tzyy-Chang Ho, Tzu-Hsun Tsai, I-More Fan, Ping-Kang Hou10.1016/S0929-6646(10)60038-1Journal of the Formosan Medical Association 109, 2 (2010)2010-02-01Journal of the Formosan Medical Association2010-02-011092S0929-6646(10)X0003-1167171