The Kaohsiung Journal of Medical Sciences

The aim of the study was to determine whether serum ischemia‐modified albumin (IMA) levels in patients with carbon monoxide (CO) poisoning were higher compared with a control group of healthy volunteers. In addition, the study sought to determine if there was a correlation between serum IMA levels and carboxyhemoglobin (COHB) levels and other critical neurological findings (CNFs). In this prospective study, the IMA levels of 100 patients with CO poisoning and 50 control individuals were compared. In addition, the IMA and COHB levels were analyzed according to absence or presence CNFs in patients with CO poisoning. The levels of IMA (mg/dL) on admittance, and during the 1^st hour and 3^rd hour, in patients with CO poisoning (49.90 ± 35.43, 30.21 ± 14.81, and 21.87 ± 6.03) were significantly higher, compared with the control individuals (17.30 ± 2.88). The levels of IMA in the 6^th hour were not higher compared with control individuals. The levels of IMA on admittance, and during the 1^st hour, 3^rd hour, and 6^th hour, and COHB (%) levels in patients who had CNFs were higher compared with IMA levels and COHB levels in patients who had no CNFs (p < 0.001). However, when the multivariate model was created, it was observed that IMA level on admittance was a poor indicator for prediction of CNFs (odds ratio = 1.05; 95% confidence interval, 1.01–1.08). We therefore concluded that serum IMA levels could be helpful in the diagnosis of CO poisoning. However, we believe that IMA levels cannot be used to predict which patients will develop CNFs due to CO poisoning.

This study investigates the correlation between computer‐assisted nuclear morphometry and known prognostic factors in thyroid follicular carcinoma. Thirty‐six patients with thyroid follicular carcinoma who underwent surgery between 1991 and 2001 were grouped according to sex, age, size of the primary lesion, the presence of vascular invasion, and metastases. Four nuclear parameters were measured and analyzed: mean nuclear area, mean nuclear perimeter, largest to smallest diameter ratio of the nuclei, and coefficient of variation of the nuclear area. Our results indicated that none of the chosen nuclear variables were significantly correlated with the prognostic factors studied. In conclusion, nuclear morphometry does not seem to correlate with known prognostic factors and cannot serve as an additional predicting factor for biologic behavior.

Enteroviruses are environmental triggers in the pathogenesis of type 1 diabetes mellitus (DM). A sequence of six identical amino acids (PEVKEK) is shared by the 2C protein of Coxsackie virus B and the glutamic acid decarboxylase (GAD) molecules. Between 1995 and 2002, we investigated 22 Coxsackie virus B5 (CVB5) isolates from southern Taiwan. Four of these isolates were obtained from four new‐onset type 1 DM patients with diabetic ketoacidosis. We compared a 300 nucleotide sequence in the 2C protein gene (p2C) in 24 CVB5 isolates (4 diabetogenic, 18 non‐diabetogenic and 2 prototype). We found 0.3‐10% nucleotide differences. In the four isolates from type 1 DM patients, there was only 2.4‐3.4% nucleotide difference, and there was only 1.7‐7.1% nucleotide difference between type 1 DM isolates and non‐diabetogenic isolates. Comparison of the nucleotide sequence between prototype virus and 22 CVB5 isolates revealed 18.4‐24.1% difference. Twenty‐one CVB5 isolates from type 1 DM and non‐type 1 DM patients contained the PEVKEK sequence, as shown by the p2C nucleotide sequence. Our data showed that the viral p2C sequence with homology with GAD is highly conserved in CVB5 isolates. There was no difference between diabetogenic and non‐diabetogenic CVB5 isolates. All four type 1 DM patients had at least one of the genetic susceptibility alleles HLA‐DR, DQA1, DQB1. Other genetic and autoimmune factors such as HLA genetic susceptibility and GAD may also play important roles in the pathogenesis in type 1 DM.

Coronary artery aneurysms are not uncommon. They are usually arteriosclerotic in origin, and may be congenital or secondary to injury, dissection, infection, inflammation, or Kawasaki disease (KD). Herein, we report a case involving a 25‐year‐old male smoker with acute myocardial infarction (AMI). Coronary angiography showed triple‐vessel disease, coronary artery aneurysms, and diffuse ectasia. Coronary artery bypass grafting was performed without complications. Based on his history, serologic examinations, and angiographic findings, we suspected that his coronary artery aneurysms and ectasia were the adult sequelae of KD. This case is a good reminder that KD victims may suffer from young‐onset AMI.

The aim of this study was to examine the associations of behavioral temperamental traits, comorbid autism spectrum disorder (ASD), and bullying involvement with anxiety and depression among adolescents with attention‐deficit/hyperactivity disorder (ADHD) in Taiwan. A total of 287 adolescents aged 11–18 years diagnosed with ADHD participated in this study. Their severities of anxiety and depression were assessed. Multiple regression analysis was used to examine the correlates of anxiety and depression. The results show that adolescents with ADHD who reported a higher behavioral inhibition system (BIS) score, had comorbid ASD, and were bullying victims, reported more severe anxiety and depressive symptoms. Adolescents with ADHD who bullied others reported more severe depressive symptoms than those who did not bully. The results of this study indicated that behavioral temperamental traits on the BIS, comorbid ASD, and bullying involvement were significantly associated with anxiety and depression among the adolescents with ADHD.

Trẻ sơ sinh thiếu tháng là những trẻ được sinh ra trước 37 tuần thai. Bệnh còi xương là một bệnh lý về xương đặc trưng bởi sự chậm phát triển do sự mở rộng của lớp tế bào sụn tăng trưởng và sự thất bại trong việc khoáng hóa xương. Kết quả là, xương trở nên mềm và cho phép sự uốn cong và biến dạng rõ rệt. Mặc dù tỷ lệ mắc bệnh còi xương ở trẻ sơ sinh thiếu tháng thấp hơn do những cải tiến trong chăm sóc sức khỏe và dinh dưỡng, vẫn còn những trẻ có nguy cơ cao với căn bệnh này. Tuy nhiên, ít báo cáo đề cập đến việc điều trị bệnh còi xương ở trẻ sơ sinh thiếu tháng. Hơn nữa, các nghiên cứu trường hợp được công bố về kinh nghiệm sử dụng calcitriol như một liệu pháp tiềm năng cho bệnh còi xương ở trẻ sơ sinh thiếu tháng là rất hiếm. Trong bài báo này, chúng tôi mô tả việc phát hiện bệnh còi xương ở trẻ sơ sinh thiếu tháng và kinh nghiệm của chúng tôi với việc điều trị bằng calcitriol trong hai trường hợp. Chúng tôi khuyến nghị sử dụng calcitriol qua đường miệng với liều lượng từ 0.03 đến 0.125 μg/kg/ngày, bên cạnh một loại công thức phù hợp cung cấp đủ lượng canxi và phosphate cần thiết. Một bệnh nhân được chỉ định calcitriol trong 40 ngày và bệnh nhân còn lại trong 37 ngày. Hai trẻ sơ sinh đã hồi phục dần dần và được xuất viện mà không có tác dụng phụ rõ rệt. Chúng tôi khuyến nghị mức phốt-phat kiềm nên được theo dõi trong vòng 1 tháng sau khi sinh ở trẻ sinh thiếu tháng có trọng lượng khi sinh <1000 g. Những trẻ có mức phốt-phat kiềm cao là ứng viên cho việc khảo sát xương dài.

Posttransplant hepatitis C virus (HCV) recurrence is universal in chronic hepatitis C recipients. Antiviral therapy is suggested after liver transplant to halt disease progression. Pegylated interferon plus ribavirin therapy remains the standard of care in many areas where direct antiviral agents are poorly accessible. This study aimed to assess the treatment efficacy and safety of the regimen for Taiwanese patients with post‐transplant HCV recurrence. Nine patients with HCV recurrence postliver transplantation were allocated. Patients received either pegylated interferon α‐2a 180 μg/wk or pegylated interferon α‐2b 1.5 mg/kg/wk plus ribavirin for 24–48 weeks. The primary endpoint was the achievement of sustained virological response (SVR), defined as undetectable HCV RNA throughout 6 months of follow‐up after the end of treatment. The safety profiles were also documented. The rates of rapid virological response, early virological response, end‐of‐treatment virological response, and SVR were 33%, 63%, 75%, and 56% respectively. Of the four patients who failed antiviral treatment, the treatment responses were nonresponse (n = 1), loss of follow‐up (n = 1), and relapse (n = 2). Three patients terminated therapy early due to severe adverse events, including severe anemia, intra‐abdomen infection, and hepatocellular carcinoma recurrence. One of the three patients who terminated treatment early at Week 6 experienced rapid virological response followed by SVR. Pegylated interferon/ribavirin combination allowed a chance for cure with a fair SVR rate in Taiwanese chronic hepatitis C patients postliver transplantation. Early identification of side effects and careful monitoring during therapy might enhance the treatment efficacy.

Sacrococcygeal teratoma is a rare fetal neoplasm with an incidence of 1 in 40,000 births. Antenatal diagnosis is usually made after 22 weeks of gestation. Fetuses with this malformation are at risk of significant perinatal morbidity and mortality. Malignant components, coexisting with life‐threatening anomalies, and chromosomal abnormalities are rare. Postulated causes of perinatal death include hydrops, dystocia, tumor rupture, preterm labor secondary to polyhydramnios, and anemia due either to hemorrhage or hemolysis within the tumor. Herein, we present a case of fetal sacrococcygeal teratoma diagnosed as early as 17 weeks of gestation.

Quadricuspid aortic valve (QAV) is a rare congenital heart defect that often causes symptomatic aortic insufficiency in adulthood, imposing valve replacement. Herein, we describe one unusual case of QAV which underwent valve replacement uneventfully.

Establishing the discriminative factors for unprotected sex among adolescents is essential for early identification of at‐risk teens and for the prevention of unplanned pregnancy and sexually transmitted diseases. The aim of this study was to examine the discriminative effects of demographic, individual, family, peers, and school life factors on unprotected sex in a large‐scale, representative adolescent population in Southern Taiwan. A total of 9,736 adolescent students were recruited into this study and completed the questionnaires. The multidimensional discriminative factors for unprotected sex were examined using χ² automatic interaction detection analysis and logistic regression models. The results of the χ² automatic interaction detection analysis revealed that having friends, using illicit drugs, being of an older age, suspension from school, and low family monitoring had discriminative effects on unprotected sex in adolescents. The logistic regression analysis further confirmed the discriminative effect of these factors. Because of the adverse effects of unprotected sex in adolescents, we suggest that parents and health professionals should pay attention to adolescents with the discriminative factors for unprotected sex identified in this study.