The relationship between various risk factors and lung cancer was evaluated in a case-control study. One hundred and forty-one cancer patients newly cytologically or pathologically diagnosed from May 1990 to July 1991 at Tri-Service General Hospital (TSGH) were recruited as cases. Two control groups were also studied: 282 hospital controls two-to-one matched with cases on sex, age, hospital of admission and insurance status were selected from the TSGH Ophthalmologic Department, and 282 neighborhood controls two-to-one matched on sex, age, and residence were randomly selected from eligible neighbors. A comparison of interview data between cases and hospital controls based on multiple conditional logistic regression revealed that cigarette smoking, keeping doves as pet, occupational exposure to cotton dust and working as a cook were risk factors for lung cancer. An inverse association between incense burning and lung cancer was noted. The comparison between cases and neighborhood controls showed lung cancer was significantly associated with cigarette smoking, keeping doves, prior chronic bronchitis, occupational exposure to cotton dust, asbestos and radiation, low frequency of burning incense, and low intake of vitamin A derived from vegetables and fruits. There was no association between lung cancer and working as a cook when cases were compared with neighborhood controls.

BACKGROUNDS:Diabetes mellitus (DM) is a common endocrine disorder and an increasing epidemic worldwide. Proportional diabetic patients eventually develop cutaneous diseases. OBJECTIVES:This study determined the statistical association of cutaneous manifestations and DM as well as the DM-associated cutaneous manifestations in elderly male residents. METHODS:A cross-sectional study was conducted in a Veterans Home in Taiwan. The cutaneous manifestations and major systemic diseases of the residents were recorded separately. Univariate logistic regression and multivariate analysis after adjustment for age, body mass index and significant major systemic diseases provided odds ratios and P values for the statistical association. RESULTS:A total of 313 male residents (age ≥65 years) were recruited, including 70 (22.4%) with DM. Their most common cutaneous manifestations included fungal infection (77%) and brown spots on the legs (38.3%). Chronic ulcers adjusted odds ratios (AOR 4.90, 95%CI: 1.82-13.19; P = 0.002), brown spots on the legs (AOR 6.82, 95%CI: 3.60-12.89; P < 0.001) and pruritus (AOR 12.86, 95%CI: 4.40-37.59; P < 0.001) were significantly associated with DM. The diabetic residents were inclined to have chronic ulcers, brown spots on the legs and pruritus at a 7.46-fold higher risk (AOR 7.46, 95%CI: 3.86-14.43; P < 0.001). The diabetic residents exhibited marginally higher risks of bacterial infection, scabies, or skin tags. CONCLUSION:The DM-associated cutaneous manifestations were chronic ulcers, brown spots on the legs, and pruritus. By observing clues of diabetic cutaneous features, a more complete condition of diabetic patients can be appreciated. The information is essential for providing appropriate treatment and key nursing points regarding the diabetes-associated skin diseases.

OBJECTIVE:To investigate the association of miR-499a genetic polymorphism with the risk of oral leukoplakia, oral submucous fibrosis (OSF), oral squamous cell carcinoma (OSCC), and clinicopathological outcomes of OSCC.METHODS:The genotyping of miR-499a T>C (rs3746444) using TagMan assay was conducted in two case-control studies of 1549 subjects. miR-499a-5p and miR-499a-3p were assayed using stem-loop RT-PCR for 63 paired OSCC and adjacent normal tissues.RESULTS:T/C+C/C genotypes [adjusted odds ratio (AOR) 1.84, P = 0.032] and C allelic type (AOR 1.91, P = 0.007) at miR-499a T>C were associated with an increased risk of BQ-related OSF as compared to those with T/T genotype or T allelic type, respectively. Conversely, T/C+C/C genotypes and C allelic type decreased the risk of OSCC, especially for non-BQ-related OSCC (for genotype: AOR 0.49, P = 0.010; for allelic type: AOR 0.50, P = 0.007). Additionally, downregulation of miR-499a-5p was found in OSCC tissues (P = 0.001) and correlated with the TT genotype (P = 0.001).CONCLUSION:The T/C+C/C genotypes of MiR-499a may contribute to an increased risk of BQ-related OSF, but a decreased risk of OSCC. miR-499a T>C influences the expression levels of miR-499a-5p during the tumorigenesis of OSCC.

Objective and Method . We have previously successfully applied the Acute Physiology and Chronic Health Evaluation (APACHE) II system to assess the severity of patients with acute paraquat poisoning, and this article investigates further evidence of the usefulness of APACHE II system in predicting the in-hospital mortality of 64 patients with acute paraquat poisoning over a period of 12 years. The predictive factors including APACHE II score, plasma paraquat concentration, severity index of paraquat poisoning (SIPP), and estimated ingestion dosage of paraquat for evaluating the outcome in paraquat-poisoned patients were assessed. Results . Overall mortality was 71.9%: 46 out of 64 patients died. Non-survivors (n=46) had a higher APACHE II score (23.3 +/- 12.7) than survivors (n=18) (6.1 +/- 4.2) ( p<0.001). The plasma paraquat concentration, SIPP, and estimated ingestion dosage of paraquat were significantly higher in non-survivors than in survivors (p<0.05, in all comparisons). By multiple logistic regression analysis, only the APACHE II score and peak data of blood sugar in 24 h after admission were capable of predicting in-hospital mortality. By using the area under receiver operating characteristic curves (AURC), the APACHE II system yielded better discriminative power (AURC=0.893) than SIPP (AURC=0.674), plasma paraquat concentration (AURC=0.676), and estimated ingestion dosage of paraquat (AURC=0.673). An APACHE II score greater than 13 predicted in-hospital mortality with 67% sensitivity and 94% specificity. Conclusions. The APACHE II score is a simple, reproducible, and practical tool for evaluating the severity of acute paraquat poisoning.

Tazarotene and calcipotriol are both effective in the treatment of psoriasis. An investigator-blind, bilateral comparison of 44 lesion pairs in 19 patients was conducted to evaluate the efficacy, side effects and duration of therapeutic effects of once-daily tazarotene 0.1% gel plus petrolatum with twice-daily calcipotriol 0.005% ointment in plaque psoriasis. It consisted of a 12-week treatment phase, followed by a 4-week post-treatment observation phase. At the end of the treatment phase, tazarotene-petrolatum was as effective as calcipotriol in both objective and subjective overall efficacy assessment. Calcipotriol had a significantly greater effect in reducing erythema than tazarotene-petrolatum at weeks 2-8. At week 16, tazarotene-petrolatum demonstrated a significantly better maintenance effect in all parameters. Local irritation was noted only in tazarotene-petrolatum-treated lesions. Once-daily tazarotene 0.1% gel plus petrolatum was as effective as twice-daily calcipotriol 0.005% ointment in the treatment of plaque psoriasis, but had a better maintenance effect after the cessation of therapy.

Background. The host genetic factors that determine the clinical outcomes for Helicobacter pylori-infected individuals remain unclear.Aims. To elucidate the relations among interleukin-1 locus polymorphisms, and H. pylori infection in the development of duodenal ulcers.Materials and methods. In a case-control study involving 168 control subjects and 147 patients with duodenal ulcer, biallelic polymorphisms of two interleukin-1 loci, IL-1B(-511) and IL-1B(+3954), as well as the penta-allelic variable number of tandem repeats of interleukin-1 receptor antagonist IL-1RN, were genotyped, and the H. pylori states of controls and patients were examined.Results. Helicobacter pylori infection, male gender and the carriage of IL-1RN*2 independently increased the risk of duodenal ulcer with odds ratios of 6.4 (95% confidence interval, 3.7-11.0), 1.9 (95% confidence interval, 1.1-3.4) and 2.7 (95% confidence interval, 1.1-6.8), respectively. Statistical analysis revealed an interaction between IL-1RN*2 and H. pylori infection with the duodenal ulcer risk conferred by the H. pylori infection substantially increased (odds ratios, 22.6; 95% confidence interval, 5.9-86.5) by the carriage of IL-1RN*2. In addition, a synergistic interaction between IL-1RN*2 and blood group O existed. The combined risk of H. pylori infection, the carriage of IL-1RN*2 and blood group O for duodenal ulcer was 27.5 (95% confidence interval, 3.1-243.6).Conclusions. This work is the first to verify IL-1RN*2 as an independent factor that governs the development of duodenal ulcers. Our data indicate that H. pylori infection and IL-1RN*2 synergistically determine susceptibility to duodenal ulcer. The blood group phenotype is possibly a crucial determinant for the outcome of the impact of an interleukin-1 locus polymorphism on H. pylori-infected individuals.

A hospital-based quasi-experimental (pretest and post-test) study was conducted in Kaohsiung Veteran General Hospital, Taiwan. This study was to evaluate a continuing education program (CEP) on nurses' practices of cancer pain assessment and their acceptance of patients' pain reports with respect to four types of misconceptions. A questionnaire was sent to on-duty nurses or head nurses with patient care responsibilities before the implementation of CEP (n=645) and six months after the program (n=630). The response rates were 92.6% and 91.3% for pretest and post-test surveys, respectively. The CEP was implemented in 8 weeks with four-repeated sessions of 4-hour lectures. A one-day workshop focused on cancer pain assessment and treatment was held 3 months after the four-repeated sessions. Several educational strategies and teaching materials were used in the CEP. The results showed that CEP made statistically significant yet moderate improvement in nurses' practices of pain assessment using pain rating scales (pretest 3.29±0.76 vs. post-test 3.48±0.75, P<0.001) and acceptance of patient's pain reports without misconceptions on addiction (3.12±0.80 vs. 3.39±0.90, P<0.001), phantom pain (3.91±0.96 vs. 4.07±0.92, P=0.005), and placebo testing (3.63±0.72 vs. 3.81±0.73, P<0.001), except on patient gender-age-related doubts (3.60±0.72 vs. 3.67±0.77, P=0.109). In order to achieve further improvement, additional follow-up CEP combined with a hospital-wide institutionalization of pain assessment should be promoted and implemented in the future.

Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis worldwide. Human infection occurs after ingestion of the worms in raw snails or fish that serve as intermediate hosts. Two outbreaks of central nervous system infection with A. cantonensis occurred in Kaoshiung, Taiwan, during 1998 and 1999 among Thai laborers who ate raw snails. A detailed clinical studies of 17 of these patients was conducted, including study of 13 patients who underwent magnetic resonance imaging (MRI) scans of the brain. The MRI scans revealed high signal intensities over the globus pallidus and cerebral peduncle on T1-weighted imaging, leptomeningeal enhancement, ventriculomegaly, and punctate areas of abnormal enhancement within the cerebral and cerebellar hemisphere on gadolinium-enhancing T1 imaging, and a hyperintense signal on T2-weighted images. There was a significant correlation between severity of headache, cerebrospinal fluid (CSF) pleocytosis, and CSF and blood eosinophilia with MRI signal intensity in T1-weighted imaging (P < 0.05). Eosinophilic meningitis produced by A. cantonensis needs to added to the list of causes of hyperintense basal ganglia lesions found on T1-weighted MRI scans in tropical countries.

PURPOSE To evaluate the authors' experience with a technique for management of thrombosed Brescia-Cimino arteriovenous fistula. MATERIALS AND METHODS Forty patients with 42 thrombosed arteriovenous fistulas were percutaneously treated. Thrombosis occurred within 24 hours of attempted angioplasty in five fistulas, between 24 and 72 hours in 27, and longer than 72 hours in 10. Thrombosed fistulas were approached in a retrograde fashion followed by direct balloon dilation with 5-8-mm balloon catheters. If retrograde catheterization failed to cross the arterial anastomosis, an antegrade puncture directly into the thrombosed drainage vein close to the anastomosis was performed with ultrasonographic guidance, as an aid to catheterize the arterial inflow. Thrombolytic therapy with infusion of urokinase directly into the thrombus was performed in selected patients with visible thrombus that had compromised blood flow in the partially restored vascular access. Postintervention primary and secondary patency was calculated by using Kaplan-Meier analysis. Patency rates between patients without and with urokinase infusion were examined by using the log-rank test. RESULTS Anatomic success was achieved in 39 (93%) of 42 fistulas; and clinical patency, in 38 (90%) of 42 fistulas. Postintervention primary and secondary patencies (including initial technical failure) at 6, 12, and 18 months were 81% and 84%, 70% and 80%, and 63% and 80%, respectively. No significance of patency rate between patients without and with urokinase infusion was found (P =.912). Three patients died of unrelated causes at 1, 2, and 5 months after the procedures. No major complications were encountered. CONCLUSION High anatomic success and excellent clinical patency can be achieved in the salvage of thrombosed arteriovenous fistulas. Percutaneous restoration of arteriovenous fistulas should be attempted before surgical recreation to optimize outcome in patients undergoing hemodialysis.

OBJECTIVES:Prone-position ventilation (PPV) induces acute improvement in oxygenation in many patients with acute respiratory distress syndrome (ARDS), with some maintaining their oxygenation even after they were returned to the supine position, but it is unclear what clinical factors determine the sustained oxygenation benefit. We hypothesized that patients with ARDS who have a larger shunt would have a better acute and sustained oxygenation response to PPV. DESIGN:Prospective, nonrandomized interventional study. SETTING:Medical and surgical intensive care units, university tertiary care center. PATIENTS:Twenty-two consecutive patients, with ARDS with an average PaO2/FiO2 of 94, were administered PPV for 12 hrs followed by supine-position ventilation for 2 hrs. MEASUREMENTS:Hemodynamic and gas exchange variables were monitored. The shunt was measured as venous admixture at an FiO2 of 1.0, and compliances of the respiratory system, lung, and chest wall were measured by the esophageal balloon technique before PPV, during PPV, and during subsequent supine-position ventilation. MAIN RESULTS:Fourteen patients (64%) responded to PPV, with PaO2/FiO2 increasing by > or =20. These changes were associated with a decrease in chest wall compliance. Responders had significantly shorter time from ARDS to PPV, a lower baseline PaO2/FiO2, and a higher venous admixture. All responders maintained the improvement in oxygenation and had a greater respiratory system compliance after returning to the supine position. Time from ARDS to PPV and baseline lung injury score were negatively associated, whereas chest wall compliance, heart rate, and PaCO2 were positively associated with sustained improvement in oxygenation. CONCLUSIONS:PPV induced acute and sustained improvement in oxygenation in many patients with ARDS. The sustained improvement is more significant if PPV is administered early to patients with a larger shunt and a more compliant chest wall. Measuring venous admixture and chest wall compliance before PPV may help select a subgroup of patients with ARDS who may benefit the most from PPV.

Objectives: To determine the efficacy of a two week and a four week course of oral steroids in the conservative treatment of carpal tunnel syndrome. Methods: 109 patients with carpal tunnel syndrome were randomly divided into two treatment groups: (1) two weeks of prednisolone 20 mg daily followed by two weeks of prednisolone 10 mg daily (n = 53); (2) two weeks of prednisolone 20 mg daily and two weeks of placebo (n = 56). A symptom questionnaire was used to rate the five major symptoms of carpal tunnel syndrome (numbness, pain, weakness/clumsiness, tingling, and nocturnal awakening) on a scale of 0 (nil) to 10 (severe); the resulting global symptom score was used to evaluate the efficacy of treatment. Assessments were made at baseline and at one, three, six, nine, and 12 months. Electrodiagnosis was repeated at the end of the study to validate improvement. Results: In an intention to treat analysis at the end of the study, improvement in the four week treatment group was achieved in 66.0% of the patients after one month and in 49.0% at the end of the study; in the two week treatment group, the respective values were 48.2% and 35.7%. In the four week treatment group, 51% were considered treatment failures (including those lost to follow up, receiving surgery, or with mild or no improvement), compared with 64.3% for the two week group. Though the percentage improvement was higher in the four week group, the difference did not reach a statistical significance. Persistence of improvement was 74.2% in the four week group v 74.1% in the two week group, suggesting no difference in the long term effect. Efficacy analysis showed no significant difference in global symptom score reduction between the two groups. Follow up electrodiagnosis showed significant improvement in all measured variables except for the amplitude of compound muscle action potentials. Conclusions: Short term low dose oral steroid are effective treatment for carpal tunnel syndrome. The dose of steroids and the duration treatment are not key determinants of efficacy.

We conducted a dose-ranging study of dexamethasone for preventing nausea and vomiting within the first 24 h after the administration of epidural morphine. Two hundred twenty-five women (n = 45 in each of the five groups) undergoing simple abdominal total hysterectomy under epidural anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. When the incision closure was completed, patients received IV dexamethasone, 10 mg, 5 mg, or 2.5 mg; IV droperidol 1.25 mg; or saline 2 mL. All patients received epidural morphine 3 mg for postoperative analgesia. We found that patients who received dexamethasone 5 mg or 10 mg or droperidol 1.25 mg were significantly different from those who received saline alone in the following variables: the total incidence of nausea and vomiting, the incidence of more than four vomiting episodes, the number of patients requiring rescue antiemetics, the total number of patients with no vomiting and/or no antiemetic medication (P < 0.05 to P < 0.01). The differences among dexamethasone 10 mg and 5 mg and droperidol 1.25 mg were not significant. Dexamethasone 2.5 mg was ineffective. In conclusion, because dexamethasone 5 mg was as effective as 10 mg as an antiemetic, we recommend the smaller dose for preventing nausea and vomiting associated with epidural morphine.

To evaluate the usefulness of the posterior 180° acquisition technique for renal defects in acute pyelonephritis (APN), a prospective study was conducted using planar imaging, 360° and posterior 180° renal single photon emission computed tomography (SPECT) with 99Tcm-dimercaptosuccinic acid. Sixty subjects with the suspicion of APN were included. The kidneys were divided into three zones: each was graded as positive, equivocal or negative for renal defects. To evaluate inter-observer variation, each study was read in a double-blind fashion by two nuclear physicians. Renal defects were found in 24 patients (31 kidneys and 47 zones) with posterior 180° SPECT, 23 patients (29 kidneys and 44 zones) with 360° SPECT (McNemar's test, P = 0.375 for zones) and 15 patients (16 kidneys and 24 zones) with planar image (P = 0.001 for zones, vs 180° and 360° SPECT). The proportion of positive agreement for posterior 180° and 360° SPECT between readers for the presence of renal defects was 0.81 and 0.62, respectively, whereas the proportion of negative agreement was 0.92 and 0.87, respectively. Both posterior 180° and 360° SPECTs significantly detected more renal defects than planar imaging. The detectability of renal defects in APN by posterior 180° renal SPECT was equal to 360° SPECT but inter-observer agreement was better.

The purposes of this study were to examine the attitudes of physicians regarding the optimal use of analgesics for cancer pain management (CPM), to evaluate their knowledge and attitudes toward opioid prescribing, and to comprehend their perceptions of the barriers to optimal CPM. A survey was conducted on 356 physicians with cancer patient care responsibilities practicing in two medical centers in Taiwan. A total of 204 (57%) physicians responded, including internists (28%), surgeons (27%), oncologists (11%), anesthesiologists (10%), and other specialties (24%). The majority of physicians displayed significantly inadequate knowledge and negative attitudes toward the optimal use of analgesics and opioid prescribing. Multivariate analyses showed that the following six categories of physicians would be inclined to have inadequate knowledge of opioid prescribing: 1) those with perception of good medical school training in CPM, 2) those with perception of poor residency or fellowship training in CPM, 3) those with a medical specialty in surgery, medicine, or oncology (vs. anesthesiology), 4) those with limited clinical experience in cancer patient care (number of patients less than 30), 5) those with a limited aim of pain relief, and 6) those with an underestimation of analgesic effect. Additionally, physicians with inadequate knowledge of opioid prescribing and with hesitation to intervene earlier with maximal dose of analgesia would be inclined to have reluctant attitudes toward opioid prescribing. The most important barriers to optimal CPM identified by physicians themselves were physician-related problems, such as inadequate guidance from a pain specialist, inadequate knowledge of CPM, and inadequate pain assessment. The results of this study suggest that active analgesic education programs are urgently needed in Taiwan.

At present, there is no study that simultaneously addresses the apparent differences between bacterial and host factors in patients with bleeding and nonbleeding Helicobacter pylori-related ulcer diseases. Therefore, we designed this prospective study to evaluate whether there are identifiable differences between the two groups of patients whose H. pylori-related peptic ulcer diseases present with bleeding or dyspepsia. From July 1996 to November 1996, consecutive patients presenting with upper gastrointestinal bleeding or dyspepsia were enrolled if H. pylori-related ulcer diseases were confirmed. Fifteen clinical, endoscopic, histologic, and serologic factors were tested for association with ulcer bleeding by a logistic regression analysis. In the study period, bleeding occurred in 39 out of 119 patients with H. pylori-related peptic ulcer diseases. Multivariate analysis showed that ingestion of nonsteroidal antiinflammatory drugs (NSAIDs; p = 0.0156; odds ratio = 5:4), ulcer size > or = 1 cm (p = 0.0033; odds ratio = 4:2), and low bacterial density (p = 0.0030; odds ratio = 4:1) were independent factors associated with the risk of bleeding. There were no associations between ulcer bleeding and age, sex, smoking, alcohol consumption, the histologic grade of gastritis, location and number of ulcers, and the cytotoxin-associated gene (CagA) status of H. pylori strain. Therefore, we concluded that H. pylori-related ulcer patients who use NSAIDs or have large ulcers are more likely to present with upper gastrointestinal bleeding; that the CagA-bearing strains are not associated with the development of bleeding complication in patients with peptic ulcer diseases; and that the exact reason concerning the association between low bacterial density and ulcer bleeding merits further investigation.

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 [C-13]-urea breath test ([C-13]-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 [C-13]-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 (CO2)-C-13 was collected 15 min after the patient drank 100 mg [C-13]-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 [C-13]-UBT was 60.3%. The sensitivity and specificity of [C-13]-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 [C-13]-UBT is a rapid but less specific protocol for detecting the presence of H. pylori infection in patients with NUD. (C) 2000 Blackwell Science Asia Pty Ltd.

Objectives: Attempting to answer a debate concerning the etiopathogenesis of the decreased forearm median motor conduction velocity (FMMCV), we tried to use proximal stimulation at the wrist, elbow, mid-arm and axillary regions to determine segmental median motor conduction velocity (MMCV). We also correlated the FMMCV with median motor distal latency (MMDL) and compound muscle action potential (CMAP) amplitudes of the abductor pollicis brevis (APB) muscle in order to assess whether the conduction block of large myelinating fibers or retrograde axonal atrophy was the major cause of the decreased FMMCV.Background: The cause of the decreased FMMCV resulting from either the conduction block of the large myelinating fibers at the wrist or distal compression with retrograde axonal atrophy remains an unresolved issue at the moment. Animal models have supported the hypothesis that the retrograde axonal atrophy might also occur in humans. Other authors believe the standard FMMCV is calculated by subtracting the distal latency which may not represent an exact assessment of FMMCV but rather the velocity of small fibers that persist through the carpal tunnel.Subjects and methods: Patients with the clinical symptoms and signs of carpal tunnel syndrome (CTS) confirmed using standard electrodiagnosis were included. The patients were arbitrarily divided into two groups based on the FMMCV, one with reduced FMMCV (n=20, FMMCV < 50 m/s) and the other with normal FMMCV (n=35, FMMCV≥50 m/s). Age-matched volunteers served as controls. We explored motor conduction proximally at wrist, elbow, mid-arm and axillary stimulation, and recorded at the APB muscles. Based on the latency differences, we calculated the FMMCV, distal arm MMCV (DAMMCV) and proximal arm MMCV (PAMMCV), and compared the conduction velocity (CV) differences of DAMMCV–FMMCV, PAMMCV–FMMCV and PAMMCV–DAMMCV in the two patient groups and the control. Furthermore, we correlated FMMCV with MMDL and CMAP amplitudes of APB muscle because MMDL and CMAP amplitudes might reflect the integrity of the large myelinating fibers.Results: CMAP amplitudes of APB muscle at wrist stimulation and MMDL were not correlated with FMMCV in either of the two patient groups; however, the CMAP amplitude was markedly decreased and MMDL was significantly prolonged when compared with normal controls. The significant increase of CV gradient of DAMMCV–FMMCV and PAMMCV–FMMCV without an equal increase of CV gradient of PAMMCV–DAMMCV only occurred in the reduced FMMCV patient group, suggesting that the conduction block is not the primary cause. The CV gradient of DAMMCV–FMMCV and PAMMCV–DAMMCV did not show any significant difference between patients with the normal FMMCV and the control group.Conclusion: The retrograde axonal atrophy, not selective damage of the large fibers at the wrist, was the direct cause of the decreased FMMCV.

BACKGROUNDThis study investigates the cell proliferation and the expression of p53 protein in Helicobacter pylori (H. pylori)-associated gastritis and assesses the effect of bacterial eradication on these epithelial factors.MATERIAL AND METHODSSeventy-nine patients with H. pylori-associated gastritis were randomized into the control group (n = 38) and anti-H. pylori group (n = 41). Each patient received endoscopic examinations with gastric biopsy before and 8 weeks after the treatment. The specimens from gastric antrum were immunostained for monoclonal antibodies against the proliferating cell nuclear antigen (PCNA) and p53 protein.RESULTSIn the control group, the total labeling index (L.I.) of PCNA and the positive index (P.I.) of p53 in the whole foveolar epithelium were unchanged after treatment. In the anti-H. pylori group, 35 of 41 cases (85.3%) achieved eradication of H. pylori. Amongst the H. pylori-eradicated cases, the total L.I. of PCNA in the whole foveolar epithelium did not meaningfully alter after H. pylori elimination (p > 0.05). However, a significant reduction of L.I. was observed in the middle compartments of the gastric pits (before vs. after treatment: 14.0 vs. 7.3, p < 0.05). With regard to the p53 expression, the P.I.s were significantly decreased in the whole foveolar epithelium (before vs. after treatment: 0.57 vs. 0.17, p < 0.05) and in each compartment of the gastric pits (before vs. after treatment: [upper compartment]: 0.34 vs. 0.15, p < 0.05; [middle compartment]: 0.67 vs. 0.23, p < 0.05; [lower compartment]: 0.71 vs. 0.20, p < 0.05) after eradication of H. pylori.CONCLUSIONSBacterial eradication reverses the hyperproliferating status of the foveolar epithelium in patients with H. pylori gastritis and leads to a decrease in p53 accumulation in the epithelial cells.