Tzu Chi Research Articles

Using structured narrative to help a medical student reflect on an unexpected clinical situation

Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan Department of Occupational Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan Department of Nursing, College of Medicine, Tzu Chi University, Hualien, Taiwan Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan Department of Medical Education, Buddhist Tzu Chi General Hospital, Hualien, Taiwan Department of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

Inpatient satisfaction with TCM medication counseling services provided by pharmacists

BackgroundTCM has been widely used to manage health around the world. Integrating TCM medication and western medicine into health care system is supported by WHO. The practices of integration mainly are contingent on the levels of physicians and pharmacists who have been trained in both. Integrating pharmacists into primary care practices is becoming increasingly recognized as a strategy to manage the complex medication needs. This questionnaire survey examined the satisfaction of patients with pharmacists directed interventions in TCM medication, health education and counseling services. MethodsA total of 60 inpatients receiving TCM medication integrated into conventional treatment were enrolled in the Buddhist Tzu Chi General Hospital from July 2009 to June 2010. A questionnaire was developed for evaluating general satisfaction with the provision by the pharmacist and pharmacy services. A five-point Likert rating scale was used before and after (pre-test and post-test) pharmacist interventions. Questionnaire responses were analyzed using SPSS statistical software package. ResultsThe 60 participants consisted of patients themselves (52%), family members of patients (38%) and caregivers (10%). Response rate to the survey was 100%. The majority of respondents were female (68.3%), aged between 41 and 60 years (61.7%). The pre-test/post-test changes in satisfaction with pharmacist interventions were significantly different for 8 out of the 13 items. ConclusionsRespondents were generally satisfied with pharmacist interventions as indicated by an overall average score of integrated outcomes effectiveness on pharmacist interventions greater than 4.0. Future studies on the effectiveness of pharmacist interventions should provide integrated outcome assessments.

Validation of the laboratory risk indicator for necrotizing fasciitis (LRINEC) score for early diagnosis of necrotizing fasciitis

ObjectiveNecrotizing fasciitis is a surgical emergency. It has a poor outcome after late operative intervention but the clinical diagnosis is difficult. The laboratory risk indicator for necrotizing fasciitis (LRINEC) score was first introduced in 2004 and several clinicians have suggested it is useful for early recognition of necrotizing fasciitis but its validation still needs to be examined. We collected our hospital data from May 2003 to September 2010 to validate whether the LRINEC score can aid in early recognition of necrotizing fasciitis. Materials and MethodsThis is a validation cohort study. We reviewed all necrotizing fasciitis patients admitted from the emergency department at Buddhist Tzu Chi Dalin General Hospital in Taiwan from May 2003 to September 2010. All patients had pathological diagnoses. We used multiple imputations for missing patient data. We analyzed these data and examined whether the LRINEC score had a higher diagnostic value than the clinical diagnosis before admission. We also examined the LRINEC score in patients with severe cellulitis to determine its usefulness in excluding necrotizing fasciitis. ResultsA total of 233 patients with necrotizing fasciitis and 3155 with severe cellulitis were included in our study. A LRINEC score ≥6 had a sensitivity of 59.2% (CI 52.9–65.6%), specificity of 83.8% (CI 81.9–85.7%), likelihood ratio of 3.89, positive predictive ratio of 37.9% (95% CI 32.9–42.9%), and negative predictive ratio of 92.5% (95% CI 91.0–94.0%). The rate of clinical diagnosis of necrotizing fasciitis by emergency physicians before admission was 58.4% (95% CI 52.0–64.8%). Of the 97 patients with necrotizing fasciitis who were not clinically diagnosed before admission, 43.3% (95% CI 36.9–49.7%) had a LRINEC score <6. ConclusionThe LRINEC score is an impressive diagnostic tool to distinguish necrotizing fasciitis from other severe soft tissue infections, but it is not useful for early recognition of necrotizing fasciitis.

Corticotropin‐releasing factor involves in promotive effect of restraint on neuronal activation by methamphetamine

The mesocorticolimbic (MCL) system is the main place methamphetamine (MA) manifests its addictive characteristics. Stress is one of the risk factors engaging in initiation, recurrence and relapse of drug‐taking behaviors, but the mechanism is still ambiguous. Corticotropin‐releasing factor (CRF) acts as an integrator of stress responses. So, we planned to clarify the role of CRF on the promotive effect of restraint (RST) on MA‐induced neuronal activation in nuclei of the MCL system by immunohistochemistry. Either RST (30 min) or MA (2.5 mg/Kg, ip) induced increase the number of cFos‐immunoreactive (‐ir) cells in nucleus accumbens (NA) and medial prefrontal cortex (mPFC). RST prior to MA challenge induced more neuronal activation. The promotive effect of RST was eliminated by central injection of CRF receptor antagonist, alpha‐CRF9‐41. So, we proposed that RST may potentiate stimulatory effect of MA by activating CRF signaling. For tracing the origin of CRF signal, retrograde tracer, fluro‐gold, was injected in the NA. Besides ventral tegmental area (VTA) and substantia nigra, lots of neuronal were labled with FG in the basolateral amygdale which receives CRF‐ir innervation. So, the stress signal may be transmitted into the MCL system through BLA by CRF signaling. This work was sponsored by Tzu Chi Foundation

Decreased release of methyl palmitate in perivascular adipose tissue in hypertension

Our recent studies have demonstrated that palmitic acid methyl ester (PAME) is the major perivascular adipose tissue (PVAT)‐derived relaxing factor. We determined if PAME release from the PVAT and/or its vasorelaxing activity decreased in hypertension. PAME release from aortic PVAT preparations of Wistar Kyoto rats (WKY) and spontaneously hypertensive rat (SHR, 20‐week old) was estimated pharmacologically using superfusion bioassay cascade technique and biochemically by GC/MS. Results indicated that the PVAT of WKY and SHR aorta spontaneously released PAME. The release was significantly less but with an increased release of angiotensin II in SHR. Also, PAME‐induced relaxation of SHR aortic smooth muscle diminished drastically, which was reversed by losartan. Incubation of isolated PVAT preparations of SHR in Krebs solution containing losartan (10 £gM) for 30 min enhanced PVAT‐elicited vasorelaxation, with enhanced PAME release. These results suggest a noble role of PVAT &amp; PAME in pathogenesis of hypertension. Antihypertensive effect of losartan is partly attributed to its increasing PAME release and reversing diminished PAME‐induced vasorelaxation (Supported by NSC, Tzu Chi Found &amp; TCU).

Effectiveness of rater consensus training in objective structured clinical examination using Kolb’s experiential learning

conceptualization 1. Discuss immediately the concrete experience using the immediate response system 2. Discuss rating scores for two cycles under modified Delphi consensus training 3. Observation of inconsistent rater behaviors Active experimentation 1. Rating during consensus training 2. Rating at high-stake OSCE OSCE1⁄4 objective structured clinical examination. Table 2 Inter-rater reliability among each station. Station Paired t-test Pearson correlation Mean (n1⁄4 58) CI SD (95%) p value * r p value ** 1. Leg pain 0.17 1.11w 0.76 3.560 0.71 0.55 0.000 2. Headache 0.17 1.06w 1.40 4.676 0.78 0.49 0.000 3. Dizziness 0.97 2.56w 0.02 3.770 0.06 0.56 0.000 4. Palpitation 0.43 0.33w 1.19 2.878 0.26 0.70 0.000 5. Pancreatitis 0.62 1.86w 0.62 4.720 0.32 0.45 0.000 6. Menopause 0.50 0.38w 1.38 3.336 0.26 0.70 0.000 7. Cough 0.28 0.53w 1.08 3.048 0.49 0.65 0.000 8. H1N1 0.88 1.73w 0.02 3.250 0.04 0.34 0.009 *value obtained from the paired t-test (a1⁄4 0.05). **value obtained from the Pearson correlation (a1⁄4 0.01). CI1⁄4 confidence interval; SD1⁄4 standard deviation. S.-Y. Chu et al. / Tzu Chi Medical Journal 24 (2012) 155e156 156 concrete experience, and trainers can immediately fill in gaps in knowledge. We found behavior level changes, as determined by the self-evaluation, to be high. However, raters’ scoring variations remained high on two stations in this OSCE examination. Further investigation is needed to determine the reasons contributing to these raters’ persistent scoring variations. Nonetheless, these early results support the idea that Kolb’s cycle of experiential learning model can facilitate rater consensus training in a high-stakes OSCE setting.

Pneumocystis jirovecii pneumonia manifesting as a lung abscess in a woman with systemic lupus erythematosus

Department of Nursing, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei City, Taiwan Department of Pharmacy, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei City, Taiwan Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei City, Taiwan d School of Medicine, Tzu Chi University, Hualien, Taiwan Graduate Institute of Bioengineering and Bioinformatics, National Taiwan University, Taipei, Taiwan Department of Pathology, Buddhist Tzu Chi General Hospital, Taipei Branch, New Taipei City, Taiwan

Male sex, hiatus hernia, and Helicobacter pylori infection associated with asymptomatic erosive esophagitis

Asymptomatic erosive esophagitis (AEE) is an easily forgotten subgroup of gastroesophageal reflux disease due to its lack of warning symptoms, despite having the risk of developing complications, such as bleeding, stricture, or even esophageal adenocarcinoma. A total of 2843 potentially eligible patients were screened at the health management center of Buddhist Tzu Chi General Hospital. A total of 1001 patients responded to the survey and gave informed consent; 998 patients who completed the reflux disease diagnostic questionnaire were enrolled. Of them, 594 patients who had no reflux symptoms were included for final analysis. The presence and severity of erosive esophagitis was graded according to the Los Angeles classification. Active infection of Helicobacter pylori (H. pylori) was determined by the Campylo-like organism (CLO) test during endoscopies. A total of 14.5% (86/594) of asymptomatic patients had endoscopic findings of erosive esophagitis. In the univariate analysis, male sex and hiatus hernia were significantly associated with AEE. Positive CLO tests had a trend association. Based on the multivariate analysis, male sex (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.35-3.98), hiatus hernia (OR: 4.48, 95% CI: 2.35-89.17), and positive CLO test (OR: 0.57, 95% CI: 0.34-0.95) were associated with AEE, as compared to the healthy controls. AEE is not a rare condition, and constitutes 14.5% of the asymptomatic population. Male sex, hiatus hernia, and H. pylori infection are factors associated with AEE. These findings are not only helpful in identifying such asymptomatic patients, but also provide information to improve understanding of the relationship between H. pylori infection, reflux symptoms, and erosive esophagitis.

Increased Anterior Cingulate Regional Homogeneity After Duloxetine Therapy in First-Episode, Drug-Naïve, Major Depressive Disorder With Panic Disorder Patients: A Case Series

Increased Anterior Cingulate Regional Homogeneity After Duloxetine Therapy in First-Episode, Drug-Naïve, Major Depressive Disorder With Panic Disorder Patients: A Case Series

Associations among birth weight, placental weight, gestational period and product quality indicators of umbilical cord blood units

IntroductionNumbers of CD34+ cell and total nucleated cell (TNC) and cord blood volume are commonly used as indicators for haematopoietic potential of umbilical cord blood (UCB) units. The purpose of this study was to investigate the relationship between donor-related factors and the quality indicators of UCB. MethodsObstetric and neonatal clinical laboratory data of a total of 1549 UCB units were obtained from Buddhist Tzu Chi Stem Cells Center (BTCSCC) Cord Blood Bank. A retrospective multivariate analysis was conducted to analyze the data. ResultsOur results showed that birth weight had positive correlations with each of the clinical features of CD34+ cell number, TNC count and unit volume of UCB, followed by the placental weight. Longer gestational period would decrease CD34+ cell number and volume of UCB. Female baby and mode of vaginal delivery of neonates were found to have larger amount of TNC in UCB. ConclusionOur results would be helpful and beneficial in building up standard criteria for evaluating stored UCB units.

Clonal spread of multidrug-resistant Acinetobacter baumannii in eastern Taiwan

This study was conducted to investigate the molecular epidemiology and antimicrobial susceptibility of multidrug-resistant (MDR) Acinetobacter baumannii to three types of antibiotics. One hundred and thirty-four specimens of MDR A baumannii were collected from three branches (Taipei, Dalin, and Hualien branches) of Buddhist Tzu Chi Hospital, which are located in northern, southern, and eastern Taiwan, during 2007. Genotyping was performed by pulsed-field gel electrophoresis. Antibiotic susceptibilities to colistin, rifampicin, and tigecycline were determined. The synergistic effects of rifampin and colistin were also evaluated. Antibiotic susceptibility testing showed that 10.4%, 47.8% and 45.5% of the MDR A baumannii isolates are resistant to colistin, rifampicin, and tigecycline, respectively. A majority of the rifampicin-resistant isolates (62.7%) were found in the Haulien branch, whereas 62.2% of tigecycline-resistant isolates were found in the Taipei branch. The combination of colistin and rifampicin had a synergistic effect on all of the isolates. Genotyping by pulsed-field gel electrophoresis identified 17, 23, and 11 pulsotypes in the Taipei, Dalin, and Haulien branches, respectively. Furthermore, 74.5% of isolates in the Haulien branch were identified as one of three pulsotypes. Among 37 rifampicin-resistant and 22 tigecycline-resistant MDR A baumannii isolates found in the Haulien branch, 51.3% (19/37) and 50% (11/22) of the isolates belonged to the same clone, respectively. This study confirms the high prevalence of resistance to rifampicin and tigecycline in MDR A baumannii in the three hospitals that were studied, and the high proportion of identical strains that exist in eastern Taiwan.

Predicting insulin resistance using the triglyceride-to-high-density lipoprotein cholesterol ratio in Taiwanese adults

BackgroundThe triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) has been advocated as a simple clinical indicator of insulin resistance. Thresholds of TG/HDL-C appeared to depend on ethnicity. However, no studies have specifically compared the accuracy of TG/HDL-C with and without other clinical and demographic factors in predicting insulin resistance in Taiwanese adults. The aim of the present investigation was to use TG/HDL-C and other clinical available factors to predict insulin resistance in Taiwanese adults.MethodsA total of 812 subjects were recruited from at the time of their general health examination at the Buddhist Dalin Tzu Chi General Hospital, Taiwan. Demographic information and clinical characteristics were obtained. Insulin resistance was defined by the homeostasis model assessment for insulin resistance (HOMA-IR). Simple and multiple logistic regression analyses were used to obtain probabilities of insulin resistance (HOMA-IR > 2) using TG/HDL-C with (Model 2) and without (Model 1) other clinical variables. A receiver operating characteristic (ROC) analysis was conducted to evaluate the ability of the two models to correctly discriminate between subjects of low and elevated HOMA-IR.ResultsFemale sex, greater waist circumferences, and higher ALT levels were significantly associated with the risk of elevated HOMA-IR in addition to TG/HDL-C in the multiple logistic regression (Model 2). The area under the ROC curve (AUC) of Model 2 was 0.71 [95% CI = 0.67-0.75] and was significantly higher (P = 0.007) than the AUC 0.66 [95% CI = 0.62-0.71] of Model 1.ConclusionsThe diagnostic accuracy of insulin resistance, defined by HOMA-IR, using TG/HDL-C can be significantly enhanced by including three additional clinically available factors - sex, waist circumferences, and ALT levels.

Methicillin-resistant Staphylococcus aureus in skin and soft tissue infections and minocyclin treatment experience in the dermatological setting of eastern Taiwan

Staphylococcus aureus ( S aureus ) is the major cause of skin and soft tissue infections (SSTIs). Increased methicillin-resistant strains have attracted a global concern. The aim of this study is to evaluate the prevalence of methicillin-resistant S aureus (MRSA) SSTIs in dermatologic settings and evaluate their susceptibility results. A retrospective chart analysis of patients diagnosed with SSTIs in the Department of Dermatology, Buddhist Tzu Chi General Hospital in Hualien, Taiwan from November 2003 to July 2007 was conducted. Wound or pus bacterial culture results from a wound site were collected. The epidemiology, microbiology, and antibiotic susceptibility were assessed. Minocycline treatment experience in 15 MRSA SSTIs inpatients was presented. Of the 443 SSTI episodes included, 59.6% were males and 40.4% were females. S aureus was the leading cause (53.3%), and among them 53.0% were MRSA. Minocycline (94.4%), trimethoprim/sulfamethoxazole (95.2%), levofloxacin (95.7%), and fusidic acid (98.9%) were the major susceptible antimicrobial agents to MRSA. Only 14.4% was susceptible to clindamycin. In the MRSA infected inpatients, 75.6% were community-associated. In our clinical experience, 15 inpatients with poor clinical response to beta-lactam empirical antimicrobial therapy received minocycline as combination therapy based on the susceptibility results, all of which obtained satisfied clinical remission. S aureus is still the leading causative bacterial organism for SSTIs in the dermatologic settings in eastern Taiwan. Methicillin-resistant strains are increasing and among which most are community-associated in eastern Taiwan. MRSA strains are still susceptible to other non-beta lactam antibiotics, such as minocycline, trimethoprim/sulfamethoxazole, levofloxacin, and fusidic acid in dermatological settings, of which minocycline is an alternative choice in our clinical experience.

Impact of total vaginal mesh surgery for pelvic organ prolapse on female sexual function

Objective To evaluate the short-term impact of surgical repair with total transvaginal mesh (TVM) on sexual function among women with pelvic organ prolapse (POP). Methods Twenty-seven sexually active women who underwent total TVM procedures for symptomatic POP at Buddhist Dalin Tzu Chi General Hospital between 2007 and 2010 were included in the retrospective study. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP-Q) system, urodynamic studies, and a personal interview to evaluate urinary and sexual symptoms via the urogenital distress inventory (UDI-6), incontinence impact questionnaire (IIQ-7), and female sexual function index (FSFI). Results The mean patient age was 51.4 years (range 36–68 years) and the mean parity was 2.7 (range 0–4). Regarding POP-Q parameters, there were significant improvements at points Aa, Ba, C, Ap, and Bp after surgery ( P < 0.001). Similarly, the UDI-6 and IIQ-7 scores significantly dropped postoperatively ( P < 0.01). After surgery, the scores for the dyspareunia and the lubrication domains of FSFI worsened significantly ( P < 0.05). There was no significant change in other domains (desire, arousal, orgasm, satisfaction, and total score; P > 0.05). Two-thirds (66.7%) of women had a lower total FSFI score postoperatively. Conclusion TVM surgery was found to contribute successfully to the anatomic correction of POP, but individual domains of sexual function sometimes worsened.

Hepatitis C virus and lipid profiles: more questions than answers?

Overnutrition and sedentary lifestyle have increased the global prevalence of diabetes and obesity [1]. In addition, the accompanying metabolic derangements, cardiovascular diseases [2], non-alcoholic fatty liver disease [3], and different malignant diseases also heavily impact public health and economic burden worldwide. Insulin resistance, the essence of metabolic syndrome with a constellation of metabolic derangements as well as risk factors for both cardiovascular diseases and diabetes [2], is known to aggravate hepatic steatosis, drive liver fibrosis progression, and increase the risk of hepatocellular carcinoma (HCC) [4]. Therefore, metabolic factors and their adjustments have been increasingly recognized in the clinical practice of hepatology, and become hot subjects in this active research field [5]. In the meantime, hepatitis C virus (HCV) infection affects [170 million people with severe liver disease, including chronic hepatitis, liver fibrosis, cirrhosis, and HCC [6]. Therefore, HCV infection bears a huge disease burden globally, and it is prudent to eradicate the virus and halt disease progression in patients with chronic HCV infection. Unfortunately, the current standard of care with pegylated interferon-a plus ribavirin (RBV) for the treatment of chronic hepatitis C (CHC) is costly, poorly tolerated, and only effective in a certain portion of patients [7]. With these reasons, identifying and modifying factors associated with disease progression or predictive of therapeutic response in CHC patients is a matter of clinical concern. Of note, ample epidemiologic and clinical evidence has demonstrated a close association of HCV infection with metabolic derangements [8]. CHC patients are known to have an increased prevalence of diabetes and hepatic steatosis. In addition, serum lipid profiles of CHC patients are different from healthy or other disease control subjects. For example, CHC patients usually have lower serum triglyceride, total cholesterol, but higher serum adiponectin, homeostasis model assessment (HOMA)-insulin resistance index, and serum high-density lipoprotein (HDL) levels than matched healthy adults [9]. Moreover, serum HCV RNA levels were positively proportional to HOMA-insulin resistance index, serum triglyceride, and total cholesterol levels in CHC patients [10, 11]. Additionally, several lines C.-S. Hsu Division of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Taipei, Taiwan

P90. Treatment of laryngeal cancer at Buddhist Tzu Chi General Hospital

P90. Treatment of laryngeal cancer at Buddhist Tzu Chi General Hospital

Complete Blood Count Reference Values of Cord Blood in Taiwan and the Influence of Gender and Delivery Route on Them

Cord blood banking has become more popular in recent years. Checking cord blood complete blood count (CBC) and white blood cell (WBC) differential counts (DCs) is essential before cryopreserving the cord blood units. Therefore, establishing the normal reference values of cord blood CBC and WBC DC is important in clinical practice and research. To obtain a large-scale population-based normal CBC and WBC DC reference values of healthy neonates' cord blood from a public cord blood bank and to investigate the influence of the gender and delivery route. From September 2001 to November 2006, the cord blood of healthy Taiwanese neonates with gestational age 36 weeks and more were collected by Tzu Chi Cord Blood Bank with written informed consents. All cord blood samples were analyzed by Sysmex XE2100 automated hematology analyzer (Sysmex Corporation, Kobe, Japan) to obtain the CBC. The WBC DC was calculated by manual method. We used Student's t test and Mann-Whitney U test for investigating the influences of gender and delivery route on the CBC and WBC DC reference values. The results were presented by mean±standard deviation or 2.5-97.5th percentiles. In the study period, totally 5602 cord blood samples were collected eligibly for analysis. The cord blood CBC and WBC DC normal reference values were calculated. The female neonates had significantly higher mean corpuscular volume, platelet count, and WBC count, but lower red blood cell (RBC) count, hemoglobin (Hb), hematocrit, and mean corpuscular Hb concentration values (p<0.001). Newborns through vaginal delivery had significantly higher RBC count, Hb, hematocrit, platelet count, and WBC count (p<0.001). The percentages of some different types WBC were significantly influenced by gender and delivery routes. Male babies had higher lymphocyte, monocyte, eosinophil, basophil, and nucleated RBC ratios than the female neonates. Newborns through cesarean section had significantly lower neutrophil, monocyte, and nucleated RBC ratios, but higher lymphocyte and eosinophil ratios, than newborns through vaginal delivery. We successfully obtained the normal CBC and WBC DC reference values of the cord blood in Taiwan. Gender and delivery routes were important confounding factors that influenced the cord blood CBC and WBC DC values.

Letters to Silent Teachers in Tzu Chi Medical School: A Spiritual Interaction

This article examines the spiritual communication between medical students and the donated dead body they anatomized, referred to as the silent teacher. Data were obtained from the medical school of Tzu Chi University in Taiwan, where students are required to write a letter to the silent teacher at the end of the semester after they have anatomized the body. The school has collected and published a total of 89 letters from 1996 to 2001. This article content analyzes all the 89 letters published and draws common themes from them. Based on the results of this content analysis, we have developed a model of spiritual communication.

Methyl palmitate is the perivascular adipose tissue‐derived relaxing factor

The perivascular adipose tissue (PVAT)‐derived relaxing factor (PVATRF) is known to significantly regulate the vascular smooth muscle tone. Its chemical nature, however, remains unknown. We determined whether methyl palmitate or palmitic acid methyl ester (PAME) was the PVATRF. Release of PVATRF and PAME from aortic PVAT preparations of Wistar Kyoto rats was estimated using superfusion bioassay cascade technique and gas chromatography/mass spectrometry (GC/MS). The PVATRF and PAME were spontaneously and calcium‐dependently released from PVAT preparations. Both releases were inhibited by 4‐aminopyridine (2 mM) and tetraethylammonium (TEA) at 10 mM, but were not affected by TEA at 3 mM, glibenclamide (3 μM) or iberiotoxin (100 nM). Aortic vasorelaxations induced by PVATRF‐ and PAME‐containing Krebs' solutions were not affected after heating at 70°C, and were equally attenuated following hexane extractions. Culture mediums of differentiated adipocytes, but not those of fibroblasts, contained significant PAME and caused aortic vasorelaxation. These results indicate that PAME and PVATRF share similar characteristics in biochemistry and pharmacology. It is concluded that PAME is the PVATRF, causing aortic vasorelaxation by opening voltage‐dependent K+ channels on the smooth muscle cells (Supported by NSC, Tzu Chi Foundation &amp; TCU).

Effect of vitamin B12 supplementation on plasma homocystein levels in Taiwanese vegetarians

ObjectiveElevated plasma homocystein (Hcy), a risk factor for cardiovascular disease, has been observed in vegetarians in countries with limited vitamin B12 fortified foods. We investigated the effect of vitamin B12 supplementation on Hcy.MethodsIn a double‐blind placebo‐control trial, 65 vegetarians (age 54±9) with Hcy &gt;12μmol/L were randomly assigned to receive either a daily supplementation of 500μg vitamin B12 or placebo, for 6 months. Fasting serum vitamin B12 and Hcy were measured at month 0, 3, 6, 9, and 12.ResultsVitamin B12 group, compared with control, had a 35% reduction in Hcy in 3 months: month 0 (18.1±7.2 vs. 17.9±6.4 μmol/L), month 3 (11.7±2.4 vs. 17.8±7.7 μmol/L, p&lt;0.001), with no further decrease after 3 months. During supplementation, serum vitamin B12 increased correspondingly as Hcy decreased. Upon cessation of supplementation, Hcy levels in the B12 group were maintained until month 12, while serum vitamin B12 dropped in month 9.ConclusionThis is the first trial to show that vitamin B12 supplementation alone is effective in treating Taiwanese vegetarians with hyperhomocysteinemia. A supplementation of 500μg of vitamin B12 for 6 months resulted in a sustained reduction of Hcy 6 months after cessation, despite the earlier drop in serum vitamin B12. Serum vitamin B12 may be more sensitive, than Hcy, to recent reduction in vitamin B12 intake.This study was supported by Tzu Chi Hospital.