Four and a half LIM domains protein 1 (FHL1) and FHL2, as the name suggests, contain four and a half LIM domain binding proteins. Proteins in this family capable of interacting with many types of proteins, including structural proteins, kinases, and several classes of transcription factors, have been identified. These interactions have been found to have important roles in a variety of fundamental processes including transcriptional regulation, cardiovascular development, hypertrophy, atherosclerosis, and angiogenesis. This article reviews recent advances in the characterization of FHL1 and FHL2, their biological roles, LIM domain binding proteins, and functions in the cardiovascular system.

Huntington's disease (HD) is an autosomal dominant, progressive neurodegenerative disorder, characterized by an array of different psychiatric manifestations, cognitive decline and choreiform movements. The underlying molecular genetic defect is an expanded trinucleotide (CAG)n repeat encoding a polyglutamine stretch in the N-terminus of the huntingtin protein. The mechanisms by which mutant huntingtin causes neuronal dysfunction and degeneration are not fully understood. Nevertheless, impaired ubiquitin-proteasome activity, defective autophagy-lysosomal function, transcriptional dysregulation, oxidative stress, apoptosis, mitochondrial and metabolic dysfunction, and abnormal protein-protein interaction have been shown to play important roles in the pathogenesis of HD. Neurons are energy-demanding and more susceptible to energetic failure and oxidative damage than other types of cell. Given that mitochondria play a central role in both processes of metabolism and oxidative stress, and increasing direct evidence shows mitochondrial abnormalities in both HD mouse models and patients, this article will review the studies of mitochondrial dysfunction, metabolic deficits, and increased oxidative stress in HD, and discuss the potential therapeutics targeting these abnormalities.

Background: The purpose of this study was to investigate the outcomes of doctors who studied at a graduate degree program at a domestic institute for clinical medicine. Methods: The academic results of 45 doctors who studied at the Graduate Institute of Clinical Medical Sciences- Kaohsiung Branch (GICMS-KB) of Chang Gung University (CGU) were analyzed and compared with those of 83 doctors who had studied abroad or at domestic institutions other than CGU (non- CGU), as well as with 263 who did not pursue further graduate studies (no GS) during the study period from 2003 to 2007. The 128 doctors who had pursued graduate study were sent a survey consisting of 6 questions about factors which hamper research activity. Results: The average number of Science Citation Index (SCI) articles published by the doctors of GICMS-KB as the first author over five years was 3.16 ± 0.52, which was significantly higher than 1.51 ± 0.22 in the no GS group (p = 0.005) and 2.31 ± 0.39 in the non-CGU group. The average number of research grants was 3.62 ± 0.64 in GICMS-KB group, which was higher than 1.57 ± 0.28 in the non-CGU and 1.56 ± 0.20 in the no GS groups (p < 0.001 in both). The percentage of the doctors with faculty positions was 58% in GICMS-KB group, higher than 43% in the non-CGU and 38% in the no GS groups, with a p value of 0.055 comparing GICMS-KB with the no GS group. The survey indicated that all doctors who pursued post-graduate training had similar problems, such as lack of time and lack of research manpower with no difference between the GICMS-KB and non-CGU groups. Conclusion: The academic performance of doctors who did postgraduate study at our graduate institute for clinical medicine was generally better than those who did not pursue further graduate studies or those with postgraduate studies outside CGU. Factors such as adaptation of the GICMS-KB doctors to our system and policies which include enforced grant writing and publication for graduation during the training course may account for the difference.

Background: Recently, a model of the ossicular chain for finite element analysis has been developed. However, the natural vibration characteristics of human ossicles have never been studied. Herein, we investigated the dynamic characteristics of the coupling of in-vivo ossicles using finite element analysis. Methods: The geometry of the ossicular chain was obtained by high-resolution computed tomography of the temporal bone, and a 3D model of the ossicular chain was reconstructed by the medical imaging software, Amira®. The file was then imported into the finite element analysis software, ANSYS®. The natural vibration characteristics of human ossicles were measured by finite element analysis. Results: The characteristic dimensions of the model were measured and compared with previously published data. The malleus resonated to sound stimuli at 3 kHz and 4 kHz; the incus and stapes did not resonate to sound stimuli at any frequency. A coupling of the incus and malleus easily resonated to sound stimuli at 5 kHz. A coupling of the incus and stapes easily resonated to sound stimuli at 3 kHz. The coupling of the ossicular chain easily resonated to sound stimuli at 5 kHz, 6 kHz and 8 kHz. Conclusion: The dynamic characteristics of the ossicular chain were analyzed by finite element analysis method. The characteristics of a free vibration model of the ossicles could be determined, which would be helpful in evaluation and consultation for ossicular prosthesis development.

Background: To obtain magnetic resonance images of the in-vivo human tympanic membrane to avoid radiation exposure. Methods: Images of the in-vivo human tympanic membrane were obtained by magnetic resonance imaging (MRI). The differences in resolution of the images obtained by multi slice single echo (MSSE) and 3-dimentional (3D) SNAP sequences were then compared. Results: The resolution of the 2D MR images acquired by MSSE sequences was higher than that obtained by 3D SNAP. The voxel size of the MR images was smaller than that with 3D SNAP because of the narrower slice thickness. Therefore, the spatial resolution of the 3D SNAP sequenced images was better than that of MSSE images. The scanning time for MSSE and 3D SNAP were 12 minutes and 40 seconds and 1 minute and 42 seconds respectively. The signal-to-noise ratio (SNR) of MR images with 3D SNAP was 0.32 decibels higher than that with MSSE. Conclusion: In this study, MR images of the in-vivo human tympanic membrane could be obtained with a 9-cm surface coil with MSSE and 3D SNAP sequences. The spatial resolution of MR images acquired with 3D SNAP was better than that with MSSE. The scanning time with 3D SNAP was shorter than that with MSSE based on similar SNRs. The structure and geometry of the tympanic membrane can be observed clearly, which would be helpful for diagnosis in clinics and can avoid radiation exposure.

Background: Pruritus is the most common side effect of epidural morphine analgesia. Diphenhydramine is a widely used agent for the treatment of urticarial pruritus. Nalbuphine is a mixed opioid agonist– antagonist and has been reported to be effective in treating opioid-induced pruritus. We compared the effectiveness of intramuscular diphenhydramine and nalbuphine for the prevention of epidural morphine-induced pruritus after cesarean section. Methods: One hundred and fifty, American Society of Anesthesiologists physical status I or II, women undergoing cesarean section with epidural anesthesia were randomly assigned to three groups. Group S, group D, and group N received intramuscular normal saline (1 ml; n = 50), diphenhydramine (30 mg/1 ml; n = 50), and nalbuphine (10 mg/1 ml; n = 50), respectively, after delivery of the baby. The occurrence and the severity of pruritus were assessed at 1, 4, 12, and 24 hours after surgery. Results: The overall incidence of pruritus during the 24 hr follow-up period was 72%, 68%, and 44% for group S, group D, and group N, respectively. Pruritus occurred less frequently in group N than group D (p = 0.027). At 4 and 12 hrs postoperatively, the pruritus severity was significantly different (p = 0.003 and p = 0.002) and was significantly less in group N than group D in the intergroup comparison (p = 0.013 and p = 0.012). Conclusion: Nalbuphine proved better than diphenhydramine for prevention of epidural morphine-induced pruritus in patients who underwent cesarean section. Prophylactic intramuscular nalbuphine (10 mg) is effective in decreasing the incidence and severity of pruritus and does not affect analgesia.

Background: There are presently several options for the management of posterior urethral disruption. However, these options remain controversial for several reasons. Thus, this medical issue has been continuously investigated. Methods: From 1991 to 2001, 22 patients with complete posterior urethral disruption out of 720 urethral injury cases were retrospectively reviewed using strict criteria. The 22 cases were grouped into two different management groups, the endoscopic early realignment (ER) group and the delayed urethrotomy (DU) group. The frequency of optic internal urethrotomy for urethral strictures and individual medical costs were evaluated over a two-year period. Results: The ER group had a mean frequency of 1.3 ± 0.82 urethrotomies in the first year and 1.8 ± 1.23 over two years while the DU group had a significantly higher urethrotomy frequency, 2.5 ± 1.35 in the first year and 4.1 ± 1.91 over two years. The costs for the DU group were 50% higher than the ER group at the end of second year. Conclusion: An early endoscopic realignment operation saved up to NT 36,000 (New Taiwan Dollars) in costs with an average of 2.3 fewer further urethrotomy procedures in each case during the 2-year follow-up period. Therefore, early urethral realignment for traumatic complete posterior urethral disruption should be encouraged to prevent intractable urethral stricture and lower medical costs.

Background: Psoriasis has a significant negative impact on quality of life. The aim of this study was to identify factors associated with the quality of life of patients with psoriasis in Taiwan. Methods: A retrospective study analyzing data from psoriasis patients who visited the outpatient clinics in the Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital at Taipei, Taoyuan and Keelung from July 2009 to January 2010 was performed. Results: A total of 480 patients who had completed the assessment of disease severity and the dermatology life quality index (DLQI) questionnaire were analyzed. Of these patients, 67.5% were men. The mean score on the DLQI was 9.16 �� 6.3 and 67% of all patients reported a moderate to extremely large impact on their quality of life (DLQI > 6). A higher psoriasis area and severity index (PASI), younger age and initial lesions on the nails significantly negatively impacted patients' quality of life. Smoking, alcohol intake and gender were also weakly correlated. Conclusion: The clinical severity, age and site of initial lesions are associated with negative impacts on the quality of life of patients with psoriasis. These findings provide significant new insights into factors that affect the life quality of patients with psoriasis in Taiwan.

Background: Elders commit suicide almost twice as frequently as people in the general population. This study aimed to investigate the prevalence and associated factors of suicide ideation among a representative sample of elderly people in Taiwan. Methods: We used data from the Health Promotion Knowledge, Attitudes, and Performance Survey in Taiwan and focused on 3,853 subjects with over 65 years old. Univariate and multivariate logistic regression were used to compare subjects with and without suicide ideation in terms of their subject characteristics, smoking, disability, depressive symptoms, physical disorders, and pain symptoms. Results: The point prevalence of elderly suicidal ideation was 6.1%. Female gender, age over 85 years, low level of of education, single status, unemployment. no income, disability, current smoking, self-perceived bad to very bad health, depressive symptoms, various physical disorders (heart disease, diabetes, asthma, osteoporosis), and pain symptoms (joint pain, lower back pain, neck pain, sciatica, headache) were strongly associated with suicide ideation. Multivariate analyses showed that the female gender, former smoker, no income, depressive symptoms, and heart disease were the predictors of elderly suicide ideation. Conclusion: Elderly subjects who are women, or former smokers, and have depressive symptoms, heart disease or no income should be cautioned about the risk of suicide.

Background: Nausea and vomiting are common chief postoperative complaints. The clinical literature indicates that postoperative nausea and vomiting (PONV) is common after orthopedic surgery. This study examines the clinical therapeutic efficacy of Ondansetron injected intravenously before the end of shoulder arthroscopy as antiemetic prophylaxis to help reduce the incidence of PONV. Methods: Participants were identified through retrospective chart review and patients undergoing shoulder arthroscopy performed by the same rthopedic surgeon at the same hospital from 2005 to 2009 were analyzed. Subjects were classified into two groups based on whether Ondansetron was given. Differences in the incidence of PONV among the two groups were compared. Basic patient information, anesthesia records, and surgical records were obtained, as well as records on PONV, postoperative pain intensity, and postoperative analgesic injections within 24 hours after surgery. Results: The study involved 90 patients. The Group A contained 34 patients who did not receive Ondansetron, and the Group B contained 56 patients who were given Ondansetron. Analytical results for the postoperative 24 hour period showed a significant difference in the incidence of vomiting between the two groups, with a lower incidence (p < 0.05) for the. Group B. However there was no significant difference in the incidence of nausea between the two groups in the same postoperative 24 hour period, although there was a trend of a lower incidence in the Group B (p = 0.17). The overall incidence of PONV during the 24-hour period was lower in the Group B (14%) than the Group A (32%), and the Group B demonstrated lower pain intensity andlower analgesic injection needs. Conclusion: Routine intravenous injection of Ondansetron 30 minutes before completion of shoulder arthroscopy can reduce the incidence of vomiting and overall PONV in patients. Additionally, the patients using Ondansetron demonstrated lower pain intensity and lower analgesic injection needs than the control group.

Peripheral primitive neuroectodermal tumor of the chest wall is a rare malignant tumor usually occurring in children. The tumor shares a similar histology, immunohistology and cytogenetics to Ewing's sarcoma. The location of the tumor in the chest wall poses a major challenge with respect to the diagnostic workup and treatment which involves multidisciplinary management. Neoadjuvant chemotherapy is given initially and is followed by complete surgical resectioning of the mass followed by repeat chemotherapy with or without radiotherapy. We report a case of peripheral primitive neuroectodermal tumor of the chest wall in a 5-year-old boy and review the literature regarding its diagnosis and management.

Functional separation of the lungs may be accomplished by several methods. Patients with a stiff neck and limited mouth opening restrict options to a one-lung ventilation. We report the use of the WuScope video system, a new tool for facilitating double-lumen endotracheal tube placement for one-lung ventilation, in a patient who suffered from ankylosing spondylitis with a stiff, flexed neck and limited mouth opening for his recurrent spontaneous pneumothorax.