Urban-Rural Disparity of Generics Prescription in Taiwan: The Example of Dihydropyridine Derivatives

The aim of the current study was to investigate the urban-rural disparity of prescribing generics, which were usually cheaper than branded drugs, within the universal health insurance system in Taiwan. Data sources were the cohort datasets of National Health Insurance Research Database with claims data in 2010. The generic prescribing ratios of dihydropyridine (DHP) derivatives (the proportion of DHP prescribed as generics to all prescribed DHP) of medical facilities were examined against the urbanization levels of the clinic location. Among the total 21,606,914 defined daily doses of DHP, 35.7% belonged to generics. The aggregate generic prescribing ratio rose from 6.7% at academic medical centers to 15.3% at regional hospitals, 29.4% at community hospital, and 66.1% at physician clinics. Among physician clinics, the generic prescribing ratio in urban areas was 63.9 ± 41.0% (mean ± standard deviation), lower than that in suburban (69.6 ± 38.7%) and in rural (74.1% ± 35.3%). After adjusting the related factors in the linear regression model, generic prescribing ratios of suburban and rural clinics were significantly higher than those of urban clinics (β=0.043 and 0.077; P=0.024 and 0.008, resp.). The generic prescribing ratio of the most popular antihypertensive agents at a clinic was reversely associated with the urbanization level

Comparison of secondary signs as shown by unenhanced helical computed tomography in patients with uric acid or calcium ureteral stones

AbstractUnenhanced helical computed tomography (UHCT) has evolved into a well-accepted diagnostic method in patients with suspected ureterolithiasis. UHCT not only shows stones within the lumen of the ureter, it also permits evaluation of the secondary signs associated with ureteral obstruction from stones. However, there we could find no data on how secondary signs might differ in relation to different compositions of ureteral stones. In this study, we compared the degree of secondary signs revealed by UHCT in uric acid stone formers and in patients forming calcium stones. We enrolled 117 patients with ureteral stones who underwent UHCT examination and Fourier transform infra-red analysis of stone samples. Clinical data were collected as follows: age, sex, estimated glomerular filtration rate (eGFR), urine pH, and radiological data on secondary signs apparent on UHCT. The uric acid stone formers had significantly lower urine pH and eGFR in comparison to calcium stone formers, and on UHCT they also had a higher percentage of the secondary signs, including rim sign (78.9% vs. 60.2%), hydroureter (94.7% vs. 89.8%), perirenal stranding (84.2% vs. 59.2%) and kidney density difference (73.7% vs. 50.0%). The radiological difference was statistically significant for perirenal stranding (p=0.041). In conclusion, we found that UHCT scanning reveals secondary signs to be more frequent in patients with uric acid ureteral stones than in patients with calcium stones, a tendency that might result from an acidic urine environment

PDA: Pooled DNA analyzer

BACKGROUND: Association mapping using abundant single nucleotide polymorphisms is a powerful tool for identifying disease susceptibility genes for complex traits and exploring possible genetic diversity. Genotyping large numbers of SNPs individually is performed routinely but is cost prohibitive for large-scale genetic studies. DNA pooling is a reliable and cost-saving alternative genotyping method. However, no software has been developed for complete pooled-DNA analyses, including data standardization, allele frequency estimation, and single/multipoint DNA pooling association tests. This motivated the development of the software, 'PDA' (Pooled DNA Analyzer), to analyze pooled DNA data. RESULTS: We develop the software, PDA, for the analysis of pooled-DNA data. PDA is originally implemented with the MATLAB(® )language, but it can also be executed on a Windows system without installing the MATLAB(®). PDA provides estimates of the coefficient of preferential amplification and allele frequency. PDA considers an extended single-point association test, which can compare allele frequencies between two DNA pools constructed under different experimental conditions. Moreover, PDA also provides novel chromosome-wide multipoint association tests based on p-value combinations and a sliding-window concept. This new multipoint testing procedure overcomes a computational bottleneck of conventional haplotype-oriented multipoint methods in DNA pooling analyses and can handle data sets having a large pool size and/or large numbers of polymorphic markers. All of the PDA functions are illustrated in the four bona fide examples. CONCLUSION: PDA is simple to operate and does not require that users have a strong statistical background. The software is available at

Rupture of Renal Pelvis in an Adult with Congenital Ureteropelvic Junction Obstruction After Blunt Abdominal Trauma

Isolated injury to the renal pelvis following blunt abdominal trauma is very rare. However, a pre-existing renal abnormality will increase the risk of rupture. We present a 24-year-old man with rupture of the left renal pelvis following blunt abdominal trauma. He had pre-existing left ureteropelvic junction (UPJ) obstruction. Delayed computed tomography scan with excretory phase revealed contrast medium extravasation from the left UPJ, and left renal pelvis rupture was diagnosed. He was managed successfully with ureteral double-J stenting for 2 months

Longitudinal Changes in Retinal Nerve Fiber Layer Thickness after Acute Primary Angle Closure Measured with Optical Coherence Tomography

PURPOSE. Longitudinal follow-up of peripapillary retinal nerve fiber layer (RNFL) thickness after an episode of acute primary angle closure (APAC) using Stratus optical coherence tomography (OCT). METHODS. Seventeen patients who had experienced a single unilateral APAC episode (intraocular pressure, Ͼ50 mm Hg) were enrolled. The average and superior, temporal, inferior, and nasal quadrant RNFL thicknesses of the affected and fellow eyes at 1, 4, and 12 weeks after remission were compared by using StratusOCT. The relationship between average RNFL thickness and interval of follow-up were evaluated with regression analysis. RESULTS. The mean duration of the APAC episode was 13.8 hours (range, 3-40). Comparison of the average and four quadrant RNFL thicknesses in the affected eyes longitudinally showed significant differences between 1 and 4, and 1 and 12 weeks, but not between 4 and 12 weeks. The average and four-quadrant RNFL thicknesses for the affected eyes were greater than the analogous values for fellow eyes at 1 week. In contrast, the inferior-and superior-quadrant RNFL thicknesses for the affected eyes were lower at 4 and 12 weeks, whereas the average and nasal quadrant values for the affected eyes were lower than those in fellow eyes at 12 weeks. Average RNFL thickness for the affected eyes was correlated with the interval of follow-up by using inverse regression analysis (P Ͻ 0.001; R 2 ϭ 0.60). Controlling for duration of APAC episode, the interval of follow-up on RNFL thickness reduction remained significant (P Ͻ 0.001, r ϭ Ϫ0.69). CONCLUSIONS. This study demonstrated an initial increase in diffuse RNFL thickness after a single APAC episode, followed by a subsequent decrease. (Invest Ophthalmol Vis Sci. 2007; 48:1659 -1664) DOI:10.1167/iovs.06-0950 A cute primary angle closure (APAC) is an ophthalmic emergency and a potentially blinding disease. Optic nerve damage can occur after the sudden rise in intraocular pressure (IOP) associated with an APAC episode. The optic disc appears edematous during this episode, and pallor with or without cupping may develop after remission. When treatment is delayed, vision may be markedly reduced to hand movement or light perception. 1 Perimetric examination during acute episodes is difficult and usually unreliable. After remission, visual field defects vary greatly in severity and type. 2 Measurement of retinal nerve fiber layer (RNFL) thickness loss after APAC is very important, as it is both objective and sensitive in terms of detection of the optic disc damage with either normal or unreliable visual fields. Scanning laser polarimetry with fixed corneal compensator (SLP-FCC) has been used for quantification of RNFL thickness change after APAC in cross-sectional study, 5 However, the latter investigation included several patients with poor IOP control after an APAC episode, as determined by RNFL measurement at follow-up. Moreover, SLP-FCC has limited functionality in measurement of RNFL thickness because of the lack of correction for variation in corneal polarization axis and corneal curvature. StratusOCT is a powerful imaging technology that can measure RNFL thickness and image tissue structure to an axial resolution of Ͻ10 m. 7 The stronger association with function in StratusOCT RNFL measurement compared with SLP-VCC suggests that the former may be superior for evaluation of glaucoma progression. 8 Therefore, the purpose of this study was to use StratusOCT to detect longitudinal change (1-12 weeks) in RNFL thickness after remission from a single APAC episode. MATERIALS AND METHODS In this prospective study, longitudinal observations were made using RNFL measurements obtained from StratusOCT at 1, 4, and 12 weeks after a single episode of unilateral APAC. Seventeen consecutive patients were recruited while undergoing treatment in the emergency or the ophthalmology outpatient departments of the Chang Gung Memorial Hospital-Kaohsiung Medical Center over a 1-year period. The study and data accumulation were in conformity with all relevant Taiwanese laws, and the investigation was conducted in accordance with the tenets of the Declaration of Helsinki. The APAC definition used for the study consisted of: The inclusion criteria were: (1) duration of episode less than 48 hours (interval from onset of acute symptoms to first hospital presentation); (2) resolution of acute episode and IOP control (Ͻ21 mm Hg) after antiglaucoma medication prescribed on first presentation, with interval between presentation and resolution under 2 hours (patients were treated with intravenous mannitol drip, oral acetazolamide, topical ␤-blocker and pilocarpine; the IOP was then rechecked 30 to 60 minutes after treatment); (3) subsequent laser iridotomy (LI) performed within 2 days of presentation on both affected and fellow eyes; and, (4) IOP Ͻ 21 mm Hg in both eyes for up to 12 weeks after treatment. Antiglaucoma medication was used to control IOP before and after LI in both eyes to prevent elevation (IOP Ͼ 21 mm Hg). The exclusion criteria were: (1) history of previous APAC in the affected or fellow eyes; (2) previous intraocular surgery, coexisting From th

Differential expression of centrosomal proteins at different stages of human glioma

BACKGROUND: High-grade gliomas have poor prognosis, requiring aggressive treatment. The aim of this study is to explore mitotic and centrosomal dysregulation in gliomas, which may provide novel targets for treatment. METHODS: A case-control study was performed using 34 resected gliomas, which were separated into low- and high-grade groups. Normal human brain tissue was used as a control. Using immunohistochemical analysis, immunofluorescent microscopy, and RT-PCR, detection of centrins 1 and 2, γ-tubulin, hNinein, Aurora A, and Aurora B, expression was performed. Analysis of the GBM8401 glioma cell line was also undertaken to complement the in vivo studies. RESULTS: In high-grade gliomas, the cells had greater than two very brightly staining centrioles within large, atypical nuclei, and moderate-to-strong Aurora A staining. Comparing with normal human brain tissue, most of the mRNAs expression in gliomas for centrosomal structural proteins, including centrin 3, γ-tubulin, and hNinein isoforms 1, 2, 5 and 6, Aurora A and Aurora B were elevated. The significant different expression was observed between high- and low-grade glioma in both γ-tubulin and Aurora A mRNA s. In the high-grade glioma group, 78.6% of the samples had higher than normal expression of γ-tubulin mRNA, which was significantly higher than in the low-grade glioma group (18.2%, p < 0.05). CONCLUSIONS: Markers for mitotic dysregulation, such as supernumerary centrosomes and altered expression of centrosome-related mRNA and proteins were more frequently detected in higher grade gliomas. Therefore, these results are clinically useful for glioma staging as well as the development of novel treatments strategies