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There are many pathological causes and potential mechanisms for hypercalcemia. We measured intact parathyroid hormone (PTH) and parathyroid hormone related protein (PTHrP) in the hypercalcemic in-patients and attempted to evaluate the roles of PTH and PTHrP in hypercalcemia due to malignancy. We performed a prospective study of 178 patients with corrected serum calcium concentrations greater than 2.74 mmol/l in a hospital over a 3-year period. We measured calcium and albumin using a Hitachi 747 autoanalyzer, and we measured PTH and PTHrP by two-site immunoradiometric assays (IRMA). Hypercalcemia was attributed to malignancy alone in 93 patients (52.3%), primary hyperparathyroidism (HPT) alone in 28 patients (15.7%), uremia with hemodialysis in 23 patients (12.9%), unknown in 16 patients (9%), primary HPT coexisting with malignancy in 7 patients (3.9%) and other rare causes (6.2%). Plasma PTHrP levels were elevated in 71/93 (76.3%) patients with hypercalcemia due to malignancy, but the elevated PTHrP percentage differed for each kind of tumor. PTHrP levels were elevated in 100% of patients with squamous carcinomas (CA) in the lung, esophagus, skin, cholangiocarcinoma of liver, and breast CA. The positive bony metastatic rate was 44.1% (41/93). There was no correlation between high PTHrP and bony metastasis. There was a good correlation between the corrected serum calcium and PTHrP levels (r = 0.476, p < 0.001), but no correlation between survival time and serum calcium level or PTHrP level. There was no significant difference in life expectancy after cancer diagnosis between the high PTHrP group and normal PTHrP group, and there was no significant difference in life expectancy after the first occurrence of hypercalcemia between the two groups. Measurement of both PTH and PTHrP levels led to a change in the initial diagnosis in 7 patients. In routine practice, measurement of serum PTH alone is not enough. This study suggests that the appropriate combination of PTH and PTHrP assays results in a more accurate diagnosis of the hypercalcemic causes. In addition, especially high PTHrP levels should be screened for malignancy. However, the prognosis in cancer patients after hypercalcemia with high PTHrP group, as compared to those with the normal PTHrP group is not significantly different.

Perceived body image and health beliefs are associated with self-reported health behavior among patients with diabetes with BMI measurement greater than 24 Kg/m(2). Diabetes educators may apply the findings of this study and the Health Belief Questionnaire to instruct and monitor patients with diabetes about self management behaviors.

Aim: In this study we used the Nelson's Modified Card Sorting Test (MCST) to find the differences between Alzheimer's disease (AD) group/Vascular dementia (VD) group and a normal control group (non-dementia and non-AD), and to identify the commonality between the MCST and dementia patients. Patients and Methods:The MCST was administered to 32 AD patients, 18 vascular dementia patients, and 38 controls. The relationship between the MCST performance and demographic characteristics was evaluated. Results: There were no statistical differences in age, sex, level of education, smoking, drinking and depression in the three groups. The MCST was classified into four groups for analysis-number of categories completed (Cat), preservative error score (PE), non-preservative error score (NPE), unique error (UE) and total error (TE). For Cat, UE and TE showed a significant difference in all three groups, whereas PE and NPE revealed no significant difference. Conclusion: These findings suggest that cognitive function appears to significantly impair MCST performances in AD and VD patients, so these should be taken into consideration during an interpretation of the clinical assessment. For the effective use of the MCST in a clinical setting, further studies of specific clinical populations are planned to develop normative data for elderly Taiwanese people.

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