Researches

1. Clinical trials for viral hepatitis treatment and treatment of complications of liver cirrhosis
2. Clinical studies of viral hepatitis B, C, alcoholic liver disease, non-alcoholic fatty liver disease, and autoimmune liver disease
3. Molecular biologic studies of viral hepatitis B, C, alcoholic liver disease, and non-alcoholic fatty liver disease in collaboration with National Taiwan University College of Medicine, Taipei Medical University School of Nutrition

Bibliography

Bibliography 

 * SCI, # correspondence

1.#Yang SS, Liaw YF. Mechanisms of Hepatic Coma. Medicine Today 1984; 11: 890-2.

1.*Yang SS, Chu NS, Liaw YF. Somatosensory evoked potentials in hepatic encephalopathy. Gastroenterology 1985; 89: 625-30.

1.*Liaw YF, Yang SS, Chen TR, et al. Acute exacerbation in hepatitis B e antigen positive chronic type B hepatitis: - A clinicopathological study. J Hepatol 1985; 1: 227-33.

2.      *Chu NS, Yang SS, Cheng CL. Somatosensory evoked potentials: monitoring cerebral functions following liver transplanta­tion. Clin Electroenceph 1985; 16: 192-4

3.      #Yang SS, Liaw YF. Treatment of Chronic Porto-systemic Encephalopathy. Medicine Today 1986; 13: 199-201.

4.      *#Yang SS, Chu NS, Liaw YF. Brainstem auditory evoked poten­tials in hepatic encephalopathy. Hepatology 1986; 6: 1352-55.

5.      *Chu NS, Yang SS. Brain-stem auditory evoked potentials in different types of hepatic diseases. Electroencephalo Clin Neurophysiol 1987; 67: 337-9.

6.      *Chu NS, Yang SS. Somatosensory and brainstem evoked poten­tials in alcoholic liver disease with and without encepha­lopathy. Alcohol 1987; 4: 225-30.

7.      *#Yang SS, Hughes RD, Williams R. Digoxin-like immunoreactive substances in severe acute liver disease due to viral hepatitis and paracetamol overdose. Hepatology 1988; 8: 93-7.

8.      #Yang SS, Hughes RD, Williams R. Increased levels of digoxin-like immunoreactive substances in encephalopathy due to acute liver failure. In: Soeters PB, Wilson JHP, Meijer AJ, Holm E, eds. Advances in ammonia metabolism and hepatic encephalopathy. Oxford, Excerpta Medica, 1988: 543-8.

9.      *Chu NS, Yang SS. Portal-systemic encephalopathy: alterations in somatosensory and brainstem auditory evoked potentials. J Neuro Sci 1988; 84: 41-50.

10.  *#Yang SS, Korula J, Sunderheimer JE, Keyser AJ. Digoxin-like immuno-reactive substances in chronic liver disease. Hepatology 1989; 9: 363-6.

11.  *#Yang SS, Kanel G. Fibrinous pericarditis in alcoholic liver disease. J Clin Gastroenterol 1989; 11: 53-5.

12.  *#Yang SS, Ralls PW, Korula J.  The effect of oral nitroglycerin on portal blood velocity as measured by ultrasonic Doppler-a double blind, placebo controlled study. J Clin Gastroenterol 1991; 13: 173-7.

13.  *#Yang SS, Chu NS, Wu CH. Disappearance of N20 and P25 components of somatosensory evoked potential: An ominous sign in severe acute hepatitis. J Formosan Med Assoc 1993; 92: 46-9 (NSC-78-0412-B-0182-17).

14.  *#Yang SS, Chu NS, Wu CH. Subcortical somatosensory evoked potentials in patients with hepatic encephalopahty caused by severe acute hepatitis. J Gastroenterol Hepatol 1993; 8: 545-9 (NSC-78-0412-B-0182-17).

15.  *#Huang YY, Yang SS, Wu CH, et al. Impact of screening blood donors with hepatitis C antibody on posttransfusion hepatitis: A prospective study with second-generation anti-hepatitis C virus assay. Transfusion 1994; 34: 661-5.

16.  *#Yang SS, Chu NS. Diffuse neuropathy in chronic liver disease without hepatic encephalopathy. Eur J Gastroenterol Hepatol 1994; 6: 375-6.

17.  *#Yang SS, Wu CH, Chen TK, et al. Portal blood flow in acute hepatitis with and without ascites: A non-invasive measurement using ultrasonic Doppler. J Gastroenterol Hepatol 1995; 10: 36-41.

18.  *#Yang SS, Wu CH, Huang CT, et al. Early interferon therapy and abortion of posttransfusion hepatitis C viral infection. J Clin Gastroenterol 1995; 21: 38-41.

19.  *#Yang SS, Tsai G, Wu CH, et al. Circulating soluble intercellular adhesion molecule-1 in type C viral hepatitis. Hepato-Gastroenterology 1996; 43: 575-81.

20.  #Lai YC, Yang SS, Wu CH. Portal vein thrombosis after splenectomy in a patient with liver cirrhosis and esophageal varices. J Med Ultrasound 1997; 5: 21-5.

21.  #Yang SS, Chu NS, Wu CH. The role of somatosensory evoked potentials on hepatic encephalopathy. Biomed Eng Appl Basis Comm 1997; 9: 154-7.

22.  #Yang SS, Lai YC, Wu CH, et al. Acute viral hepatitis in alien residents in Taiwan: a hospital-based study. Taiwan J Gastroenterol 1997; 14: 185-91.

23.  *Chu NS, Yang SS, Liaw YF. Evoked potentials in liver disease. J Gastroenterol Hepatol 1997; 12: s288-93.

24.  *#Yang SS, Wu CH, Chiang TR, et al. Somatosensory evoked potentials in sub-clinical porto-systemic encephalopathy: a comparison with psychometric tests. Hepatology 1998;27: 357-61.

25.  *#Yang SS, Wu CH, Chen LL, et al. Nutritional status in non-alcoholic subclinical porto-systemic encephalopathy. World J Gastroenterology 1998; 4: 380-4.

26.  #Yang JN, Yang SS, Wu CH, et al. Senorineural hearing loss and brainstem auditory evoked potential changes during interferon therapy: a prospective study in 9 patients. Taiwan J Gastroenterol 1998; 15: 240-4.

27.  #Yang JN, Yang SS, Wu CH, et al. Hydrogen breath test in the assessment of orocecal transit time in irritable bowel syndrome. Taiwan J Gastroenterol 1999; 16: 1-8.

28.  *Chen TK, Wu CH, Lee CL, Lai YC, Yang SS. Endoscopic ultrasonography in the differential diagnosis of giant gastric folds. J Formos Med Assoc 1999; 98: 261-4.

29.  *#Lai YC, Yang SS, Wu CH, et al. Endoscopic hemoclip treatment for bleeding peptic ulcer. World J Gastroenterology 2000; 6: 53-6.

30.  *#Yang SS, Wu CH, Chen TH, et al. TT viral infection through blood transfusion: retrospective investigation on patients in a prospective study of post-transfusion hepatitis. World J Gastroenterology 2000; 6: 70-3.

31.  #Yang SS. Hepatic encephalopathy. In: Wang TY, et al eds. Digestive Medicine Vol. 13, Guidelines for common digestive diseases. Taipei, Taiwan Gastrointestinal Association, 2000: 141-5.

32.  *Huang CS, Luo GA, Huang MJ, Yu SC, Yang SS. Variation of the bilirubin uridine-diphosphoglucuronosyl transferase 1A1 gene in healthy Taiwanese. Pharmacogenetics 2000; 10: 539-44.

33.  *Chiu CH, Chang-Chien CS, Liaw YF, Yang SS. Albumin gradient and portal vein velocity in severe viral hepatitis patients complicated with ascites. Hepato- Gastroenterology 2000; 47: 1700-2.

34.  Yang SS, Chu NS, Chen DS. The role of somatosensory evoked potentials in the assessment of hepatic encephalopathy. In: Advances in hepatic encephalopathy and metabolism in liver disease, ISHE, Ankara, Ankara University Press, 2000, 253-6.

35.  *Chen TK, Wu CH, Lee CL, Lai YC, Yang SS, Tu TC. Endoscopic ultrasonography to study the causes of extragastric compression mimicking gastric submucosal tumor. J Formos Med Assoc 2001; 100: 758-61.

36.  *#Yang Z, Yang SH, Yang SS, et al. A hospital-based study on the use of alternative medicine in patients with chronic liver and gastrointestinal diseases. Am J Chinese Med 2002; 30: 637-43.

37.  *#Yang SS, Cheng KS, Wu CH, et al. Decreasing serum alpha-fetoprotein levels in predicting poor prognosis of acute hepatic failure in patients with chronic hepatitis B. J Gastroenterol 2002; 37: 626-32.

38.  *Dai DY, Chen JH, Chang DT, Chen ST, Liao LY, Kou TH, Chen YY, Chen JK, Yang SS, et al. An 8-year nationwide survival analysis in relatives of patients with hepatocellular carcinoma: role of viral infection. J Gastroenterol Hepatol 2002; 17: 682-9.

39.  *#Lai YC, Hu RT, Yang SS, Chen DS. Coinfection of TT virus and response to interferon therapy in patients with chronic hepatitis B or C. World J Gastroenterology 2002; 8: 567-570.

40.  *Lai YC, Wang TH, Liao CC, Huang SH, Wu CH, Yang SS, et al. Correlation between the degree of duodenal bulbar deformity and the density of Helicobacter pylori infection in patients with active duodenal ulcers. J Formosan Med Assoc 2002; 101: 263-7

41.  *#Yang SS, Hsu CT, Hu JT, et al. Lamivudine does not increase the efficacy of interferon on the treatment of mutant type chronic viral hepatitis B. World J Gastroenterology 2002; 8: 868-71.

42.  Yang SS, Lai YC, Wu CH, Chen DS. Alpha-fetoprotein levels in predicting poor prognosis of acute hepatic failure. In: Asian Pacific Association for the Study of the Liver Meeting 2002. Monduzzi Editore, International proceeding Division, Bolongna, Italy, 2002, pp185-8.

43.  *Huang MJ, Yang YC, Yang SS, et al. Coinheritance of variant UDP-glucuronsyl transferase 1A1 gene and glucose-6-phosphate dehydrogenase deficiency in adults with hyperbilirubinemia. Pharmacgenetics 2002; 12: 663-6.

44.  #Hu JT, Yang SS, Lai YC, et al. Mesenteric hemangiopericytoma presenting as acute abdomen: report of a case. Taiwan J Gastroenterol 2003; 20: 257-62.

45.  #Hu RT, Yang SS, Lai YC, et al. Multiple hepatic angiolipomas: report of a case. Taiwan J Gastroenterol 2003; 20: 252-7.

46.  *#Yang SS, Tu TC, Wu CH, et al. Combination of interferon alfa-2a and amantidine does not improve the efficacy of interferon therapy in patients with chronic hepatitis C. Hepato-Gastroenterology 2003; 50: 1575-8.

47.  *#Hu RT, Yang SS, Lai YC, et al. Percentage of peak-to-peak pulsatility of portal blood flow can predict right-sided congestive heart failure. World J Gastroenterol 2003; 9: 1828-31.

48.  *Lai YC, Shih CY, Yang SS, et al. Hepatic arterial infusion chemotherapy for hepatocellular carcinoma with tumor thrombosis of the portal vein. World J Gastroenterol 2003; 9: 2666-70.

49.  *#Yang SS, Lai YC, Hu RT, et al. Role of zinc in sub-clinical in hepatic encephalopathy: comparison with somatosensory-evoked potentials. J Gastroenterol Hepatol 2004; 19: 375-9.

50.  *Chen CH, Chen YY, Chen GH, Yang SS, et al. Hepatitis B Virus Transmission and Hepatocarcinogenesis: A 9-Year Retrospective Cohort of 13,676 Relatives with Hepatocellular Carcinoma. J Hepatol 2004; 40: 653-9.

51.  *Yang SS, Cheng KT, Lin YS, et al. Pectin hydroxamic acids exhibit antioxidant activities in vitro. J Agricul Food Chem 2004; 52: 4270-3.

52.  *Huang MJ, Yang SS, Lin MS, Huang CS. Polymorphisms of the UDP- glucuronosyltransferase 1A7 gene in Taiwan Chinese. World J Gastroenterology 2005; 11: 797-802.

53.  *Huang CS, Huang MJ, Lin MS, Yang SS, Teng HC, Tang KS. Genetic factors related to unconjugated hyperbilirubinemia among adults. Pharmacogenet Genomics. 2005; 15: 43-50.

54.  *Huang YY, Huang CS, Yang SS, Lin MS, Huang MJ, Huang CS. Effects of variant UDP-glucuronosyltransferase 1A1 gene, glucose-6-phosphate dehydrogenase deficiency and thalassemia on cholelithiasis. World J Gastroenterol. 2005; 11: 5710-3.

55.  *Ho CM, Yang SS, Chien TY, et al. Detection and quantitation of human papillomavirus type 16, 18 and 52 DNA in the peripheral blood of cervical cancer patients. Gynecologic Oncology 2005; 99: 615-21.

56.  *Yang SS, Huang CC, Chen JR, et al. Effects of ethanol on antioxidant capacity in isolated rat hepatocytes. World J Gastroenterol 2005; 11: 7272-6.

57.  *#Shih CY, Yang SS, Hu JT, et al. Portal vein pulsatility index is a more important inducator than congestion index in the clinical evaluation of right heart function. World J Gastroenterol 2006; 12: 768-71.

58.  *Liu CJ, Lai MY, Chao YC, Liao LY, Yang SS, et al. Interferon alpha-2b with and without ribavirin in the treatment of hepatitis B e antigen-positive chronic hepatitis B: a randomized study. Hepatology 2006; 43: 742-9.

59.  *Huang CS, Tan N, Yag SS, et al. Crigler-Najjar syndrome type 2. J Formosan Med Assoc 2006; 105: 950-3.

60.  Yang SS, Liu CJ, Yu ML, et al. Management of adverse effects associated with interferon treatment for chronic hepatitis C. Gastroenterol J Taiwan 2006; 23: 53-6.

61.  *Yang SS, Hou WC, Huang LW, et al. A new γ-lactone from the leaves of Cinnamomum kotoense. Natural Product Research 2006;20:1246-50.

62.  #Yang SS. Duplex Doppler ultrasonography in portal hypertension. J Med Ultrasound 2007; 15: 107-5. (review)

63.  *Teng HC, Huang MJ, Tang KS, Yang SS, et al. Combined UGT1A1 and UGT1A7 varient alles are associated with increased risk of Gilbert’s syndrome in Taiwanese adults. Clin Genet 2007; 72: 321-8.

64.  *Lin CL, Hu RT, Yang SS, et al. Unexpected emergence of acute hepatic injury in patients treated repeatedly with ketoconazole. J Clin Gastroenterol 2008;42:432-3.

65.  #Yang SS. Alcoholic liver disease: clinical and sonographic features. J Med Ultrasound 2008; 16: 140-9. (review)

66.  *Huang YY, Huang MJ, Yang SS, et al. Variations in the UDP-glucuronosyl- transferase 1A1 gene for the development of unconjugated hyperbilirubinemia in Taiwanese. Pharmacogenomics 2008;9:1229-35.

67.  Yen CL, Jeng CM, Yang SS. The benefits of comparing conventional sonography, real-time spatial compound sonography, tissue harmonic sonography, and tissue harmonic compound sonography of hepatic lesions. Clin Imaging 2008;32:11-5.

68.  #Yang SS, Hu RT, Huang YW, et al. The role of narrow band imaging system in the evaluation of esophageal varices. Gastroenterol J Taiwan 2009; 26:164-70.

69.  *Huang YW, Hu CY, Chen CL, Liao YT, Liu CJ, Lai MY, Chen PJ, Yang SS, et al. Human leukocyte antigen-DRB1*1101 correlates with less severe hepatitis in Taiwanese male carrier of hepatitis B virus. J Med Virol 2009;81:588-93.

70.  *Liu CJ, Chung WL, Lee CM, Yu ML, Lu SN, Wu SS, Liao LY, Chen CL, Kuo HT, Chao YC, Tung SY, Yang SS, et al. Peginterferon alfa-2a plus ribavirin for the treatment of dual chronic infection with hepatitis B and C viruses. Gastroenterology 2009;136:496-504.

71.  *Yang SS, Wang CJ, Wang SY, et al. New constituents with iNOS inhibitory activity from Mycelium of Antrodia camphorate. Planta Med 2009;75:1-5

72.  *Huang YW, Liao YT, Chen W, Chen CL, Hu JT, et al. Vitamin D receptor gene polymorphisms and distinct clinical phenotypes of hepatitis B carrier in Taiwan. Genes Immunity 2010;11:87-93.

73.  *Huang YW, Chayama K, Tsuge M, Takahashi S, Hatakeyama T, Abe H, Hu JT, Liu CJ, Lia MY, Chen DS, Yang SS, Kao JH. Differential effects of interferon and lamivudine on serum HBV RNA inhibition in patients with chronic hepatitis B. Antiviral therapy 2010;15:177-84.

74.  *#Lin CW, Yang SS. Esophagogastric varices predict mortality in hospitalized patients with alcoholic liver disease: a medical center experience in Taiwan. Hepatogastroenterology 2010; 57:305-8.

75.  *#Peng HC, Chen JR, Chen YL, Yang SC, Yang SS. β-Carotene Exhibits Antioxidant and Antiapoptotic Properties to Prevent Ethanol-induced Cytotoxicity in Isolated Rat Hepatocytes. Phytother Res 2010;24: S183-9.

76.  *YangSS, Wang CJ, Cheng KF, et al. Bioactive γ-lactones from the fermented broth of Neosartorya sp. Planta Med 2010; 76: 1701-5.

77.  *Yu ML, Lee CM, Chung WL, Lu SN, Dai CY, Huang JF, Lin ZY, Hu TH, Chen CH, Hung CH, Wang JH, Chen CL, Kao JH, Lai MY, Liu CH, Su TH, Wu SS, Liau LY, Kuo HT, Chao YC, Tung SY, Yang SS, et al. HBsAg profiles in patients receiving peginterferon alfa-2a plus ribavirin for the treatment of dual chronic infection with hepatitis B and C viruses. J Inf Dis 2010;202:86-92.

78.  *Peng HC, Chen YL, Chen JR, Yang SS, et al. Effects of glutamine administration on inflammatory responses in chronic ethanol-fed rats. J Neutri Biochem 2011;22:282-8.

79.  Huang YW, Yang SS, Chen PJ. Overview of alcoholic liver disease in Taiwan. J Clin Hepatol 2010;26:247-8.

80.  #Hwang YW, Yang SS, Kao JH. Pathogenesis and management of alcoholic liver cirrhosis: a review. Hepatic Medicine: Evidence and Research 2011;3:1–11.

81.  *#Chen YL, Chen LJ, Bair MJ, Yao ML, Peng HC, Yang SS, Yang SC. Antioxidative status of patients with alcoholic liver disease in southeastern Taiwan. W J Gastroenterol 2011;28;17:1063-70.

82.  *#Huang YW, Hy RT, Yang SS. Complications of alcoholic liver cirrhosis: active assessment by endoscopy and sonography. Hepatology 2011;52:1864-5.

83.  #Hu JT, Yang SC, Huang SF, Lin CL, Lin PH, Tseng TL, Yang SS. Current status of alcoholic liver disease in Taiwan. Gastroenterol J Taiwan 2011;28:234-41.

84.  Chang LC, Liu PF, Huang YL, Yang SS, Chang WY. Risk factors associated with unplanned endotracheal self-extubation of hospitalized intubated patients: a 3-year retrospective case-control study. Applied Nursing Research 2011; 4:188-92.

85.  Chen YL, Yang SS, Peng HC, Hsieh YC, Chen JR, Yang SC. Folate and vitamin B12 improved alcohol-induced hyperhomocysteinemiain rats. Nutrition 2011;27:1034-9.

86.  Yang HY, Tzeng YH, Chai CY, Hsieh AT, Chen JR,*, Chang LS, Yang SS. Soy protein retards the progression of non-alcoholic steatohepatitis via improvement of insulin resistance and steatosis. Nutrition 2011;11:943–8.

87.  *#Sarantuya G, Hu JT, Chen DS, Yang SS. Acute rhabdomyolysis and chylous ascites in a patient with cirrhosis and malignant hepatic tumor. J Formosan Med Assoc 2012;111: in press.

88.  *Huang CC, Lin KJ, Cheng YW, Hsu CA, Yang SS, and Shyur LF. Hepatoprotective effect and mechanistic insights of deoxyelephantopin, a phyto-sesquiterpene lactone, against fulminant hepatitis. J Nutri Biochem 2012, in press

Abstracts

 

1.   Yang SS, Tsai KL, Lo HU, et al. Polypoid Lesions of Gall­ bladder. Proceedings to the 13th Annual Meeting of Taiwan Gastroenterological Society, 1983: 92.

2.   Yang SS, Chen TR, Chu CM, Liaw YF. Further Study on the Histological Changes Preceding HBeAg Clearance in Chronic Type B Hepatitis. Proceedings to the 14th Annual Meeting of the Taiwan Gastroenterological Society, 1984:82.

3. Chen TR, Yang SS, Liaw YF, Kuo CT.  The nature course of histological changes in hepatitis B viral infection. Proceedings to the 14th Annual Meeting of the Taiwan Gastroenterological Society, 1984: 48.

4. Yang SS, Chu NS, Liaw YF. Somatosensory evoked potentials in hepatic encephalo-pathy: - A preliminary report. J Formosan Med Assoc 1984;83:s44.

5. Yang SS, Chu NS, Liaw YF. Somatosensory Evoked Potentials in Hepatic Encephalo-pathy. Taiwan J Gastroenterol 1985; 2: 28.

6. Yang SS, Hughes RD, Williams R. Digoxin-like immunoreactive substances in severe acute liver disease. Clin Sci 1987; 72 (Suppl 16):90P.

7. Yang SS, Hughes RD, Williams R. Increased level of digoxin-like immunoreactive substances in encephalopathy due to acute liver failure. J Hepatol 1987; 4: S48.

8. Yang SS, Korula J, Keyser AJ. Increased digoxin-like sub­stance in liver cirrhosis, possible role as a natriuretic hormone. Hepatology 1987;7:1056.

9.   Yang SS, Korula J. Increased digoxin like immunoreactive substance (DLIS) in cirrhosis. J Gastroenterol Hepatol 1988; 3: 702.

10. Yang SS, Ralls PW, Korula J. The effect of oral nitroglycerin on portal vein flow using ultrasonic Doppler - A double blind placebo controlled study. Hepatology 1988; 8: 1349.

11. Yang SS. Digoxin-like immunoreactive substances in chronic liver disease. Taiwan J Gastroenterol 1989; 6: 66.

12. Yang SS, Ralls PW, Korula J. The effect of oral nitroglycerin on portal vein flow. Taiwan J Gastroenterol 1989; 6: 202-3.

13. Lee CC, Chau CH, Yang SS. A Doppler study on portal system in severe acute viral hepatitis. Taiwan J Gastroenterol 1990; 7: 46.

14. Chau CH, Yang SS, Chang-Gian CS, et al. Albumin gradient and portal vein velocity in severe acute hepatitis. Taiwan J Gastroenterol 1990; 7: 232-3.

15. Tsai CC, Yang SS. Digoxin-like immunoreactive substances in acute viral hepatitis and biliary obstruction: - A preliminary report. J Formosan Med Assoc 1990; 89: s46.

16. Yang SS, Chu NS, Wu CH, et al. Prognostic values of somatosensory evoked potentials on hepatic encephalopathy due to severe acute hepatitis. Taiwan  J Gastroenterol 1991; 8: 70-1.

17. Chiu NW, Yang SS, Wu CH, et al. The effect of congestive heart failure on portal blood flow. Taiwan J Gastroenterol 1991; 8: 65-6.

18. Yang SS, Wu CH, Chen TK, et al. Transient stagnant and hepatofugal portal blood flow in right heart failure. Chinese Med J (Taipei). 1991; 2: 95.

19. Yang SS, NS Chu, CH Wu. Prognostic value of somatosensory evoked potentials in hepatic encephalopathy caused by severe acute hepatitis. J Hepatol 1991; 13: s182.

20. Yang SS, Wu CH, Chen ZK, et al. The portal blood flow in severe acute hepatitis; an ultrasonic Doppler study. Taiwan J Gastroenterol 1991;8:236.

21. Lai YC, Yang SS, Yang CS, et al. The transient appearance and disappearance of anti-HBs in hemodialysis patients: - A preliminary report. Taiwan J Gastroenterol 1991; 8: 238-9.

22. Yang SS, Wu CH, Chen TK, et al. Transient lost and appearance of anti-hepatitis B surface antibody in hemodialysis patients: - A preliminary report. Proceeding to the Third International Symposium of Viral Hepatitis and Hepatocellular Carcinoma. Dec. 5-8, Taipei, Taiwan 1991; s59.