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Identification of alloantibodies and achieving a reduction in the rate of red blood cell (RBC) alloimmunization are important issues to prevent transfusion complications. The aim of this study was to identify the antigen and alloantibodies in our patients and to study the association of alloimmunization with previous transfusion. Transfusion records from the blood bank of Kaohsiung Medical University Hospital between 2015 and 2017 were retrospectively enrolled in the study. Antigen and antibody identification was performed using routine blood bank methods. In total, 56,422 transfusion records from 2015 to 2017 were included in the study. Among them, 1858 alloantibody episodes were found in the pre‐transfusion survey, and anti‐Mia, anti‐E, and cold antibodies were the most common alloantibodies, with a prevalence of 3.29% (1858/56,422). Among them, 130 episodes involved newly found alloantibodies with no alloantibodies found in the previous transfusion survey. Tracing back to these newly transfusion‐induced alloantibodies, the antibody was found with a mean of 10.8 ± 7.8 units of packed RBC transfusion, a mean of 66.3 ± 52.8 days, and with a mean of 4.3 ± 2.7 times of transfusion from the first transfusion therapy. An antibody survey revealed that Rh‐ee (62.1%) was the most common phenotype in these newly identified antibodies. In summary, this hospital‐based study revealed that RBC alloantibody rates were present at rates of 3.29%, with anti‐Mia, anti‐E, and cold antibodies being the most common alloantibodies. Among them, anti‐E was the most commonly developed alloantibody. Given that the Rh‐ee group is the most common phenotype in our population, the strategy of using Rh‐ee blood for Rh‐ee recipients is reasonable for transfusion safety.

Perivascular epithelioid cell tumors (PEComas) are uncommon mesenchymal tumors characterized by the presence of both myogenic and melanocytic markers, and huge soft tissue PEComas are even rarer. With low prevalence, there has been no common consensus therapy in the past and the treatment response varies. As the aberrant activation of mammalian target of rapamycin (mTOR) pathway has been revealed in previous studies, mTOR inhibitor is now one of the treatment choices in malignant PEComa. Here we report a case of a 50-year-old man with identified 16-cm soft tissue mass at left flank with multiple lung and bone metastases, revealing typical immunohistochemical and pathological of malignant PEComa. Sirolimus was applied in an adjuvant setting, however interval progression in size was observed. To find the optimal dose of mTOR inhibitors, we performed a literature review for dosing strategy as well.

Paroxysmal nocturnal hemoglobinuria (PNH) is an extremely rare acquired disorder. The aim of this study was to investigate the demographics, clinical manifestations, and outcomes of PNH patients in southern Taiwan. Data on PNH patients diagnosed over a 30‐year period (1985–2015) were retrospectively collected from four tertiary medical centers in southern Taiwan. Blood samples were collected for hematologic panel testing and flow cytometry detection of PNH clones. Radiologic studies were performed to assess the frequency of complications. Twenty‐four patients were enrolled in this study. The median duration of disease in the study participants was 10.8 years. The median granulocyte PNH clone size was 92.5% (range, 1.3%–99.8%), and the median lactate dehydrogenase (LDH) level was 2920.2 ± 1462.0 IU/L. The incidence of thromboembolism and impaired renal function was 16.7% and 29.2%, respectively. The primary treatment strategies included steroids (79.2%), androgens (42.0%), eculizumab (33.3%), immunosuppressants (16.7%), and anticoagulants (4.2%). In eight patients treated with eculizumab, there was a marked reduction in the LDH levels of 14.89‐fold–1.63‐fold that of the upper limit of normal; seven patients exhibited decreased transfusion requirements. Twenty‐one patients were alive with regular follow‐up at the time of publication. Our study demonstrates that PNH patients in southern Taiwan may exhibit different clinical characteristics and outcomes relative to patients in other countries. There was a trend toward a greater PNH granulocyte clone size, which may lead to more hemolysis. In our study, the percentage of patients with impaired renal function, but not the percentage of patients with thrombotic events, was higher than values reported worldwide and in the observational cross‐sectional International PNH Registry. More large‐scale studies with comprehensive data on the clinical response to different treatments are needed.

Paroxysmal nocturnal hemoglobinuria (PNH) is an extremely rare acquired disorder. The aim of this study was to investigate the demographics, clinical manifestations, and outcomes of PNH patients in southern Taiwan. Data on PNH patients diagnosed over a 30-year period (1985–2015) were retrospectively collected from four tertiary medical centers in southern Taiwan. Blood samples were collected for hematologic panel testing and flow cytometry detection of PNH clones. Radiologic studies were performed to assess the frequency of complications. Twenty-four patients were enrolled in this study. The median duration of disease in the study participants was 10.8 years. The median granulocyte PNH clone size was 92.5% (range, 1.3%–99.8%), and the median lactate dehydrogenase (LDH) level was 2920.2 ± 1462.0 IU/L. The incidence of thromboembolism and impaired renal function was 16.7% and 29.2%, respectively. The primary treatment strategies included steroids (79.2%), androgens (42.0%), eculizumab (33.3%), immunosuppressants (16.7%), and anticoagulants (4.2%). In eight patients treated with eculizumab, there was a marked reduction in the LDH levels of 14.89-fold–1.63-fold that of the upper limit of normal; seven patients exhibited decreased transfusion requirements. Twenty-one patients were alive with regular follow-up at the time of publication. Our study demonstrates that PNH patients in southern Taiwan may exhibit different clinical characteristics and outcomes relative to patients in other countries. There was a trend toward a greater PNH granulocyte clone size, which may lead to more hemolysis. In our study, the percentage of patients with impaired renal function, but not the percentage of patients with thrombotic events, was higher than values reported worldwide and in the observational cross-sectional International PNH Registry. More large-scale studies with comprehensive data on the clinical response to different treatments are needed.

Mucoepidermoid carcinoma is considered to be one of the salivary gland-type cancers, which seldom originate from the lung. Herein, we report a 69-year-old female with primary pulmonary high-grade mucoepidermoid carcinoma. The disease progressed rapidly and reached an unresectable status. We treated the patient with bi-weekly doses of docetaxel and the clinical response allowed for the disease to become more stable. The patient survived for only six months from the onset of the symptoms. The case demonstrated that single use of docetaxel would appear to be a treatment option for mucoepidermoid carcinoma of the lung.

In this article, we employed the local adaptive differential quadrature method to solve multi-dimensional heat transport equation at the microscale. The local adaptive differential quadrature method was employed to tackle the boundary conditions by using both localized interpolation basis functions and exterior grid points. We found that accurate numerical solution can be obtained by using a small number of gird points for boundary treatments. The governing equation of heat transport was employed to describe the thermal behavior of microstructures, which was of vital importance in microtechnology applications. Four examples showed the effectiveness and accuracy of our algorism in providing excellent estimates of unknown temperature from the given data. We found that the proposed scheme is applicable to the heat transport equation at the microscale.

Diamond-like carbon (DLC) films have attracted great interest due to their outstanding mechanical, biocompatibility, thermal, optical and electrical properties. The DLC films can be produced by microwave plasma chemical vapor deposition (MPCVD) using Argon, methane and hydrogen mixed gases. The film properties depend strongly on the experimental parameters such as substrate temperatures; microwave power, process pressure and hydrogen concentration (H2/Ar+CH4+H2). In this study, the properties of nanomechanics of DLC films with various experimental parameters are firstly discussed which include hardness and Young’s modulus characterizing by depth-sensing nanoindentation technique. The nanoindentation is an excellent method for measuring nanomechanical properties of both bulk and thin films. The probe was conducted using a Berkovich diamond tip. To find the optimized process parameters, the statistical and mathematical response surface methodology (RSM) is used to model and analyze the effect of substrate temperature (T), microwave power (W), process pressure (P) and hydrogen concentration (H) on the properties of nanomechanics of DLC films. The central composite experimental design (CCD) is used to evaluate the interaction parametric effects of multiple experimental variables on process response (hardness and Young’s modulus). The predictive quadratic model proposed herein considering the analysis of variance (ANOVA) are proved to fit and predict values of the hardness and Young’s modulus close to those readings recorded experimentally. The most significant influential factors for maximizing the hardness and Young’s modulus have been identified from the ANOVA table. The RSM technique is demonstrated to be a powerful tool in exploration of the manufacturing parameters space of complex physical process of DLC films deposition by MPCVD.

The primary infection of Epstein-Barr virus (EBV) may result in fatal infectious mononucleosis or hemophagocytic syndrome (HPS) in 2 diseases; that is, X-linked lymphoproliferative disorder (XLP) and hemophagocytic lymphohistiocytosis (HLH). XLP is linked to mutations of the SAP/SH2D1A gene with dysregulated T-cell activation in response to EBV infection. Patients with sporadic HLH, however, usually have no mutation of the SAP/SH2D1A gene, and EBV latent membrane protein-1 (LMP1) can up-regulate Th1 cytokines in EBV-infected T cells. Since both diseases share common manifestations of HPS, it is important to clarify whether a cross-talk exists between signaling lymphocyte activation molecule (SLAM)–associated protein (SAP) and LMP1-mediated pathways to explain the common pathogenesis of HPS. In this study, no mutation of the SAP/SH2D1A gene at exon 2/3 was detected in 7 HLH cases. Interestingly, EBV LMP1 could transcriptionally inhibit the expression of SAP/SH2D1A and activate downstream molecules ERK and interferon-γ (IFN-γ). LMP1-mediated SAP/ERK/IFN-γ signals appear to act via the TNF receptor–associated factor (TRAF)2,5/nuclear factor κB (NF-κB) pathway, since dominantnegative TRAF2/5 and NF-κB inhibitor could rescue SAP expression and downregulate IFN-γ. Although HLH is genetically distinct from XLP, our data suggest that both diseases share a common signal pathway, through either the mutation or LMP1-mediated suppression of the SAP gene, leading to overt T-cell activation and enhanced Th1 cytokine secretion in response to EBV infection.

The primary infection of Epstein-Barr virus (EBV) may result in fatal infectious mononucleosis or hemophagocytic syndrome (HPS) in 2 diseases; that is, X-linked lymphoproliferative disorder (XLP) and hemophagocytic lymphohistiocytosis (HLH). XLP is linked to mutations of the SAP/SH2D1Agene with dysregulated T-cell activation in response to EBV infection. Patients with sporadic HLH, however, usually have no mutation of the SAP/SH2D1Agene, and EBV latent membrane protein-1 (LMP1) can up-regulate Th1 cytokines in EBV-infected T cells. Since both diseases share common manifestations of HPS, it is important to clarify whether a cross-talk exists between signaling lymphocyte activation molecule (SLAM)–associated protein (SAP) and LMP1-mediated pathways to explain the common pathogenesis of HPS. In this study, no mutation of the SAP/SH2D1Agene at exon 2/3 was detected in 7 HLH cases. Interestingly, EBV LMP1 could transcriptionally inhibit the expression of SAP/SH2D1Aand activate downstream molecules ERK and interferon-γ (IFN-γ). LMP1-mediated SAP/ERK/IFN-γ signals appear to act via the TNF receptor–associated factor (TRAF)2,5/nuclear factor κB (NF-κB) pathway, since dominantnegative TRAF2/5 and NF-κB inhibitor could rescue SAP expression and downregulate IFN-γ. Although HLH is genetically distinct from XLP, our data suggest that both diseases share a common signal pathway, through either the mutation or LMP1-mediated suppression of the SAPgene, leading to overt T-cell activation and enhanced Th1 cytokine secretion in response to EBV infection.

Ground glass hepatocytes (GGHs) are the historic hallmarks for the hepatocytes in the late and non-replicative stages of hepatitis B virus (HBV) infection. We have identified type I and type II GGHs that contain two mutant types of large HBV surface antigens (HBsAg) with deletions over the pre-S1 and pre-S2 regions, respectively. These pre-S mutant HBVsAg accumulate in endoplasmic reticulum (ER), resulting in strong ER stress. Type II GGHs often appear in hepatic nodules in the late phases of HBV infection and proliferate in clusters, suggesting that these mutant pre-S1/S2 HBsAg may be involved in HBV-related hepatocarcinogenesis, associated with ER stress. In this study, we investigated the potential genomic instability imposed by pre-S mutant HBsAg. Based on the analysis of comet assays, we found that the pre-S1 and pre-S2 mutant HBsAg caused oxidative stress and DNA damage. The DNA repair gene ogg1 was greatly induced by over-expression of pre-S mutant HBsAg. Induction of the DNA repair gene ogg1 was also detected in the pre-S2 HBsAg transgenic mice, as well as the type II GGHs from patients with hepatocellular carcinoma, strongly suggesting that the pre-S mutant HBsAg contributes to the oxidative DNA damage to hepatocytes. In addition, the mutation rates in the X-linked hprt gene were enhanced in mouse hepatoma ML1-4a cells, which constitutively expressed the pre-S1/S2 HBsAg. These results indicate that pre-S1/S2 mutant HBsAg, which make up GGHs, induce oxidative DNA damage and mutations in hepatocytes in the late stages of HBV infection.

Ground glass hepatocyte (GGH) represents a histological hallmark of chronic hepatitis B virus infection and contains surface antigens in the endoplasmic reticulum (ER). Several types of GGHs are recognized at different hepatitis B virus replicative stages. The recent identification of pre-S mutants from GGHs encourages us to investigate whether different GGHs may harbor specific mutants and exhibit differential biological activities. In this study, we applied laser capture microdissection to isolate specific GGHs from a total of 50 samples on eight resected liver specimens. The surface genes in two major types of GGHs were analyzed. Type I GGHs expressed an inclusion-like pattern of hepatitis B surface antigens and harbored mutants with deletions over pre-S1 region, whereas type II GGHs, distributed in clusters and emerged at late replicative phase, contained mutants with deletions over pre-S2 region that defines a cytotoxic T lymphocyte (CTL) immune epitope, and may represent an immune escape mutant. Transfection of pre-S mutants in Huh7 revealed decreased syntheses of middle and small S proteins with accumulation of large surface antigen in ER, which in turn led to the activation of ER stress response with differential activities for different mutants. This study therefore demonstrates that different GGHs may contain specific mutants and exhibit differential biological activities.

An accurate and efficient time domain BEM for the 2D elastodynamic wave transient analysis method is presented. Emphasis is focused on developing time domain fundamental convoluted kernels and methodology for quadratic temporal solution procedures which have never been presented before. In the presented BEM method, called the QC method, the temporal variations of displacement and traction are assumed to be quadratic and constant, respectively.

A new boundary-element formulation using particular integrals is developed for the free-vibration analysis of axisymmetric solids. The numerical results for a number of axisymmetric free-vibration problems are given and some of the results are compared with those obtained from Finite Element Method, Series Solution Method, or experimental method. Generally, agreement among all of these results is satisfactory.