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肥厚型心肌病是一种常见的单基因遗传性心血管疾病，是35岁以下人群发生心脏性猝死最常见的原因。多数病例呈常染色体显性遗传，自然受孕的情况下，有50%的概率将该疾病遗传给下一代。单基因遗传病胚胎植入前遗传学检测（PGT-M）能够选择不携带致病基因的胚胎植入宫腔，以获得表型正常的胎儿。该文报道肥厚型心肌病患者经PGT-M后，获得不携带致病基因的囊胚，顺利胚胎移植并成功临床妊娠一例。.

To explore the potential indicators including patients' characteristics, electrocardiogram (ECG), echocardiography, and serological assay in predicting the major adverse cardiovascular events (MACE) within 1 year for patients with low-risk chest pain with a nomogram.The detected indicators of patients with low-risk chest pain were obtained as the alternative predictors for MACE. After the 1-year follow-up, patients with MACE were enrolled in the MACE group while the remained patients were in the non-MACE group. A nomogram was constructed based on the multivariable Cox regression to link the independent predictors and the MACE within 1 year for patients with low-risk chest pain.The incidence of MACE within 1 year was 6.94% according to the follow-up result. Multivariate analysis revealed that risk factors of CAD, P-terminal force in lead V1 (PTFV1), C-reactive protein (CRP), and transmitral inflow early diastolic peak velocity (E wave) /peak early diastolic velocity (Em) (E/Em) were the independent predictors for the MACE. A nomogram incorporating these independent predictors with a good discrimination (0.79 in C-index) and calibration was constructed to predict the incidence of MACE within 1 year. It could be used to help select the patients with a high risk of MACE and develop preventive treatment strategies.Risk factors of CAD, PTFV1, CRP, and E/Em were the independent predictors for the MACE within 1 year in patients with low-risk chest pain. The present nomogram provides a user friendly tool in the prediction of MACE for these patients.

This study aims to clarify the influences of miRNA-584 on proliferative and invasive abilities in NK/T-cell lymphoma, and to illustrate the underlying mechanism.MiRNA-584 levels in peripheral blood of NK/T-cell lymphoma patients and healthy controls were detected by qRT-PCR. Potential relationship between miRNA-584 level and clinical indicators of NK/T-cell lymphoma patients was analyzed. Kaplan-Meier curves were depicted for assessing the prognostic value of miRNA-584 in NK/T-cell lymphoma patients. After overexpression or knockdown of miRNA-584, changes in proliferative and invasive abilities in KHYG-1 and SNK-6 cells were assessed by CCK-8 and transwell assay, respectively. The potential mechanism of miRNA-584 and its downstream gene FOXO1 in regulating the development of NK/T-cell lymphoma was explored by Dual-Luciferase reporter gene assay and rescue experiments.Peripheral blood levels of miRNA-584 were lower in NK/T-cell lymphoma patients than those of healthy control. Compared with NK/T-cell lymphoma patients expressing high level of miRNA-584, those expressing a low level suffered worse tumor staging, higher rate of bone marrow invasion, and worse prognosis. Overexpression of miRNA-584 suppressed proliferative and invasive abilities in KHYG-1 and SNK-6 cells. On the contrary, knockdown of miRNA-584 yielded the opposite results. FOXO1 was showed to be the direct target binding miRNA-584, and its level was negatively regulated by miRNA-584. Notably, FOXO1 could partially abolish the regulatory effects of miRNA-584 on proliferative and invasive abilities in NK/T-cell lymphoma.Low level of miRNA-584 is closely linked to advanced stage, susceptibility to bone marrow invasion, and poor prognosis in NK/T-cell lymphoma. MiRNA-584 suppresses proliferative and invasive abilities in NK/T-cell lymphoma by targeting FOXO1.

The management of hepatitis B virus (HBV) infection in pregnancy is a unique issue. Telbivudine (LdT) is recommended to block HBV mother-to-child transmission (MTCT) in the third trimester. However, the safety of LdT treatment during the entire pregnancy for the long-term growth of infants is unclear. The aim of this study was to evaluate the efficacy and long-term safety of LdT for the entire pregnancy period. This retrospective cohort study included 40 pregnant women and 43 children from 2011 to 2017. The antiviral effects and maternal abnormalities were evaluated. In addition, adverse events regarding infants at delivery and HBV vaccination outcomes were recorded. The status of physical development in the children during follow-up was also evaluated. Among pregnant women, the rates of HBV DNA flare were 5.00% during pregnancy and 7.50% postpartum, and the HBeAg seroconversion rates were 7.50% during pregnancy and 7.50% postpartum. No severe maternal abnormalities were observed. Regarding the infants, no one was positive for HBsAg, and only one infant was negative for anti-HBs in children over 7 months of age. Furthermore, no birth defects or severe adverse events were observed at delivery, and 97.67% normal height and 93.02% normal weight in children were observed on follow-up until 5 years of age. In conclusion, LdT use for the entire pregnancy is both effective for treating pregnant women and blocking HBV MTCT. Moreover, LdT is safe for women and infants. Most importantly, the long-term follow-up indicated that LdT is safe and does not affect the growth of children.

It is well verified that lncRNA are emerging as imperative regulators in various tumors. LncRNA CALML3-AS1 (CALML3-AS1), a freshly discovered lncRNA, has been confirmed as a tumor promoter in bladder cancer. This present study aimed to explore the biological functions and molecular mechanisms of CALML3-AS1 in cervical cancer (CC).We analyzed RNA sequencing data from The Cancer Genome Atlas (TCGA) datasets to determine dysregulated lncRNAs in CC. Real Time-Polymerase Chain Reaction (RT-PCR) was applied for the assays of CALML3-AS1 amplification in CC samples and cell lines. Kaplan-Meier analysis and multivariate assays were carried out for determination of the prognostic values. The functions of CALML3-AS1 on cell proliferation, invasion, migration, and apoptosis were determined by a series of cells experiments by knocking down CALML3-AS1. MRNA and protein expressions of signaling pathways were examined using Western blot.We found that CALML3-AS1 was upregulated in CC tissues and this upregulation was associated with FIGO stage, histological grade, and reduced overall survival. Multivariate assays indicated that high CALML3-AS1 expression was an independent prognostic parameter indicating poorer clinical outcome for CC patients. Functional assays suggested that knockdown of CALML3-AS1 suppressed the proliferation, migration, and invasion of CC cells, and induced apoptosis. Mechanistic investigations revealed that inhibiting the expression of CALML3-AS1 decreased the levels of β-catenin, cyclin D1, and c-myc via Western blot.Our study revealed that CALML3-AS1 could be an oncogenic lncRNA promoting the growth and metastasis of CC by modulating Wnt/β-catenin pathway, suggesting that CALML3-AS1 may be an important contributor to CC progression.

Background Diabetes mellitus (DM) is a well-known risk factor for cognitive dysfunction in aged populations. However, there are inconsistent reports about impaired fasting glucose or prediabetes as an independent risk factor for cognitive function. Glutamic acid decarboxylase 65 (GAD65) is the key enzyme responsible for γ-aminobutyric acid synthesis in the central nervous system. Antibodies against GAD65 (GAD65Abs) are not only detected in approximately 80% of early-onset type 1 DM, but also linked to several neurological disorders. Aim This study aims to investigate the association between GAD65Ab titer levels and cognitive performance. In addition, we assessed the effect of GAD65Ab on cognitive function in adults with normal fasting glucose, prediabetes and DM. Methods A total of 328 subjects aged 49.10 ± 5.72 years were enrolled from the Third Health and Nutrition Examination Survey dataset. Cognitive performance was assessed by three computerized neurobehavioral tests, including the serial digit learning test, simple reaction time test (SRTT) and symbol-digit substitution test (SDST). Results Subjects with higher GAD65Ab titers had significantly poorer cognitive function in the SRTT and SDST (P Conclusions These results indicate that GAD65Ab may be a potential marker for cognitive impairment in non-diabetic adults.

Accumulating evidence showed aberrant expressions of long non-coding RNAs (lncRNAs) strongly correlated to the development of cancers, including pancreatic cancer (PC). Whether lncRNA ABHD11-AS1 (ABHD11-AS1) is involved in PC remains to be elucidated. Thus, we aimed to evaluate the effects of ABHD11-AS1 on PC and the underlying molecular mechanism.RT-PCR was used to detect the expression level of ABHD11-AS1 in both PC tissue and cell lines. Then, the correlation of ABHD11-AS1 expression with clinicopathological features and prognosis was studied. Cell proliferation, apoptosis, migration and invasion abilities were detected by MTT, flow cytometry, and transwell assays. We further investigated the effect of abnormal ABHD11-AS1 expression through the PI3K/AKT and EMT pathway by Western blot assays in treated PC cells.We found that the expression of ABHD11-AS1 was significantly increased in both PC tissues and cell lines. The clinical analysis revealed that a high level of ABHD11-AS1 expression was correlated with distant metastasis, TNM stage, and tumor differentiation. The Kaplan-Meier analysis showed that high ABHD11-AS1 expression levels predicted poorer survival. Moreover, univariate and multivariate analyses confirmed that the expression of ABHD11-AS1 was an independent and significant factor associated with poor overall survival rates. Loss-of-function experiments showed that the knockdown of ABHD11-AS1 suppressed PC cell proliferation, migration, invasion, and EMT in vitro. Mechanistically, the knockdown of ABHD11-AS1 decreased phospho(p) AKT and phospho(p) PI3K expression, but did not affect the AKT and PI3K expression in PC cells CONCLUSIONS: This study suggested that ABHD11-AS1 may potentially function as a valuable prognostic biomarker and a therapeutic target for PC patients.

Background Recipient hepatectomy can be complicated by severe bleeding during caudate lobe dissection in living-donor liver transplantation (LDLT), especially when the inferior vena cava is encased or with dense adhesions from prior interventions. Total hepatic vascular exclusion (TVE) including total hepatic inflow (Pringle maneuver) and occlusion of supra- and infra-hepatic inferior vena cava during the partial hepatectomy has been studied well, but it has not been mentioned regarding recipient hepatectomy in LDLT. The aim of this study is to evaluate hemodynamic impact and surgical outcome by using the technique of TVE in LDLT. Methods From April 2010 to June 2010, 30 consecutive LDLT recipients at Kaohsiung Chang Gung Memorial Hospital with TVE (TVE group, n = 14) or without TVE (non-TVE group, n = 16) for the caudate lobe dissection were analyzed retrospectively. Results The TVE group had a mean decrease in systolic blood pressure and cardiac index of 21% and 41% during caudate dissection in recipient hepatectomy, respectively. The TVE group had shorter time for caudate mobilization and less blood loss compared with the non-TVE group (3904 mL vs. 5650 mL, P = .461). Two patients in the non-TVE group were shifted to TVE as a salvage procedure to control bleeding. Three patients in the non-TVE group underwent relaparotomy for homeostasis. Conclusions Short-term TVE is a technically feasible procedure and should be considered during recipient hepatectomy with difficult caudate lobe dissection in LDLT to create a bloodless surgical field. Most patients tolerated the TVE without hemodynamic impact under anesthetic management.

We aimed to compare the invasive (iICP) and a non-invasive intracranial pressure (nICP) monitoring methods in patients with traumatic brain injury, based on the similarities of the signals' power spectral densities.We recorded the intracranial pressure of seven patients with traumatic brain injury admitted to Hospital São João, Portugal, using two different methods: a standard intraparenchymal (iICP) and a new nICP method based on mechanical extensometers. The similarity between the two monitoring signals was inferred from the Euclidean distance between the non-linear projection in a lower dimensional space (ISOMAP) of the windowed power spectral densities of the respective signals. About 337 h of acquisitions were used out of a total of 608 h. The only data exclusion criterion was the absence of any of the signals of interest.The averaged distance between iICP and nICP, and between arterial blood pressure (ABP) and nICP projections in the embedded space are statistically different for all seven patients analysed (Mann-Whitney U, p0.05).The similarity between the iICP and nICP monitoring methods was higher than the similarity between the nICP and the recordings of the radial ABP for all seven patients. Despite the possible differences between the shape of the ABP waveform at radial and parietal arteries, the results indicate-based on the similarities of iICP and nICP as functions of time-that the nICP method can be applied as an alternative method for ICP monitoring.

Long noncoding RNAs (lncRNAs) have been reported to have crucial roles in the regulation of various tumors. Recently, lncRNA TCONS_00027978 (TCONS_00027978) was found to be downregulated in hepatocellular carcinoma (HCC). This study aims at analyzing the value of TCONS_00027978 in valuing the prognosis of HCC patients.The expression of TCONS_00027978 was detected using qRT-PCR in 241 hepatocellular specimens and matched adjacent normal tissues. The association between TCONS_00027978 expression levels and clinicopathological factors was examined. Survival and Cox proportional-hazards regression analyses were performed to explore the association between TCONS_00027978 expression levels and prognosis in HCC patients.We found that the TCONS_00027978 expression level was significantly decreased in HCC tissues compared with matched normal tissues (p0.01). TCONS_00027978 was positively associated with TNM stage (p = 0.002), lymph node metastasis (p = 0.001) and histologic grade (p = 0.002) in HCC patients. In addition, Kaplan-Meier analysis indicated that low levels of TCONS_00027978 expression were associated with poorer overall survival (p = 0.002) and disease-free survival (p =0.001). Subsequently, multivariate analyses indicated that low TCONS_00027978 expression was an independent poor prognostic factor for HCC patients.Our study is the first to demonstrate the TCONS_00027978 expression as an independent prognostic factor in HCC.

1. The study focused on antioxidant molecular targets of wheat bran fermented by white rot fungi (WRF) in poultry. After solid-state fermentation of wheat bran by WRF for 12 d, scanning electron microscopy found that the lignocellulose structure showed degradation and fragmentation. 2. A total of 300 1-d-old broilers were evenly divided by gender and randomly allocated into the following treatments: (1) maize-soybean meal (control group), (2) 10% of wheat bran replacing maize (10% WB group) or (3) 10% of fermented wheat bran replacing maize (10% FWB group). 3. The results indicated that the antioxidant gene expression, such as haem oxygenase-1 and glutathione-S-transferase of chicken peripheral blood mononuclear cells, of the 10% FWB group was significantly higher than that of the control group at d 35. For genes of Nicotinamide adenine dinucleotide phosphate oxygenase 1 and reactive oxygen species modulator protein 1, the expression of the 10% FWB group was lower than that of the control group at d 21 and 35. 4. In conclusion, wheat bran fermented by WRF could increase lignocellulolytic enzyme activities and the levels of active components that further regulate the expression of antioxidant molecular targets in poultry.

A variety of inflammatory disorders influence the serum white blood cell (WBC) count. Elevated systemic inflammatory insult may contribute to impaired lung function, such as obstructive or restrictive lung disease. The aim of our study is to investigate the correlation between WBC count and pulmonary function.Eligible participants aged ≥18 years (n=16 312) were enrolled from the United States National Health and Nutrition Examination Survey III, 1988-1994. Pertinent information including pulmonary function test, demographics, WBC count, glucose, C-reactive protein and a personal health questionnaire were obtained for subjects without known pulmonary diseases. White blood cell counts were classified into quartiles over the normal range. Multiple hierarchical regression models and trends testing were used to assess the correlation between WBC counts and pulmonary function tests.In the unadjusted mode of quartile-based analysis, the beta coefficients interpreted as the differences in FEV1% predicted upon comparing subjects in the upper three quartiles of WBC count to those in the lowest quartile were -0.007, -0.022 and -0.041 (P0.001). After adjusting for multiple pertinent covariates, inverse association between quartiles of WBC count and FEV1% predicted remained essentially unchanged. The negative trends between FEV1% predicted and WBC count quartiles in the stratified comparison with extended-model approach were statistically significant (P for trends0.001) in quartile-based multiple linear regression.Elevated WBC count is independently associated with declined pulmonary function. It may be a simple, accessible and inexpensive indicator of changes in pulmonary function.

Objectives Recipients after liver transplantation. (OLT) often experience renal dysfunction. Acute kidney injury (AKI) and chronic kidney disease (CKD) after OLT occur among 20% to 50% and 30% to 90% of recipients, respectively; 2% to 5% of them deteriorate into end-stage renal disease each year. Since the predictable factors for CKD have not been well identified. We sought to investigate the incidence and predictors of CKD at 5 years after OLT. Patients and methods Between August 2002 and December 2005, we enrolled 77 patients who underwent adult living donor OLT with over 2 years of follow-up. The strategies to prevent renal dysfunction included induction with basiliximab to delay the use of tacrolimus: addition of mycophenolate mofetil to reduce the tacrolimus dosage; avoidance of the calcineurin inhibitor using sirolimus or administration of an angiotensin II receptor antagonist. The clinical variables were reviewed for analysis. Results The mean follow-up was 76 ± 14 months. The incidence of AKI (over 50% increase level of creatinine) was 29%. Ten (13.0%) patients developed CKD (creatinine > 2 mg/dL). One (1.3%) subject developed end-stage renal disease requiring hemodialysis. Upon multivariate analysis the development of CKD was significantly associated with the posttransplant 4-week creatinine level: 0.92 ± 0.23 versus 1.37 ± 0.93 mg/dL ( P = .008). Conclusion The 4-week creatinine value was predictive of the occurence of CKD over 5 years after OLT.

Objective Liver transplantation for intrahepatic cholangiocarcinoma is notorious for rapid recurrence with poor survival rate postoperatively and has therefore been discontinued in most centers. The purpose of this study is to distinguish hepatocellular carcinoma (HCC) from cholangiocarcinoma in pretransplantation imaging evaluation by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Materials and Methods From January 2014 to September 2015, 19 patients were included in the study, with a mean age of 62.8 years. All subjects underwent pretransplantation DCE-MRI and surgical excision or core biopsy. The DCE-MRI parameters were measured using the Tofts model 1999. Statistical analysis included nonparametric tests and area under the curve for the receiver operating characteristic. Results Fourteen HCCs and 5 cholangiocarcinomas were diagnosed by surgical pathology. The mean size of tumor was 6.4 cm (range, 1.5 cm to 13.7 cm). All DCE-MRI parameters were calculated as the ratio between the tumor and normal liver parenchyma and K trans (1/min) was used as a distinguishing parameter between the two tumors. K trans was higher in the cholangiocarcinoma group (1.89 ± 1.13) than in the HCC group (0.46 ± 0.35). Univariate analysis revealed that K trans has a high significant difference ( P = .001). The optimal K trans value cutoffs were 1 or more (area under the curve = 0.971) for detection of HCCs or cholangiocarcinomas. Conclusion The analysis of DCE-MRI with the kinetic model (Tofts, 1999) presents a new and practical approach indiscrimination of HCC from cholangiocarcinoma for pretransplantation imaging evaluation.

BACKGROUND AND STUDY AIM: Although narrow-band imaging (NBI) in endoscopy can improve detection of early-stage esophageal malignancies in patients with head and neck cancers, false-positive results may be obtained in areas with nonspecific inflammatory changes. This study evaluated the feasibility of primary screening with NBI and magnification for the presence of esophageal malignancies in these cancer patients. PATIENTS AND METHODS: Sixty-nine patients with documented head and neck cancers were enrolled from April 2008 to January 2009. All patients underwent a meticulous endoscopic examination of the esophagus using a conventional white-light system followed by re-examination using the NBI system and final confirmation with NBI plus magnification. RESULTS: Twenty-one patients (30.4 %) were confirmed to have esophageal neoplasia. Among these 21, 16 (76.2 %) had synchronous lesions, 9 (42.9 %) were asymptomatic, and 10 (47.6 %) had early-stage neoplasia. The incidence of multiple esophageal neoplasia was 57.1 %. NBI was more effective than conventional endoscopy in detecting neoplastic lesions (35 lesions in 21 patients vs. 22 lesions in 18 patients) and was particularly effective in patients with dysplasia (13 lesions in 9 patients vs. 3 lesions in 3 patients). The sensitivity and accuracy of detection were 62.9 % and 64.4 % for conventional endoscopy, 100 % and 86.7 % for NBI alone, and 100 % and 95.6 % for NBI with high magnification, respectively. CONCLUSIONS: Compared with current approaches, NBI followed by high magnification significantly increases the accuracy of detection of esophageal neoplasia in patients with head and neck cancers. The result warrants conducting prospective randomized controlled study to confirm its efficacy.

Liver retransplantation carries a significantly higher morbidity and mortality compared with patients after single transplantations. The aim of this study was to review our outcomes in liver retransplantations. From February 1984 to February 2007, 409 liver transplantations were performed on 396 patients, including 13 retransplantations (3.2%) in 12 patients. The mean follow-up was 1.6 +/- 0.4 years (range, 0.1-5.2). The mean duration between the first and the second transplantation was 2.8 +/- 1.0 years (range, 15 days-11.6 years). The indications for the first liver transplantation included biliary atresia (n = 3), hepatitis B virus (HBV)-related cirrhosis with hepatoma (n = 3), fulminant hepatic failure (n = 2), HBV-related end-stage liver disease (n = 1), hepatitis C virus (HCV)-related end-stage liver disease (n = 1), neonatal hepatitis (n = 1), and glycogen storage disease (n = 1). The indications for retransplantations were secondary biliary cirrhosis (n = 3), veno-occlusive disease-related liver failure (n = 2), hepatic arterial occlusion and graft failure (n = 2), chronic rejection with hepatic graft failure (n = 2), recurrent HBV (n = 1) and de novo HBV-related decompensated cirrhosis (n = 1), and idiopathic graft failure (n = 1). There were 4 living donor and 9 deceased donor liver retransplantations. The cumulative survival rate was 71.4 +/- 14.4%, with an estimated mean survival time of 3.9 +/- 0.7 years. Our results showed that minimizing the rate of retransplantation was critical to enhance overall patient survival. Moreover, living donor liver retransplantation is another option within the short, yet critical, waiting period, after failure of the first graft. Provided that a suitable living donor is available, we recommend early retransplantation to minimize the risk of morbidity and mortality.

Purpose. Complications are common in the early postoperative period after living donor liver transplantation (LDLT). The aims of this analysis were to describe and identify risk factors for early postoperative complications. Methods. Between June 1994 and June 2003, 140 consecutive LDLT patients were divided into 3 groups: group I was small infants

Breast cancer is one of the most common tumors in females. The therapeutic resistance of breast cancer has motivated the development of new agents for prevention and treatment. For the present study, several compounds were designed and analyzed for their antitumor activity in many cancer cell lines. 4-(3,4,5-Trimethoxyphenoxy) benzoic acid (compound 1) and its derivatives were selected for studying the anti-proliferative and cytotoxic effects on five human cancer cell lines. Results indicated that compounds 1 and 2 significantly suppressed the cell viability of MCF-7 and MDA-MB-468 cancer cells. However, compounds 1 and 2 had only minor effects on HepG2, Huh-7, and Hela cells. Moreover, compounds 1 and 2 exhibited a novel anti-tumor activity through the induction of cell-cycle arrest at G2/M and apoptosis in MCF-7 and MDA-MB-486 breast cancer cells. Both compounds reduced colony-forming ability in MCF-7 cells. Flow cytometric analysis indicated that caspase-3 activity was increased in response to treatment with compounds 1 and 2. Taken together, these findings suggest that the novel compounds 1 and 2 are potential anticancer agents with clinical promise for breast cancer therapy.

Despite the advances in cancer therapy and early detection, breast cancer remains a leading cause of cancer-related deaths among females worldwide. The aim of the current study was to investigate the antitumor activity of a novel compound, 4-(3,4,5-trimethoxyphenoxy)benzoic acid (TMPBA) and its mechanism of action, in breast cancer. Results indicated the relatively high sensitivity of human breast cancer cell-7 and MDA-468 cells towards TMPBA with IC50 values of 5.9 and 7.9 µM, respectively compared to hepatocarcinoma cell line Huh-7, hepatocarcinoma cell line HepG2, and cervical cancer cell line Hela cells. Mechanistically, TMPBA induced apoptotic cell death in MCF-7 cells as indicated by 4',6-diamidino-2-phenylindole (DAPI) nuclear staining, cell cycle analysis and the activation of caspase-3. Western blot analysis revealed the ability of TMPBA to target pathways mediated by mitogen-activated protein (MAP) kinases, 5' adenosine monophosphate-activated protein kinase (AMPK), and p53, of which the concerted action underlined its antitumor efficacy. In addition, TMPBA induced alteration of cyclin proteins’ expression and consequently modulated the cell cycle. Taken together, the current study underscores evidence that TMPBA induces apoptosis in breast cancer cells via the modulation of cyclins and p53 expression as well as the modulation of AMPK and mitogen-activated protein kinases (MAPK) signaling. These findings support TMPBA’s clinical promise as a potential candidate for breast cancer therapy.

The combination of cisplatin and 5-fluorouracil (5-FU) (PF) is the most popular regimen for treating metastatic nasopharyngeal carcinoma (NPC) but it is limited by severe stomatitis and chronic cisplatin-related toxicity. A novel approach including induction with mitomycin C, doxorubicin and cisplatin (MAP) and subsequent maintenance with weekly 5-FU and leucovorin (FL) were designed with an aim to reduce acute and chronic toxicity of PF. Thirty-two patients of NPC with measurable metastatic lesions in the liver or lung were entered into this phase II trial. Mitomycin C 8 mg m−2, doxorubicin 40 mg m−2 and cisplatin 60 mg m−2 were given on day 1 every 3 weeks as initial induction. After either four courses or remission was achieved, patients received weekly dose of 5-FU 450 mg m−2 and leucovorin 30 mg m−2 for maintenance until disease progression. With 105 courses of MAP given, 5% were accompanied by grade 3 and 0% were accompanied by grade 4 stomatitis. The dose-limiting toxicity of MAP was myelosuppression. Forty per cent of courses had grade 3 and 13% of courses had grade 4 leukopenia. No grade 3 or 4 cisplatin-related toxicity was observed. The overall response rate was 94% (95% confidence interval (CI) 84.9–100%) with a complete response rate (CR) of 6% (95% CI: 0–15.2%) and a good partial response (PR) rate of 28% (95% CI 11.7–44.6%), which was optionally defined as observance of only equivocal lesion identifiable under imaging study. Twenty-seven cases entered weekly FL maintenance phase. The median duration of maintenance with weekly FL was 38 weeks (8–91 weeks). There was no grade 3 or 4 toxicity noted during weekly FL. The median progression-free survival and overall survival were 11.6 ± 0.4 and 18.1 ± 3.6 months respectively. Six patients with a median follow-up of 19.8 months (9.6–41.0 months) were still alive and five of them had disease under control with FL. Good responders (CR and good PR) had better survival than less satisfactory responders (PR and stable disease) (P = 0.05). From Cox’s multivariate regression analysis, the only significant prognostic factor for survival was good response to MAP (P = 0.042). Liver metastasis was the only significant variable in the best subset regression model that predicted good response to MAP (CR and good PR) (P = 0.027). MAP was an effective combination for metastatic NPC with minimal stomatitis and cisplatin-related toxicity but had significant myelosuppression. Weekly FL was a maintenance therapy with minimal side-effects. The response rate and overall survival of MAP-FL were better than series previously reported even when a subset of patients with poor prognosis was selected. MAP-FL's role as neoadjuvant or adjuvant therapy is worthy of further study. © 1999 Cancer Research Campaign

Background Liver transplantation is an important treatment option in the management of end-stage liver disease. Preoperative vascular evaluation plays an important role for a safe and successful operation, especially in pediatric patients undergoing living donor liver transplantation (LDLT). Purpose The purpose of this study is to assess the usefulness and accuracy of Doppler ultrasound (US), computed tomographic angiography (CTA), and magnetic resonance angiography (MRA) in evaluating vascular anomalies in patients with biliary atresia (BA) undergoing LDLT. Methods and Materials Images of Doppler US, CTA, and MRA for preoperative vascular evaluation in 55 patients with BA undergoing LDLT were reviewed with the operative findings. Results All patients underwent preoperative US, CTA, and MRA. Pathologic portal vein (n = 18), interruption of the retrohepatic vena cava (n = 1), and aberrant right hepatic artery from the superior mesenteric artery (n = 2) were confirmed during the transplantation. The success rates of CTA and MRA in identifying vascular anomalies were 96% and 82%, respectively (P = .01). The sensitivity, specificity, and accuracy of Doppler US were 89%, 94%, and 92%, respectively. For CTA, it was 94%, 97%, and 96%, respectively; for MRA (including technical failure), it was 75%, 97%, and 89%, respectively. Conclusion Doppler US serves as an initial assessment for vascular evaluation and has the advantage in determining vascular flow quantities. CTA and MRA are used for precise surgical planning. However, MRA has lower success and accuracy rates when compared with CTA (P = .01). Doppler US with CTA can provide accurate preoperative vascular imaging in patients with BA undergoing LDLT.

Introduction The purpose of this study was to evaluate the changes in liver fatty content and the volumes of liver and spleen after body weight reduction in potential living liver donors. Materials and methods Twenty-three potential living donors had fatty livers at pretransplantation sonography and computed tomography (CT). All were advised to undergo body weight reduction by exercise and diet control. A percutaneous core liver biopsy was performed in segment 5 of the liver in 22 donors to evaluate the hepatic fat content before and after body weight reduction. We compared the changes in the liver CT attenuation values and volume changes in the left and right lobes of the liver and the spleen before and after body weight reduction. Results The mean (SD) body weight, body mass index, and fatty content of the liver biopsy specimens were 73 (17) kg, 26.8 (4.4), and 16.9% (12.7%), respectively, before body weight reduction and 70 (15) kg, 25.3 (3.8), and 6.6% (3.7%), respectively, thereafter. These changes were significant. The CT attenuation values of the left and right lobes of the liver and spleen were 54 (11), 51 (11), and 52 (5) HU, respectively, before body weight reduction and 60 (8), 58 (6), and 53 (5) HU, respectively, thereafter. The mean CT attenuation value of the left lateral segment was greater than that of the right lobe both before and after body weight reduction. The volume of the left and right lobes and spleen changed from 497 (129) cm3 to 452 (99) cm3, 927 (237) cm3 to 846 (173) cm3, and 185 (65) cm3 to 186 (63) cm3, respectively, thereafter. The right and left lobe volume change ratios were 7.0% (10.6%) and 7.6% (11.1%), respectively, but showed no significant difference. Twenty of the 23 candidates were able to donate part of their liver. Conclusion Body weight reduction by exercise and diet control in potential living liver donors is effective to reduce the fatty content of the liver. Reversed percentage of the fatty content and volume of the liver was observed in these donors. The volumes of the right and left lobes of liver decreased significantly after body weight reduction. The volume changes were proportional.

Purpose: This retrospective study of patients who underwent neck radiation as part of their treatment for squamous cell carcinoma of the oral cavity sought to identify and quantify the morbidity associated with this treatment. Patients and Methods: Thirty-five patients who received neck radiation between 1985 and 1992 were randomly recalled for examination. All patients had been treated in a standardized fashion by the Department of Radiation Oncology. The long-term effects of neck radiation on skin changes, thyroid function, and neck range of motion, of atherosclerotic carotid artery disease, xerostomia, and glottic structures were measured. Results: Fifty-seven percent of patients demonstrated grade 1 skin changes. No severe changes were noted, and no development of secondary neoplasia was observed. There was no linear trend observed between radiation dose and skin changes. Hypothyroidism developed in 14.3% of patients within 3.5 years posttreatment. Logistic regression demonstrated a significant association between hypothyroidism and radiation dose. Limitation of neck mobility was the most significant complication with deficits demonstrated in all ranges of motion. Carotid bruits were documented in 14.3% of patients, with a significant association between the higher neck dosage in N+ cases. Xerostomia was found in 68% of patients. There was persistent glottic erythema in 11.4% of patients. Conclusions: The results of this study indicate that there are persistent complications after neck radiation, which include limitation of neck movement, diminished thyroid function, accelerated carotid artery narrowing, and skin and salivary changes.

The preferred therapy for acute and chronic liver insufficiency and severe heritable disorders of liver metabolism is whole-organ transplantation. However, due to the shortage of organ donors and high cost, alternative therapeutic approaches have been proposed, including transplantation of normal allogeneic hepatocytes. Recently, it has been reported that many hepatocytes transplanted into the spleen migrated to the liver. We therefore carried out a series of large-animal experiments to reexamine the intrasplenic route and to develop a method for large-scale hepatocellular transplantation in pigs.Allogeneic porcine hepatocytes were transplanted using the following routes: (1) retrograde injection of cells via the splenic vein, (2) intraarterial injection of cells, (3) direct intrasplenic injection of cells after laparotomy, (4) percutaneous intrasplenic injection of cells under laparoscopic control, (5) laparoscopic intrasplenic injection of cells. The number of cells injected varied from 2 x 10(9) to 10 x 10(9) cells.Of all the methods tested, only direct intrasplenic injection of 2 bln of cells was found to be compatible with survival. However, even with this "small" number of cells (2% original liver mass), there was a significant risk of spleen infarction, perisplenic adhesion formation, and portal vein thrombosis. The laparoscopic approach was found to be reliable, simple, and safe.Even though the spleen is considered by many authors the optimal site for hepatocellular transplantation, transplantation of cells in a number needed to support the failing liver may be associated with significant complications, morbidity, and mortality.

Hepatitis C virus (HCV) infection frequently causes chronic hepatitis and lack of virus clearance in these patients. In addition, many patients infected by HCV also present with hypergamma-globulinemia in the early stage of chronic infection. These observations raise a possible viral superantigen effect induced by HCV, because viral superantigen found in human immunodeficiency virus (HIV) or in replication of defective murine leukemia virus (MuLV) is associated with T-cell dysfunction and polyclonal activation of B cells. The possibility was investigated of whether HCV encodes any superantigen by analyzing the usage of T-cell receptor (TCR) from the peripheral blood lymphocytes (PEL) of patients with chronic hepatitis C. Two groups, one with hyper-gammaglobulinemia and the other without hy-pergammaglobulinemia, were studied for the usage of TCR β chain by reverse transcription-polymerase chain reaction (RT-PCR) analysis. It was found that all genes of Vβ variable chain were used in the PBL of these patients. Furthermore, there was no significant difference of the TCR expression pattern between these two groups, nor a complete deletion of a particular T-cell subset in either group. These results do not provide evidence for HCV superantigen, but indicate that the TCR usage in the patients was neither defective nor biased. © 1995 Wiley-Liss, Inc.

Recurrent ovarian cancer with long-term survival is uncommon and often associated with poor prognosis. We report three cases of patients with advanced ovarian cancer who have achieved long-term disease-free survival following a single prior relapse. Case 1 relapsed with a localized bulky tumor and received a complete surgical resection and chemotherapy. Case 2 had a persistent central pelvic tumor after debulking surgery and second-line chemotherapy, and yet achieved excellent control with concurrent chemoradiation to the true pelvis. Case 3 relapsed with paraaortic lymph node metastasis and probable lung metastasis (subsequently negated by positron emission tomography) and received chemotherapy alone. These three patients have since remained disease-free for 13, 12, and seven years, respectively, since their first relapse. We conclude that select patients can obtain long-term disease-free survival after the first relapse by accurate restaging and aggressive multimodality treatment.

To investigate the problem behaviours of middle school students and its associated factors in Anhui province of China, and to provide a theoretical basis for promoting early health education.A cross-sectional survey was conducted and 4235 middle school students were measured by Prediction Test of Problem Children, Family Environment Scale - Chinese Version, Simple Coping Style Questionnaire, Psychological Sense of School Membership and general state questionnaire.The prevalence of problem behaviours in our sample was 4.5%. Using binary logistic regression analysis, we found that family environment, school belonging, coping style, relationship with mother and classmate relationship were associated with problem behaviours of middle school students.Poor family environment, poor sense of school belonging, passive acting style were significantly correlated with problem behaviours. There is an urgent need to improve problem behaviours through collaboration among families, schools and society.

Background H Coma due to acute hepatic failure produces a high mortality rate with rapid progression of cerebral edema and brain herniation. Early transplantation increases survival of patients with acute hepatic encephalopathy. In previous studies, scant attention has focused on the conscious recovery time after living donor liver transplantation ( ldlt ) and whether the conscious recovery time was directly proportional to the length of coma before transplantation. Patients and methods We have reported herein three adult patients with decompensated chronic end-stage liver disease who underwent right lobe LDLT. Their general conditions had markedly deteriorated; two patients displayed massive ascites. All three subjects displayed grade IV encephalopathy with endotracheal intubation and intensive care management. Their biochemical data revealed hyperammonemia, marked cholestasis, and coagulopathy. Results After LDLT the patients recovered from coma at a mean time similar to that in coma. Preoperatively the patients exhibited acute deep coma with respiratory failure on preoperative days 5, 3, and 1 with consciousness regained on postoperative day 5, 3 and 1, respectively. Conclusion We suggest that patients with acute deep coma (grade IV), who were formerly regarded as irreversible, benefit with LDLT, preventing worsening of complications, and that shows a time-dependent recovery the pretransplant comatose status.

The metabolic syndrome may cause disease progression in patients with chronic hepatitis B (CHB). However, the interactions between hepatitis B virus (HBV) infection and metabolic factors remain unknown. We investigated the association of HBV infection with metabolic profiles in HBV-infected and noninfected subjects. In addition, the impacts of serum HBV DNA level on metabolic profiles were studied. Initially, a case-control analysis of patients with and without chronic HBV infection was performed. The HBV group consisted of 322 patients with chronic HBV infection, and the control group consisted of 870 matched subjects without HBV infection. Fasting blood glucose, lipid profiles and adiponectin levels were compared. The results were then confirmed in a second retrospective cohort study in 122 CHB patients with serum HBV DNA levels and HOMA-IR index values. In the case-control analysis, the HBV group had significantly higher serum adiponectin, but lower triglyceride (TG) and high-density lipoprotein cholesterol (HDL) levels than the control group. These relationships already existed in subjects younger than 45 years of age and were modified by serum alanine aminotransferase (ALT) levels. In the retrospective cohort, serum HBV DNA levels were negatively proportional to TG levels, but not to other metabolic parameters. Moreover, this relationship was significant only in subjects with higher ALT levels. Compared with healthy adults, patients with chronic HBV infection have significantly higher serum adiponectin, but lower TG and HDL levels. These relationships are modified by ALT levels and already exist in middle-age patients with chronic HBV infection, implying HBV may interact with host metabolism.

Botryomycosis is an uncommon chronic suppurative granulomatous bacterial infection that can affect the skin and viscera. Clinically, lesions typically consist of small tender nodules from which draining sinuses may develop to expel a purulent discharge. Histopathological features include characteristic aggregation of microorganisms (grain) within the inflammatory infiltrate. The commonest causative organisms are Staphylococcus aureus and Pseudomonas aeruginosa, of others. Botryomycosis resulting from Prevotella melaninogenica has not been reported previously. We report the case of a middle-aged patient with botryomycosis presenting as nasal cutaneous fistulas caused by P. melaninogenica, which was successfully treated with surgical intervention combined with systemic antibiotic treatment.

The diagnosis of gastro-oesophageal reflux disease (GERD) is based on reflux symptoms. Although metabolic syndrome has been linked to erosive oesophagitis (EO), the impact of insulin resistance, the core of the metabolic syndrome, on reflux symptoms remains to be elucidated.To assess the effects of insulin resistance on GERD, including both endoscopic findings and symptoms.A total of 743 sonographic noncirrhotic adult subjects, who underwent an upper gastrointestinal endoscopic examination, completed a gastro-oesophageal reflux questionnaire and had available fasting insulin data were included. Endoscopic findings were classified according to the Los Angeles classification. Homeostatic model assessment-insulin resistance (HOMA-IR) index was used to evaluate the status of insulin resistance. Univariate and multivariate approaches were used to evaluate the associations between insulin resistance and GERD.Older age, male gender, smoking and alcohol consumption increased the prevalence of EO, but not GERD symptoms. A large waist circumference, high fasting blood glucose levels and high number of metabolic syndrome components were associated with increased prevalence of both EO and GERD symptoms, while high blood pressure was associated with increased prevalence of EO only. Moreover, higher scores in the gastro-oesophageal reflux questionnaire were associated with higher HOMA-IR index, and higher HOMA-IR index was associated with increased prevalence of EO (adjusted odds ratio 1.14, 95% CI 1.03-1.26, P = 0.012).Our findings demonstrate clear associations between insulin resistance, metabolic syndrome and GERD. Whether reducing insulin resistance may improve GERD symptoms or EO deserves prospective study.

Many studies support the role of bilirubin as a cytoprotector in chronic inflammatory diseases, such as stroke and atherosclerosis.To investigate the relationship between serum total bilirubin levels and functional dependence in older adults.Data from the National Health and Nutrition Examination Survey (1999-2002) pertaining to 2235 old adults were analysed. All participants had given a household interview, providing information of five major domains on self-reported functional status (activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility and general physical activities), had completed serum total bilirubin measurement, and a questionnaire regarding personal health. Poor performance was defined as experiencing difficulty with one or more items in a given domain. Functional dependence was defined as having three or more poor performances in the five major domains. Multiple logistic regression was performed together with quartile-based stratified odds ratio (OR) comparison and trend tests.The OR of functional dependence for each standard deviation increment in the serum total bilirubin level was 0.56 (P = 0.002). After additional adjustment, the inverse association remained essentially unchanged. In quartile-based analysis, participants with higher quartiles of serum total bilirubin tended to have lower ORs of functional dependence. The trends of lower likelihood of functional dependence across increasing quartiles of the serum total bilirubin level were statistically significant (P0.05 for all trends).Higher serum total bilirubin levels were associated with lower likelihood of functional dependence in older adults.

Gastro-oesophageal reflux disease (GERD) has been associated with reflux laryngitis.To investigate the risk factors and the predictors of pharyngeal acid reflux (PAR) in Taiwanese patients with suspected reflux laryngitis.With referral from ENT physicians, 104 patients with symptoms and signs suggestive of reflux laryngitis completed a validated symptom questionnaire, an upper endoscopy exam and ambulatory 24-h pH tests with three sensors located at the hypopharynx, proximal and distal oesophagus. Patients with one or more episodes of PAR were considered abnormal.Pharyngeal acid reflux was identified in 17% (18/104) of patients. In multivariate logistic regression analysis, PAR was independently associated with classical reflux symptoms [adjusted odds ratio (aOR) = 3.5, 95% confidence interval (CI): 1.0-12.8], hiatus hernia (aOR = 6.7, 95% CI: 1.5-30.2) and overweight (aOR = 3.4, 95% CI: 1.0-11.0). In predicting PAR, classical reflux symptoms had a sensitivity of 78% and hiatus hernia had a specificity of 95%. With all three factors, the positive predictive value for PAR was 80%. Classical reflux symptoms included heartburn, chest pain, dyspepsia and acid regurgitation.Classical reflux symptoms, hiatus hernia and overweight are independent risk factors that may predict pharyngeal acid reflux in patients with suspected reflux laryngitis.

Asperfuranone, a novel compound of genomic mining in Aspergillus nidulans, was investigated for its anti-proliferative activity in human non-small cell lung cancer A549 cells. To identity the anti-cancer mechanism of asperfuranone, we assayed its effect on apoptosis, cell cycle distribution, and levels of p53, p21 Waf1/Cip1, Fas/APO-1 receptor and Fas ligand. Enzyme-linked immunosorbent assay showed that the G0/G1 phase arrest might be due to p53-dependent induction of p21 Waf1/Cip1. An enhancement in Fas/APO-1 and its two form ligands, membrane-bound Fas ligand (mFasL) and soluble Fas ligand (sFasL), might be responsible for the apoptotic effect induced by asperfuranone. Our study reports here for the first time that the induction of p53 and the activity of Fas/Fas ligand apoptotic system may participate in the anti-proliferative activity of asperfuranone in A549 cells.

Children with atopic dermatitis (AD) are more frequently colonized by Staphylococcus aureus than healthy children.To assess whether any relationship exists between nasal meticillin-resistant S. aureus (MRSA) colonization and subsequent skin and soft-tissue infections (SSTI).From 2005 through 2006, comparative molecular analyses of 23 MRSA-colonizing isolates from 133 children with AD, 44 MRSA-colonizing isolates from 490 healthy controls, and 12 MRSA-infecting isolates from 20 children with AD and concurrent SSTI were conducted.Nasal MRSA colonization in children with AD was significantly higher compared with normal individuals (17.3% vs. 9.0%; P = 0.01). The molecular characteristics differed significantly between the MRSA isolates from children with AD and the MRSA-colonizing isolates from healthy controls. The clone characterized as sequence type (ST)59 (338)/pulsotype B/staphylococcal cassette chromosome mec (SCCmec) V(T)/Panton-Valentine leucocidin (PVL)-positive/staphylococcal enterotoxin B (SEB)-positive accounted for half of the MRSA isolates from children with AD, and another clone, characterized as ST59/pulsotype A/SCCmec IV/PVL-negative/SEB-positive accounted for 61% of the MRSA-colonizing isolates from healthy controls.We found MRSA colonizing the anterior nares of a large number of Taiwanese children, especially among those with AD. Analysis of our data provides evidence that links MRSA-colonizing isolates to MRSA-infecting isolates from concurrent SSTI in children with AD.

A 53-year-old woman with end-stage renal disease developed dyspnea soon after commencing continuous ambulatory peritoneal dialysis (CAPD) for 1 day. Low drainage volume of dialysate (infusion 1500 ml and drainage 1100 ml) was also noted. The chest radiograph taken at emergency department showed massive right-sided pleural effusion (Figure 1), which was transudative in character with high glucose level. The diagnosis of pleuroperitoneal …

We have reviewed retrospectively the records of 157 patients, less than or equal to 30 years of age with nasopharyngeal carcinoma (NPC) from 218 such cases identified in the tumor registry files of three major teaching hospitals in Taipei, Taiwan. These cases were diagnosed between 1 January 1982 and 31 December 1985, with a minimum follow-up of 2 years. The average age was 25, with a male/female ratio of 1.67. The TNM (tumor size, nodes, metastases) classification of 127 patients showed T1, 22%; T2, 33.1%; T3, 23.6%; T4, 21.3%; N0, 26%; N1, 16.5%; N2, 27.6%; N3, 30%; and M1, 13.4%. Antibody titer to Epstein-Barr virus capsular antigen (EBVCA) were elevated in 45 of 48 patients tested. Of the 29 patients who had hepatitis B (HB) viral survey done 34.5% were positive for HB surface antigen (HBsAg). Of 13 patients with elevated EBVCA antibody who were also tested for HB, six were HBsAg carrier. Actuarial survival rates of 2 and 3 years are 70 and 62%, respectively, among the 90 patients who were followed regularly or to death. HBsAg carriers and patients with M1 disease had a shorter survival time. We concluded that patients less than 30 years of age seemed to have an increased incidence of NPC, compared to that in an earlier report. Our patients frequently presented with advanced stage and poor prognosis. The high rate of HB carrier raises the possibility that HBV may play a role in the carcinogenesis and tumor growth in some NPC patients. Future prospective studies are needed.

Background The purpose of the study was to describe sensorimotor profile in children with mild intellectual disability (ID), and to examine the association between cognitive and motor function. Methods A total of 233 children with mild ID aged 7 to 8 years were evaluated with measures of cognitive, motor and sensory integrative functioning. Results Children with mild ID performed significantly less well on all test measures. 44.2% of children scored in the impaired range on seven out of 22 sensorimotor measures. They had weaker fine motor skills than gross motor skills. Sensory integrative functions were only mildly impaired. Total IQ substantially predicted overall performance on each motor test. Specifically, verbal comprehension and processing speed indexes were significant predictors of gross and fine motor function. Conclusions Sensorimotor dysfunctions were found to be very frequent in children with mild ID. Early identification of sensorimtor impairments is essential to prompt early intervention and facilitate better integration into regular school settings.

Norsolorinic acid, isolated from the Aspergillus nidulans, was investigated for its anti-proliferative activity in human breast adenocarcinoma MCF-7 cells. To identity the anticancer mechanism of norsolorinic acid, we assayed its effect on apoptosis, cell cycle distribution, and levels of p53, p21/WAF1, Fas/APO-1 receptor, and Fas ligand. The results showed that norsolorinic acid induced apoptosis of MCF-7 cells without mediation of p53 and p21/WAF1. We suggest that Fas/Fas ligand apoptotic system is the main pathway of norsolorinic acid-mediated apoptosis of MCF-7 cells. Our study reports here for the first time that the activity of the Fas/Fas ligand apoptotic system may participate in the anti-proliferative activity of norsolorinic acid in MCF-7 cells.

Background: The Janus kinase-2 (JAK-2) V617F mutation has been recently reported in patients with myeloproliferative disorders (MPD), which is believed to underlie growth factor hypersensitivity displayed by haematopoietic progenitors in these disorders. However, its frequency has been rarely determined in Taiwanese patients. Methods: The frequency of JAK2-V617F mutation in patients with polycythaemia vera, essential thrombocythaemia and idiopathic myelofibrosis (IMF) was determined in the DNA from the peripheral blood leucocytes of 108 patients by genomic polymerase chain reaction and restriction enzyme-based assay. Results: The JAK2-V617F mutation could be detected in 28 of 33 polycythaemia vera patients (85%), 29 of 49 essential thrombocythaemia patients (59%) and 2 of 6 IMF patients (33%), but was not detected in 11 patients with myelodysplastic syndrome or another 10 with other haematological diseases. The presence of the JAK2 mutation was associated with specific MPD disease subtypes (P = 0.007), longer disease duration (P = 0.005), splenomegaly (P = 0.019), a higher white blood cell count (P = 0.002) and a higher haemoglobin level (P = 0.036). However, the overall risk of thrombosis or bleeding was not affected by the presence of the JAK2 mutation (32 vs 17%; P = 0.22). Conclusion: The JAK2-V617F mutation can be frequently detected in the Taiwanese patients with MPD disorders and therefore should be incorporated into the initial evaluation of patients suspected of MPD.

The correlations between D-dimer and Glasgow Coma Scale (GCS), pupillary light reflex, distance of midline shift on brain computed tomography (CT), and Glasgow Outcome Score (GOS) in patients with trauma/non-trauma intracranial hemorrhage (ICH) are not consistent in studies. Ninety-eight traumatic and 59 non-traumatic ICH patients were studied. Pre-existing venous thrombosis, recent surgery, drug use (aspirin or coumadin), or malignancy, were excluded. D-dimer level was estimated within hours after acute insult, and statistical analyses were used for comparisons between groups. Traumatic ICH patients had higher D-dimer levels than controls (2984 vs. 256 microg/l; P = 0.001). The GCS, midline shift on brain CT, pupillary reflex, and GOS at 3 months were significantly correlated with high D-dimer value in traumatic patients (individual P0.001), but not in the non-traumatic group. Using receiver-operating characteristic curve (ROC), the cutoff point was 1496 microg/l, with sensitivity and specificity of 100% and 83%, respectively. D-dimeror =1496 microg/l predicted a poor outcome [adjusted odds ratio (OR) 14.44, 95% CI 1.16-179.27; P = 0.038]. A high D-dimer level is associated with a poor outcome in patients with traumatic ICH. It can be used in addition to neurological assessment to predict the outcome.

Objective: To evaluate the validity of transcranial Doppler (TCD) in confirming brain death from various pathological conditions. Methods: An observational case–control study over a 2.5 year period, in which transcranial Doppler (TCD) examinations were done on 101 comatose patients for confirmation of brain death. Between October 2002 to May 2005, 44 clinically diagnosed brain death cases (29 male, 15 female; mean (SD) age, 46.5 (19.5) years; Glasgow Coma Scale (GCS) score, 3.0 (0.0)) and 57 controls (36 male, 21 female; age 48.1 (16.5) years; mean GCS, 4.9 (1.7)) were examined. Reverse diastolic flow, very small systolic spikes, or no signals were considered characteristic of cerebral circulatory arrest. Results: The sensitivity and specificity of TCD examination of both the basilar artery and the middle cerebral arteries (MCAs) in confirming brain death were 77.2% and 100%, respectively. The sensitivity of TCD-diagnosed brain death increased with elapsed time. There was a trend for the basilar artery to have greater sensitivity (86.4% v 77.2%), higher positive predictive value (90.5% v 85.1%), and fewer false negatives (14% v 23.7%) than the MCAs for diagnosing brain death (all NS). The consistency of the basilar artery and the MCAs for diagnosing brain death was significant (κ = 0.877, p

A 53-year-old woman with end-stage renal disease started hemodialysis (HD) because of diabetic nephropathy that had begun 3 years before. Over the course of 2 months, she intermittently presented blisters on both dorsal hands and forearms (Figure 1), which were exacerbated by sun exposure. In addition, her bilateral malar area showed hyperpigmentation and hypertrichosis (Figure 2). A skin biopsy taken from her left forearm revealed …

Hepatic artery (HA) occlusion is a sinister complication after liver transplantation. It frequently leads to graft loss if untreated. Urgent arterial reconstruction with thrombectomy may reduce the need for retransplantation. Living donor liver transplantation (LDLT) offers further challenges due to smaller-caliber vessels, shorter vascular stumps, and occasional multiple HA. Alternatives to the HA are needed when the native HA cannot be used or when HA complications develop. We describe the use of the recipient's ileocolic artery as an alternate HA in adult LDLT. Graft revascularization and timely salvage resulted in good patient recovery. A 6-month computed tomography angiography follow-up showed patency of the alternate vessels reconstructed.

Oxygen supplementation is given routinely to parturients undergoing Caesarean section under regional anaesthesia. While the aim is to improve fetal oxygenation, inspiring a high oxygen fraction (FIO2) can also increase free radical activity and lipid peroxidation in both the mother and baby. In this prospective, randomized, double-blind study, we investigated the effect of high inspired oxygen fraction (FIO2) on maternal and fetal oxygenation and oxygen free radical activity in parturients having Caesarean section under spinal anaesthesia.Forty-four healthy parturients were randomized to breathe either 21% (air group) or 60% oxygen (oxygen group) intraoperatively via a ventimask. Maternal arterial blood was collected at 5-min intervals from baseline until delivery, and umbilical arterial and venous blood was collected at delivery. We measured blood gases and the products of lipid peroxidation (8-isoprostane, malondialdehyde (MDA), hydroperoxide (OHP)) and purine metabolites.At delivery, the oxygen group had greater maternal arterial PO2 [mean 30.0 (SD 6.3) vs 14.2 (1.9) kPa; mean difference 15.8 kPa, 95% confidence interval 12.9-18.7 kPa, P0.001] and greater umbilical venous PO2 [4.8 (1.0) vs 4.0 (1.4) kPa; mean difference 0.8 kPa, 95% confidence interval 0.0-1.5 kPa, P=0.04] compared with the air group. Maternal and umbilical plasma concentrations of lipid peroxides (8-isoprostane, MDA, OHP) were greater in the oxygen group than in the air group (P0.05).We conclude that breathing high FIO2 modestly increased fetal oxygenation but caused a concomitant increase in oxygen free radical activity in both mother and fetus.

Clinical presentation of aortic dissection is similar to that of acute myocardial infarction (AMI). Clinical differential diagnoses from lethal chest pain in emergency department include AMI, aortic dissection, pulmonary embolism, tension pneumothorax, etc. Thrombolytic therapy for recanalization of thrombotic occluded coronary artery in AMI must be considered, but it is absolutely contraindicated for aortic dissection. However, AMI secondary to aortic dissection is a rare condition, which might be caused by compression of the coronary arteries by a hematoma or extension of the dissection into the coronary arterial wall. Surgery is the first choice for AMI secondary to aortic dissection caused by extension of dissection into the coronary arterial wall. We present a case of inferior wall AMI caused by type I aortic dissection with presentation of chest pain and hemiparaplegia of right lower limb.