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Those who are challenged by dependency on prescription drugs or suffer drug addictions have few options available to them for recovery, such as psychotherapy and physiotherapy. Here we present a new approach with clinical examples involving stimulant addiction or overdose of hypnotic drugs that were received BIOCERAMIC Resonance, which was developed based on concept of 12 meridian channels of traditional Chinese medicine, and has successful withdrawal or dose reduction benefits. We describe the whole process and the clinical outcome. And by help of our previous publication on functional MRI, we discuss the possible brain locations response to BIOCERAMIC Resonance that may be corresponding to the beneficial effects of relief of depression, sleep deprivation and other mental symptoms that associate with substance abuse and withdrawal effects. We suggest this could be potentially widely application on substances abuse., Graphical abstract Image 1

Low-molecular-weight hyaluronic acid (LMWHA) was integrated with superparamagnetic Fe3O4 nanoparticles (Fe3O4 NPs). The size distribution, zeta potential, viscosity, thermogravimetric and paramagnetic properties of the LMWHA-Fe3O4 NPs were systematically examined. For cellular experiments, MCF7 breast cancer cell line was carried out. In addition, the cell targeting ability and characteristics of the LMWHA-Fe3O4 NPs for MCF7 breast cancer cells were analyzed using the thiocyanate method and time-of-flight secondary ion mass spectrometry (TOF-SIMS). The experimental results showed that the LMWHA-Fe3O4 NPs were not only easily injectable due to their low viscosity, but also exhibited a significant superparamagnetic property. Furthermore, the in vitro assay results showed that the NPs had negligible cytotoxicity and exhibited a good cancer cell targeting ability. Overall, the results therefore suggest that the LMWHA-Fe3O4 NPs have considerable potential as an injectable agent for enhanced magnetic resonance imaging (MRI) and/or hyperthermia treatment in breast cancer therapy.

Objective To report our experiences with 40 patients who were treated with magnetic resonance-guided focused ultrasound surgery (MRgFUS) for uterine fibroids and their 6-month follow-up status. Materials and Methods A total of 40 patients with uterine fibroids underwent MRgFUS from January 2009 to November 2011. The Uterine Fibroid Symptoms and Quality of Life Questionnaire was used to determine the patients' Symptom Severity Scores (SSS) prior to and 6 months after treatment. The nonperfused volume (NPV) values and NPV ratio were obtained immediately at the end of the treatment and at 6 months follow-up. Results No procedure-related complications were noted throughout the 6-month follow-up period among the 40 patients who underwent MRgFUS for uterine fibroids. The mean reduction in SSS in our patients after 6 months was 43.7%, and the mean reduction of fibroid volume was 31.7%. In addition, the mean reduction of NPV and mean NPV ratio was 52.7% and 33.3%, respectively. Conclusion The results obtained from this study demonstrated that MRgFUS can be safely and effectively used to ablate uterine fibroids to produce a significant decrease in mean fibroid volume and improve SSS for up to 6 months after treatment.

Background: Galectin-3 (Gal-3) shows the ability of survival prediction in heart failure (HF) patients. However, Gal-3 is strongly associated with serum markers of cardiac extracellular matrix (ECM) turnover. The aim of this study is to compare the impact of Gal-3 and serum markers of cardiac ECM turnover on prognostic prediction of chronic systolic HF patients. Methods: Serum Gal-3, brain natriuretic peptide (BNP), extracellular matrix including type I and III aminoterminal propeptide of procollagen (PINP and PIIINP), matrix metalloproteinase-2, 9 (MMP-2, 9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were analyzed. Cox regression analysis was used for survival analysis. Results: A total of 105 (81 male) patients were enrolled. During 980±346 days follow-up, 17 patients died and 36 episodes of HF admission happened. Mortality of these patients was significantly associated with the log PIIINP (β= 15.380; P=0.042), log TIMP-1(β= 44.530; P=0.003), log MMP-2 (β= 554.336; P

Introduction Recent advances in the treatment of NSCLC highlight the importance of distinguishing NSCLC subtypes and genotypes. We aimed to determine whether histological specimens obtained from computed tomography (CT)-guided biopsy are suitable for specific subtyping and epidermal growth factor receptor ( EGFR ) analyses of NSCLC. Patients and Methods The clinicohistological data of 332 consecutive patients undergoing 352 CT-guided biopsies for lung lesions between January 2007 and December 2011 were retrospectively analyzed. Additionally, NSCLC specimens were examined for the suitability of EGFR mutational testing. Results Of 209 specimens diagnosed as NSCLC, 197 (94.3%) were specifically subtyped into adenocarcinoma (n = 164; 78.5%), squamous cell carcinoma (n = 27; 12.9%) and other subtypes (n = 6; 2.9%). The rate of NSCLC not otherwise specified (NOS) was 5.7%, and the diagnosis of NSCLC-NOS was significantly associated with the poor differentiation of cancer (adjusted odds ratio, 6.17; 95% confidence interval, 1.62-23.55; P = .008). Of 134 histological tumor specimens submitted for EGFR molecular testing, 132 (98.5%) were suitable for analyses, and 130 of them (98.5%) showed conclusive results, revealing 59.8% (n = 79) with EGFR exon mutation(s). The sensitivity, specificity, and positive and negative predictive values of CT-guided biopsy in patients with malignancy were 92.2%, 100%, 100%, and 74.1%, respectively. Six percent (n = 21) of total lung biopsies led to pneumothorax requiring chest drainage, and no procedure-related fatality was observed. Conclusion Small tumor specimens obtained with CT-guided needle lung biopsy are suitable for specific subtyping and EGFR analyses of NSCLC, thus providing critical information for personalized therapy.

MRI provides a highly sensitive technique for early detection of abnormal breast tissue. It is useful for identifying a status of proliferation, angiogenesis, and microvascular permeability, which may indicate early breast neoplasm formation. We retrospectively studied 2005 breast MRI images from Taiwanese women and classified them as either healthy or unhealthy according to BI-RADS categories. A subgroup of our study patients had received estrogen supplements, containing estrogen components or phytoestrogen, for at least 3 months. These patients’ images were also classified into the healthy and unhealthy groups. These two groups were compared and a significant difference was found between them (P

// Yen-Tin Lin 1,* , Yen-Hung Lin 2,5,* , Xue-Ming Wu 1 , Chi-Lun Ko 3 , Ruoh-Fang Yen 3 , Ying-Hsein Chen 2 , Ron-Bin Hsu 4 , Chi-Ming Lee 2 , Shoei-Shen Wang 4 , Ming-Fong Chen 2,6 and Yen-Wen Wu 2,3,7,8 1 Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan 2 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 3 Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 4 Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 5 Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA 6 Cardiovascular Research Laboratory, Cardiovascular Center, Clinical Outcome Research and Training Center, Big Data Center, China Medical University Hospital, China Medical University, Taichung, Taiwan 7 Cardiology Division of Cardiovascular Medical Center, Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan 8 National Yang-Ming University School of Medicine, Taipei, Taiwan * These authors have contributed equally to this work Correspondence to: Yen-Wen Wu, email: // Keywords : fibrosis; restrictive filling; ventriculography Received : October 04, 2016 Accepted : November 24, 2016 Published : December 04, 2016 Abstract Myocardial fibrosis leads to a restrictive diastolic filling pattern of the left ventricle which is associated with a poor prognosis in patients with heart failure. We investigated the relationship between cardiac fibrosis and restrictive filling pattern of the left ventricle measured by Tc99m left ventriculography in patients with chronic symptomatic heart failure. Serum cardiac extracellular matrix markers including type I and III aminoterminal propeptide of procollagen (PINP and PIIINP), matrix metalloproteinase-2,9 (MMP-2,9), and tissue inhibitor of MMP-1 (TIMP-1) were analyzed. Fifty-one (39 males) patients were enrolled. Their median age was 51.8 years, and median left ventricular ejection fraction was 31.9%. Time to peak filling rate of the left ventricle was significantly correlated with serum levels of the three cardiac extracellular matrix markers (TIMP-1, PIIINP, and MMP-2). The patients with a restrictive diastolic filling pattern of the left ventricle (time to peak filling rate ≤ 154 ms) had significantly higher levels of these extracellular matrix markers. In receiver operating characteristic curve analysis, areas under the curve of PIIINP, TIMP-1, and MMP-2 were 0.758, 0.695, and 0.751 to predict the presence of a restrictive pattern. In C -statistics, all three cardiac extracellular matrix markers significantly increased the area under the curve after adding creatinine. In net reclassification improvement and integrated discrimination improvement models, PIIINP and MMP-2 significantly improved the predictive power of age, creatinine and brain natriuretic peptide. In conclusion, serum extracellular matrix markers are significantly correlated with restrictive diastolic filling pattern of the left ventricle in patients with heart failure.

Background Breast magnetic resonance imaging (MRI) is extremely sensitive for detecting lesions, but certain characteristics of malignancies, such as the washout pattern of kinetic curves, are not specific. Correlations of false-positive MRI and specific pathological results are worthy of study. Methods From March 2008 to September 2011, 217 cases received biopsy after dedicated breast MRI in our department. Biopsies were recommended for suspected malignancies based on the overall analysis of early subtracted phase images, postenhanced curve patterns, color mapping, and tumor morphology. Results Twenty-nine percent of cases were false positive for malignancy, according to MRI. These lesions included radial scar, apocrine metaplasia, atypical ductal hyperplasia, sclerosing adenosis, intraductal papilloma, fibrocystic change, and mastitis. Conclusion The ability of tumor cells to induce vascularization occurs early in the cell transformation process; therefore, premalignant breast lesions may also induce vascularization to facilitate malignant transformation. As a noninvasive method, contrast-enhanced MRI has a potential role in estimating the degree of angiogenesis and tumor microvascular permeability of breast neoplasms.

Objective This study was to investigate the usefulness and limitations of cardiac magnetic resonance imaging (MRI). We compared echocardiography (ECHO) and perfusion scans to evaluate: left ventricular wall scar formation of the myocardium; hypokinesis, akinesis, or dyskinesis of the myocardium; regurgitation of the aortic and mitral valves; post acute myocardial infarction (AMI) ventricular function; and the viable myocardium (ischemia/infarction). Methods Twenty patients received both cardiac MRI and ECHO. Among them, nine patients received perfusion scans. The modalities and methods examined in this study were not the most advanced or updated protocols. Results We compared the results of cardiac MRI with those of ECHO and perfusion scans. We found significant correlations between the interpretations of left ventricular wall morphological change with dynamic images for hypokinesia, akinesia, and dyskinesia of the myocardium. We also found possible correlations between cardiac MRI and perfusion scans regarding their results to produce a “bull's eye target figure” to evaluate severe ischemia and infarctions. Conclusion We found that cardiac MRI provided a useful adjunct to ECHO on interpretations of left ventricular wall morphological change. The correlations between qualitative interpretations of cardiac MRI versus perfusion scan respective to ‘bull's eye target figures’, were found to be moderately matching. There was an unsatisfactory mismatching of correlations between quantitative by manual input and the drawing inaccuracy and an unavoidable error of the post-processing technique of cardiac MRI on ejection fraction (EF) and end systolic volume (ESV).

Eur J Clin Invest 2012; 42 (10): 1079–1086 Abstract Objectives The goal of this study was designed to assess prognostic values of simultaneous measurement of adipocytokines in systolic heart failure (HF) patients. Methods Patients with HF manifestations and left ventricular ejection fraction (LVEF) ≤ 50% were selected in this study. Gender, age, medications and serum biochemical data were recorded upon admissions. Adipocytokines including adiponectin, leptin, resistin, visfatin and retinol binding protein-4 were measured. Results A total of 108 (83 males and 25 females) patients were enroled. The age was 62 ± 15 years and mean LVEF was 35%. Twenty patients died during 776 ± 323 days follow-up. In univariate analysis, mortality was found to be associated with the log-transformed values of serum resistin (β = 5·616, P = 0·04), log-transformed values of serum adiponectin (β = 4·377, P = 0·038), age (β = 1·071, P

Background The 64-multidetector computed tomography (64-MDCT) has developed into a mature clinical tool to detect coronary artery disease. This 64-MDCT system permits cross-sectional and longitudinal imaging of the coronary arteries with a high spatial and temporal resolution. However, small vessels, side branches and the distal portions of the main coronary arteries are not always optimally visualized. Purpose The aim of this study was to evaluate the effect of nitroglycerin (NTG) on lumen diameters and the number of visualized side branches of the coronary arteries on 64-MDCT. We also assessed whether NTG would affect the quality of the images of the coronary arteries obtained by 64-MDCT. Methods Sixty-seven patients were randomized and divided into two groups: Group C (31 patients, no sublingual NTG) and Group N (36 patients, sublingual NTG given before the scan). We measured the lumen diameter of the coronary artery and visibility of the side branches by using the 64-MDCT system and also evaluated the image quality by using the scores. Results The cardiac 64-MDCT images of these patients showed that the average diameters of the proximal segments in the right coronary artery, left main artery, left anterior descending coronary artery, and left circumflex coronary artery were 4.1 ± 0.7 mm, 3.9 ± 0.6 mm, 3.6 ± 0.7 mm, and 3.4 ± 0.6 mm, respectively, in Group N and 3.0 ± 0.5 mm, 3.1 ± 0.6 mm, 2.8 ± 0.5 mm, and 2.7 ± 0.5 mm, respectively in Group C. In addition, the scores for visibility and image quality for the side branches in Group N were significant higher than for those in Group C. Conclusion Our study indicates that CT coronary angiography using 64-MDCT with NTG administration produces images of diagnostically acceptable quality in all coronary segments. Thus, NTG might be recommended for routine 64-MDCT coronary angiography examinations.

Background/Purpose The incidence of breast cancer in Taiwan is increasing, and this form of cancer has already become the number one malignancy. Taiwanese women share similar characteristics of breast cancer with other developed Asian countries such as a younger age at diagnosis. In addition, a large proportion of Asian women have dense glandular breast tissue, which lowers the sensitivity of mammography for cancer detection. In this study, we compared possible differences in image interpretation of digital mammography and a dedicated breast magnetic resonance imaging system (using spiral RODEO). Methods From March 2008 to April 2009, we retrospectively collected data on 106 Taiwanese women who received both digital mammography and dedicated breast magnetic resonance imaging examinations in the same period. We divided these cases into non-dense and dense groups according to breast density, and compared the image interpretations based on the different modalities. Results There were statistically significant differences (p Conclusion Mammography may be useful for screening in non-dense breast tissue, but breast magnetic resonance imaging should be an additional screening tool in populations with dense breast tissue.

We evaluated bilateral femoral neck bone mineral densities (FNBMDs) in 32 men with poliomyelitis and their matched controls. Men with poliomyelitis had significantly lower FNBMD in both legs, and FNBMD was lowest in their shorter legs. Knee extensor strength and regular exercise were important predictive factors associated with decreased FNBMD.People with poliomyelitis (polio) are prone to leg fractures after mild trauma. The flaccid paralysis, asymmetric involvement, and underdeveloped growth of afflicted legs may lead to osteoporosis of either leg, characterized by different patterns. This study aimed to measure their femoral FNBMD and to explore the factors associated with changes in FNBMD in either leg.We did a prospective study to evaluate bilateral FNBMD with dual-energy X-ray absorptiometry in 32 men with polio (age range, 41-57 years; mean, 47 years) and 32 age- and body mass index-matched controls. Measuring the difference in leg length, we classified the legs of each polio subject as "longer" or "shorter." In addition, we chose the right leg of each control as a reference leg. We then used the Mann-Whitney U test to compare FNBMD of these three groups of legs and searched for the factors associated with FNBMD using stepwise multiple regression analyses.Compared to the reference leg, men with polio had significantly lower FNBMD in both their longer and shorter legs, by 13% and 23%, respectively. The difference in FNBMD between the two legs of polio subjects was significant. Knee extensor strength and regular exercise were two important factors associated with bilateral FNBMD in men with polio.Men with polio had lower bilateral FNBMD. FNBMD of the shorter leg should be the choice for predicting the risk of hip fracture in men with polio because on average, the shorter leg has lower BMD.

To perform risk stratification by serum adipocytokines and serum markers of extracellular matrix in heart failure patients with high b-type natriuretic peptide (BNP).Patients with heart failure were enrolled in this study. Serum adipocytokines and serum markers of extracellular matrix were analyzed.In total, 131 patients were enrolled and followed-up for 240+/-174 days. Mortality was significantly associated with adiponectin, resistin, type III amioterminal propeptide of procollagen (PIIINP), matrix metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinase 1 (TIMP-1), and serum creatinine. Heart failure-related admission was significantly associated with apelin, and PIIINP. Cox regression analysis identified that mortality and heart failure-related admissions were significantly associated with MMP-2 (P=0.008) and PIIINP (P=0.011), respectively.Serum markers of extracellular matrix rather than adipocytokines may warrant further risk stratification for impacting the prognosis of patients with heart failure with high BNP.

The aim of this study was to develop a cell-based bone-regeneration approach evaluated by molecular imaging and immunohistochemistry. Methods: Genetically modified NIH3T3 embryonic fibroblasts carrying enhanced green fluorescent protein (NIH3T3-G) were predifferentiated into osteoblastlike cells using platelet-rich plasma (PRP) medium, followed by intraosseous transplantation into ovariectomized senescence-accelerated mouse prone substrain 8 (OVX-SAMP8 mice). Results: PRP-conditioned NIH3T3-G (PRP/NIH3T3-G) engraftment prevented the development of osteoporosis. Molecular imaging and immunohistochemistry demonstrated the migration of NIH3T3-G cells from the implantation site throughout the skeleton. In situ analyses revealed coexpression of osteopontin and green fluorescent protein in the newly formed bone tissue, demonstrating that the transplant restored the bone trabecular architecture and mineral density in treated OVX-SAMP8 mice. Interestingly, the life span of OVX-SAMP8 mice receiving PRP/NIH3T3-G transplantation was significantly prolonged and similar to that of the congenic senescence-resistant strain of mice. Conclusion: This unique and yet simple approach could potentially be applied to the treatment of senile postmenopausal osteoporosis and perhaps inborn genetic syndromes associated with accelerated aging, such as Hutchinson–Gilford progeria syndrome, and for the prolongation of life expectancy in general.

Reported herein is the case of a 35-year-old multipara woman diagnosed (on sonography) with total placenta previa that had ruptured through the myometrium of the uterus, invading the wall of the urinary bladder. In the 32nd week of gestation the patient underwent an emergency cesarean section due to profuse vaginal bleeding. Due to possible intraoperative massive bleeding during removal of the placenta it was decided to preserve the uterus and placenta temporarily. The patient underwent superselective trans-uterine embolization through the bilateral anterior branches of the hypogastric arteries, using gelfoam cubes and coils. Two days later cesarean hysterectomy was performed, and the placenta was successfully removed from the invaded urinary bladder. The whole procedure went smoothly and the estimated blood loss was only 1300 mL.

DNA topoisomerase I (TOP1) levels of several human neoplasms are higher than those of normal tissues. TOP1 inhibitors are widely used in treating conventional therapy-resistant ovarian cancers. However, patients may develop resistance to TOP1 inhibitors, hampering chemotherapy success. In this study, we examined the mechanisms associated with the development of camptothecin (CPT) resistance in ovarian cancers and identified evodiamine (EVO), a natural product with TOP1 inhibiting activity that overcomes the resistance. The correlations among TOP1 levels, cancer staging, and overall survival (OS) were analyzed. The effect of EVO on CPT-resistant ovarian cancer was evaluated in vitro and in vivo. TOP1 was associated with poor prognosis in ovarian cancers (p = 0.024). EVO induced apoptosis that was detected using flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. The tumor size decreased significantly in the EVO treatment group compared with the control group (p < 0.01) in a xenograft mouse model. Effects of drugs targeting TOP1 for prognosis and therapy in CPT-resistant ovarian cancer are anticipated. EVO with TOP1 can be developed as an antiproliferative agent for overcoming CPT resistance in ovarian cancers.

Twenty-two consecutive patients with a continuous ambulatory peritoneal dialysis (CAPD) catheter malfunctioning due to catheter migration were treated with a novel radiological manipulation technique, the “double guidewire method.” The first guidewire is used to correct the direction of the catheter tip and the second wire is used to anchor the CAPD catheter so that an ideal course of the catheter can be maintained during removal of the first guidewire. Immediate catheter repositioning was achieved in 19 of 22 patients, and durable repositioning success was achieved in 13 patients. In conclusion, the “double guidewire method” is a simple but effective technique for prolonging CAPD catheter life in patients with malfunction due to catheter migration.

Objective Dyslipidemia with higher inflammatory states, disease activity, and longer disease duration in juvenile idiopathic arthritis (JIA) patients seemed to increase the risks of atherosclerosis. Tumor necrosis factor- α (TNF-α) receptor blocking agent etanercept has been proven to be effective in JIA. However, data about the correlation of anti-inflammatory treatment on lipid profiles and atherogenic index in JIA patients remains limited. This study aimed to investigate the longitudinal changes on lipid profiles and atherogenic index in JIA patients after etanercept treatment. Methods Twenty-three patients diagnosed with JIA (polyarticular type n = 7; oligoarticular type, n = 2; systemic type, n = 10, Enthesitis-related arthritis = 4) received treatment with etanercept during the period 2004–012 in a medical center. We measured their serum lipid profiles at baseline and 2, 4, 6, 12 months later, and determined whether there were differences in complete blood counts, inflammatory mediators, lipid levels and atherogenic indices between patients who had inactive disease (responders) and those who were poor responders (non-responders) to etanercept treatment. Results Analysis of dynamic change in total JIA patients before and after TNF inhibitor therapy showed modest increases in hemoglobin levels (P = 0.02) and decreases in WBC counts, Platelet and CRP levels progressively (p = 0.002, p = 0.006 and p = 0.006, respectively).Twelve of the 23 patients achieved inactive disease status (responders) after 12-months of treatment. In responders, compared to non-responders, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) increased significantly (P = 0.007,P = 0.044,P

Objective : To determine the clinical usefulness of computed tomography (CT) angiography in the evaluation of cerebral aneurysms. Materials and Methods : From October 1994 through April 1996, 26 patients with 30 surgical proven intracranial aneurysms underwent both CT angiography and catheter cerebral angiography. The findings of the two methods were reviewed independently and then compared with each other. Results : Comparing with catheter angiography, CT angiography was superior in demonstrating the aneurysmal neck in seven aneurysms but was inferior in one. The thrombosed part and calcification of aneurysms were clearly demonstrated on CT angiograms. CT angiography also aided in differentiating tight vascular loops from aneurysms. On CT angiograms, one posterior communicating arterial aneurysm was overlooked and another anterior choroidal artery aneurysm was misinterpreted as a posterior communicating artery aneurysm. Of note were two patients in whom the infundibulum of the orbitofrontal artery was misinterpreted as the anterior communicating artery aneurysm. Conclusion : CT angiography can compliment conventional catheter angiography for its better demonstration of the 3-dimensional anatomy. It can provide surgical information about the neck, calcification and thrombosed part of an aneurysm and its relation to adjacent structures. However, caution is advocated because CT angiography may fail to demonstrate small but important vessels such as posterior communicating, anterior choroidal and orbitofrontal arteries. Recognition of the limitations of CT angiography is important in minimizing interpretation errors.

We present a case of giant superior mesenteric artery (SMA) aneurysm in a patient with systemic lupus erythematosus (SLE). The ultrasound, computed tomography, magnetic resonance, and angiographic findings are discussed. To our knowledge, SLE associated with a giant SMA aneurysm as a late complication of previous lupus mesenteric arteritis has not been reported previously.

A 50-year-old man who had chronic peptic ulcer disease with an early-stage squamous cell carcinoma in the lower third of the esophagus. The primary tumor was not visualized on an FDG-PET study. However, a paraaortic lymphnode metastasis in the upper abdomen was demonstrated in this initial staging. The patient underwent an operation at another hospital. The postoperative staging was classified as stage I (T1N0M0: tumor invasion limited to submucosa, no regional lymph node metastasis 0/47, no distant metastais). One year later, a protruding firm mass developed over the sternum. Follow-up FDG-PET showed foci with intense activity in the sternal and epigastric regions. Although conventional MDP bone scan did not clearly show the lesion, an osteolytic skeletal metastasis to the sternum and progressive enlargement of the metastatic paraaortic lymph node were identified by PET.

Alzheimer's disease is primarily characterized by neurofibrillary tangles, senile plaques, and neurodegeneration. The major component of senile plaques is the beta-amyloid peptide (beta A4), which has been shown to be toxic to neurons in vitro. To date, the mechanism of beta A4-induced neurotoxicity has not been determined in human-derived neurons. In this report, we present evidence that programmed cell death, or apoptosis, is involved in the neurotoxic activity of beta A41-40 and beta A425-35 in the human-derived neurotypic cell line SH-SY5Y cells. The evidence for beta A4-induced apoptosis includes: (1) labeling of cell nuclei for DNA nicked ends; (2) morphological changes in ultrastructure that are consistent with apoptosis (shrunken cells with pyknotic nuclei); (3) DNA laddering which can be blocked by aurintricarboxylic acid (ATA), an inhibitor of apoptosis; and (4) marginal release of intracellular lactate dehydrogenase (LDH), an indicator of necrosis. These results suggest that apoptosis is the major event involved in beta A4-induced cytotoxicity in SH-SY5Y cells. A variety of reagents were tested to determine their activities against beta A4-induced DNA laddering. Nerve growth factor and free radical scavengers were inactive in this system. While ATA blocked DNA laddering resulting from either beta A4 or okadaic acid treatment, Congo red specifically attenuated only beta A4-induced DNA fragmentation. These results suggest that compounds which bind fibrillar beta-peptides can protect this human neurotypic cell line against apoptosis induced by beta A4.

We report a patient with a solitary spinal neurofibroma in the posterior mediastinum interpreted as a metastatic tumor. A 46-year-old female with rectal cancer who had undergone operation and subsequent adjuvant chemotherapy two years previously was referred to our department for a follow-up whole body FDG-PET study. PET scan revealed a mass with increased uptake of FDG (SUV = 4.6) in the posterior mediastinum. MRI examination showed a dumbbell neurogenic tumor originating from the intercostal nerve at T6 level. A subsequent CT-guided biopsy demonstrated a neurofibroma.

Ceramic materials with biological effects (bioceramic) have been found to modulate various biological effects, especially those effects involved in antioxidant activity and hydrogen peroxide scavenging. As arthropathy and osteopathy are the major chronic diseases of geriatric medicine, we explored the possible activity of bioceramic on these conditions using animal and cell models. Rabbits received intra-articular injections of lipopolysaccharides (LPS) to induce inflammation that mimic rheumatic arthritis. FDG isotopes were then IV injected for PET scan examinations at 16 hours and 7 days after the LPS injection. We examined and compared the bioceramic and control groups to see if bioceramic was capable of relieving inflammation in the joints by subtracting the final and initial uptake amount of FDG (max SUV). We studied the effects in prostaglandin E2 (PGE2) inhibition on the human chondrosarcoma (SW1353) cell line, and the effects on the murine osteoblast (MC3T3-E1) cell line under oxidative stress. All the subtractions between final and initial uptakes of FDG in the left knee joints of the rabbits after LPS injection indicated larger decreases in the bioceramic group than in the control group. This anti-arthritic or inflammatory effect was also demonstrated by the PGE2 inhibition of the SW1353 cells. We further proved that bioceramic treatment of the MC3T3-E1 cells resulted in increased viability of osteoblast cells challenged with hydrogen peroxide toxicity, and increased alkaline phosphatase activity and the total protein production of MC3T3-E1 cells under oxidative stress. Since LPS-induced arthritis is an experimental model that mimics RA, the potential therapeutic effects of bioceramic on arthropathy merit discussion. Bioceramic may contribute to relieving inflammatory arthritis and maintaining bone health.

PURPOSE: Heart failure (HF) had been reported with increased risk of hip fractures. However, the relationship between circulating biomarkers and bone mineral density (BMD) in chronic HF remained unclear. METHODS: This is a cross-sectional study which recruited stable chronic HF from registry of the Heart Failure Center of National Taiwan University Hospital. Patients underwent dual-energy x-ray absorptiometry (DEXA) measurements at hip and lumbar spines and biochemical assessments including B-type natriuretic peptide (BNP-32), myostatin, follistatin and osteoprotegerin (OPG). RESULTS: A total of 115 stable chronic HF individuals with left ventricular ejection fraction (EF)

The neurotransmitter glutamate is the primary excitatory neurotransmitter in mammalian brain and is responsible for most corticocortical and corticofugal neurotransmission. Disturbances in glutamatergic function have been implicated in the pathophysiology of several neuropsychiatric disorders—including schizophrenia, drug abuse and addiction, autism, and depression—that were until recently poorly understood. Nevertheless, improvements in basic information regarding these disorders have yet to translate into Food and Drug Administration–approved treatments. Barriers to translation include the need not only for improved compounds but also for improved biomarkers sensitive to both structural and functional target engagement and for improved translational models. Overcoming these barriers will require unique collaborative arrangements between pharma, government, and academia. Here, we review a recent Institute of Medicine–sponsored meeting, highlighting advances in glutamatergic theories of neuropsychiatric illness as well as remaining barriers to treatment development., National Institute of Mental Health (U.S.) (grant R37MH49334), National Institute of Mental Health (U.S.) (Intramural Research Program), National Institute of Mental Health (U.S.) (R01DA03383), National Institute of Mental Health (U.S.) (P50MH086385), National Institutes of Health (U.S.), FRAXA Research Foundation, Howard Hughes Medical Institute, Simons Foundation

Lithospermic acid B, an active principle found in a Chinese herbal medicine for treating various heart ailments, was recently isolated, purified and demonstrated by us to salvage the postischemic rabbit heart from reperfusion injury. In this work, we further report that lithospermate B is able to protect each of two types of rabbit cardiocytes, namely ventricular myocytes and aortic endothelial cells against necrosis inflicted by oxyradicals generated pharmacologically with xanthine oxidase and hypoxanthine. Biochemically, the lithospermate B also inhibits the reduction of cytochrome c by superoxide radical anion. Thus, our in vitro data here are in concord with our earlier in vivo finding that lithospermic acid B is most likely an effective antioxidant-based myocardial protector.

Chang K-H, Lai C-H, Chen S-C, Hsiao W-T, Liou T-H, Lee C-M. Body composition assessment in Taiwanese individuals with poliomyelitis. Objectives To measure the changes in the total and regional body fat mass, and assess the clinical usefulness of the body mass index (BMI) in detecting overweight subjects with sequelae of poliomyelitis. Design Prospective, cross-sectional study. Setting General community. Participants Subjects with poliomyelitis (n=17; age range, 42–57y; mean, 47y; 12 men, 5 women) and able-bodied people (n=17) matched by sex, age, body weight, and body height participated in the study. Interventions Not applicable. Main Outcome Measures Total and regional body composition was measured with dual-energy x-ray absorptiometry. Clinical characteristics such as blood pressure, serum biochemical studies, and habitual behaviors (daily cigarette smoking, alcohol consumption, and exercise regimen) of all participants were evaluated. Results Compared with able-bodied controls, subjects with poliomyelitis had a 50% greater total body fat mass, significant increases in the regional fat mass in every part of the body, and had the greatest increase of fat mass in the thorax. Nearly all the subjects (94%) with poliomyelitis were obese according to standards of body composition. However, one third of them had a BMI value of less than 25.0kg/m 2 . Conclusions People with poliomyelitis have a higher prevalence of obesity and a significant increase in total and regional fat mass. Current BMI underestimates the total body fat mass percentage compared with the control; therefore, a population-specific BMI should be used to address the prevalence of obesity in postpolio survivors.

Background: Cardiac extra-cellular matrix (ECM) fibrosis plays an important role in the pathophysiology of heart failure (HF). It may provide electrical heterogeneity and a substrate for arrhythmogenicity, which may cause sudden cardiac death (SCD). Methods: Twenty-one patients with manifestations of HF and a left ventricular ejection fraction (LVEF) ≤50% were enrolled. The median age was 62 years and median LVEF was 33%. Time- and frequency-domain analysis of heart rate variability (HRV) on 24 h ambulatory electrocardiography recording was assessed. Serum markers of ECM turnover including type I and III aminoterminal propeptide of procollagen (PINP and PIIINP), matrix metalloproteinase-2 and -9 (MMP-2 and MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were analyzed. Results: The serum PIIINP concentration was correlated significantly with standard deviation of all normal to normal R-R intervals (SDNN) (r=–0.722, p=50 ms (pNN50) (r=–0.528, p=0.014), percentage of adjacent NN interval differences >20 ms (pNN20) (r=–0.545, p=0.002), very low frequency (VLF) (r=–0.490, p=0.024), low frequency (LF) (r=–0.491, p=0.024), and high frequency (HF) (r=–0.513, p=0.018). PINP, MMP-2, -9, TIMP-1 were not correlated with time- and frequency-domain analysis of HRV. Conclusions: PIIINP was significantly correlated with time- and frequency-domain analysis of HRV in HF patients. PIIINP is a potential serological marker to evaluate cardiac autonomic control and risk of SCD in HF patients. Clin Chem Lab Med 2010;48:1821–7.

[Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] The short-term outcomes and feasibility of modular stent-graft implantation for abdominal aortic aneurysm (AAA) have been demonstrated. However, the long-term outcomes remained to be observed. A 69-year-old man presented to our

Background/purposeThe influence of home- and clinic-based caring system on the economic burden of heart failure remains unknown.MethodsBetween January 2004 and December 2004, chronic heart failure patients who were followed up by specialist nurse-led telephone visiting regularly were enrolled. Clinical and economic data half a year before enrollment were collected as control.ResultsA total of 247 patients (168 males, 79 females; mean age, 60 ± 17 years) were enrolled. The mean follow-up period was 139 ± 96 days. The mean left ventricular ejection fraction was 35%. There were 1618 times of specialist nurse-led telephone visiting (average 8 ± 6 times/patient). The mortality rate was 5.7%. Before enrollment, the total hospitalization fees were US$624,020. After enrollment, the cost was reduced to US$362,722 (41.8% reduction). The mean functional class (New York Heart Association) also improved from 2.27 ± 0.80 to 1.96 ± 0.90 (p < 0.001). The mean duration of hospital stay due to heart failure was reduced by 5.3 days (26.2% decrement). The total numbers of admission were reduced to 36 times (33.0% decrement). The readmission rate due to etiologies other than heart failure (such as infection, gastrointestinal bleeding, etc.) was reduced from 15.9% to 7.7%. The total fees of visiting emergency station were reduced from US$6528 to US$6101 (6.5% decrement). On the other hand, the frequency of visiting the outpatient department (OPD) increased from 5.2 ± 3.2 to 6.6 ± 4.1 times/patient (p < 0.001). The total fees of visiting OPD increased from US$90,783 to US$94,855 (4.4% increment).ConclusionThe home- and clinic-based caring system is capable of decreasing adverse outcomes, most notably hospitalization and length of stay, and could trigger significant cost savings in the management of heart failure. [J Formos Med Assoc 2007;106(4):313-319]

We report a case of gastrointestinal stromal tumor (GIST) of the prostate in a 75-year-old man with dysuria and urinary retention. Digital rectal examination revealed a markedly enlarged prostate. The serum level of prostate-specific antigen was 0.2 ng/dL. Imaging studies showed an expanded prostate, measuring 6.7 x 5.6 x 5.5 cm, with heterogeneity in contrast enhancement. No metastatic disease was found. The pathologic diagnosis of prostatic GIST was made based on characteristic morphological features, immunoprofiles, and molecular analysis. The possibility of secondary involvement by a rectal GIST was excluded by radiological and intraoperative findings. To our knowledge, this is the second case of a primary GIST of the prostate reported in the literature.

AIM: Acute pancreatitis (AP) is a process with variable involvement of regional tissues or organ systems. Multifactorial scales included the Ranson, Acute Physiology and Chronic Health Evaluation (APACHE II) systems and Balthazar computed tomography severity index (CTSI). The purpose of this review study was to assess the accuracy of CTSI, Ranson score, and APACHE II score in course and outcome prediction of AP. METHODS: We reviewed 121 patients who underwent helical CT within 48 h after onset of symptoms of a first episode of AP between 1999 and 2003. Fourteen inappropriate subjects were excluded; we reviewed the 107 contrast-enhanced CT images to calculate the CTSI. We also reviewed their Ranson and APACHE II score. In addition, complications, duration of hospitalization, mortality rate, and other pathology history also were our comparison parameters. RESULTS: We classified 85 patients (79%) as having mild AP (CTSI

Chronic pancreatitis is a relatively common disease. We encountered two different cases of belatedly demonstrated pancreatic carcinoma featuring underlying chronic pancreatitis. The first case was one that was highly suspected as that of a malignancy based upon imaging study, but unfortunately, it could not be confirmed by intra-operative cytology at that time. Following this, the surgeon elected to perform only conservative bypass surgery for obstructive biliary complication. Peritoneal carcinomatosis was later noted and the patient finally died. The second case, a malignant mucinous neoplasm, was falsely diagnosed as a pseudocyst, based upon the lesion’s sonographic appearance and associated elevated serum amylase levels. After suffering repeated hemoptysis, the patient was found to exhibit lung metastasis and peritoneal seeding. We reviewed some of the literature, including those studies discussing chronic pancreatitis predisposing to a malignant change. These two case analyses illustrate clearly that the diagnosis for such conditions, which is simply based upon imagery or pathological considerations may end up being one of a mistaken malignancy. Some of our suggestions for the treatment of such malignancies as revealed herein include, total pancreatomy for univocal mass lesion, and needle aspiration of lesion-contained tissue for amylase, CA199 and CEA levels for a suspicious cystic pancreatic mass.

Of 5% of patients who develop liver cysts, only 10-15% of them come for medical attention, typically because of dull right upper quadrant pain, abdominal bloating or early satiety. We treated a 77-year-old female with a rare complication of inferior vena cava thrombosis. The patient expired due to septic shock and multiple organ failure.

We report a case of caudate lobe hemangioma with an atypical CT enhancement pattern. In the present case, hemangioma exhibited a very subtle discontinuous peripheral rim enhancement at the post-enhanced arterial phase, and the peripheral enhanced zone had a moderately increased enhancement degree and with widened enhancement thickness during the portal-phase and delayed-phase. The slow enhancement rate for this caudate lobe hemangioma was due to sluggish perfusion by the small feeding arteries of caudate lobe branches as demonstrated by angiography.

AIM: Gastrointestinal stromal tumor (GIST) is a rare type of cancer. Computed tomography (CT) is an imaging modality of choice for diagnosing GIST. The aim of this retrospective study was to review the CT imaging features of 17 GIST patients. METHODS: From 1995 to 2003, there were 47 patients with pathologically proven GISTs at our hospital. Of these, 17 patients underwent preoperative CT. We collected and analyzed these CT images. The CT imaging features included tumor diameter, number and location, tumor margin, location of metastasis, hounsfield units of tumor and effect of contrasts. In addition, we also recorded the surgical findings, including complications, tumor size and location for comparative analysis. RESULTS: The results showed that 12 (70%) tumors were located in the stomach and five (30%) were located in the jejunum mesentery. GISTs were extraluminal in 12 (70%) patients. The tumor margins of 13 (76%) tumors were well defined and irregular in four (24%). The effect of contrast enhancement on GIST CT imaging was homogenous enhancement in 13 (76%) and heterogeneous enhancement in four (24%). The hounsfield units (HU) were 30.41 ± 5.01 for precontrast images and postcontrast hounsfield units were 51.80 ± 9.24. CONCLUSION: The stomach was the commonest site of GIST occurrence among our patients. The CT features of GIST were well-defined tumor margins, homogenous enhancement on postcontrast CT images.

A 43-year-old woman with cervical cancer underwent total hysterectomy 1 year earlier and was referred to our department for a follow-up fluorodeoxyglucose (FDG) positron emission tomographic study. The whole-body images demonstrated a 6-cm-diameter spherical mass in the abdomen. The mass had intense FDG uptake peripherally with central photopenia (ring shaped). It was palpable and movable, with an elastic consistency and a smooth, even surface. The tumor mass was identified as an inflammatory granuloma caused by a foreign body, very likely gauze left in the abdomen during the prior surgical procedure.

FDG PET is well recognized for its utility in cancer workup. Nonetheless, the differentiation between malignant and benign pulmonary lesions by FDG PET is challenging. The authors report three proved cases of pulmonary tuberculosis in acute active and open stages. The activities and extents of infection were demonstrable in FDG PET, which could not be observed in either chest radiograph or computed tomography.

Cryptococcosis is not uncommon. Potential interpretation pitfalls should be kept in mind when fluorodeoxyglucose (FDG) positron emission tomography (PET) is used for differentiating pulmonary nodules and for discriminating infection from malignancy, especially in areas where the prevalence of granulomatous infection is high and in immunocompromised patients. In this case, a nodular mass was shown on chest radiography and computed tomographic (CT) scanning. A consolidated infection or a bronchioloalveolar carcinoma was suspected because the CT scan showed air bronchograms within the mass and another perihilar infiltration. The FDG PET scan clearly delineated the lesion and had intermediately high glucose uptake (standard uptake value, 3.8-4.0), which led to the exclusion of the possibility of bronchioloalveolar carcinoma because most of these tumors had normal or mildly increased FDG accumulation. Cryptococcoma was finally diagnosed. Hence, the CT scan and FDG PET played complementary roles in the differential diagnosis of this nodular mass.

Foreign body ingestion is a commonly seen medical emergency in children. Retropharyngeal abscess and mediastinitis are well-documented complications from foreign body ingestion, which reflects the importance of early diagnosis. The neck radiograph is the most significant radiographic examination performed in a child with a suspected pharyngeal lesion. We report a case where the initial malpositioned lateral view neck radiograph failed to detect a potentially serious esophageal foreign body. A second lateral view neck radiograph discovered a mass of foreign body in the upper esophagus, which was found to be a chicken bone during surgery. The case suggests that a properly positioned neck radiograph is the most important examination in the initial evaluation of a child with suspected foreign body ingestion.

Previous research has identified that ceramic far infrared (cFIR)-emitting material can modulate various biological processes, particularly those involving hydrogen peroxide scavenging and antioxidant activities. The present study treated MCF-10A cells with 50 and 100 μM hydrogen peroxide before incubating them for 24 h on the top of The present study treated MCF-10A cells with 50 and 100 μM hydrogen peroxide before incubating them for 24 h on the top of cFIR or control powder. cFIR or control powder. Cells were also treated with ionizing radiation from a fluoroscopic X-ray source to induce cell damage and cultured for 48 h beneath cFIR or control powder. The effects of cFIR on cell survival were evaluated using XTT and MTT assays. A total accumulated radiation dose of 1 Gy to 2 Gy was sufficient to cause cell damage and reduce cell viability. In both the hydrogen peroxide toxicity and radiation exposure experimental models, the cFIR groups demonstrated significantly higher cell survival rates than those of the control groups (p＜0.05). Considering the relationship between indirect-ionizing-radiation- and oxidative-stress-induced cell damage and the accumulation of free radicals, these results indicate that the protection of cFIR against ionizing radiation is predominantly through an antioxidant mechanism. cFIR-emitting material has potential use in reducing radiation damage caused by medical instruments and radiation pollution.

Primary isolated chylopericardium is a rare disorder in which chylous fluid accumulates in the pericardial space. In this case report of a 61-year-old man with chylopericardium, pedal 99m Tc-sulfur colloid (SC) lymphoscintigraphy was performed after emergent pericardiocentesis, and when there was a recurrent massive pericardial effusion. The results showed that 99m Tc-SC lymphoscintigraphy can clearly reveal the lymphodynamics in patients with primary isolated chylopericardium. This noninvasive investigation is valuable and can be easily performed either before or after pericardiocentesis.

beta-amyloid peptide (A beta) and complement-derived membrane attack complex (MAC) are co-localized in senile plaques of brains from Alzheimer's disease (AD) patients. But the relationship between A beta and complement activation is unclear. We have used human neurotypic cells, differentiated SH-SY5Y, as a model system to examine regulation of neuronal MAC expression and cell death by A beta. We demonstrated that mRNAs (C1q, C2, C3, C4, C5, C6, C7, C8 and C9) and proteins (C1q, C3 and C9) for the major components of the classical complement cascade are present in the SH-SY5Y neurotypic cells, indicating that neuronal cells can synthesize the necessary proteins required for MAC formation. Furthermore, immunocytochemical studies showed the A beta-induced neuronal MAC expression on the SH-SY5Y cells after CD59 was removed by PIPLC or blocked by anti-CD59 antibody. Meanwhile, increased A beta-induced neuronal cell death was observed following treatment with anti-CD59. Taken together, these results suggest that A beta activates neuronal complement cascade to induce MAC, and a deficiency of endogenous complement regulatory proteins, e.g., CD59, may increase the vulnerability of neurons to complement-mediated cytotoxicity.

Inflammation and pain are the major chronic symptoms in geriatric medicine. This study examines the possible mechanism of a far-infrared ray-emitting ceramic material (bioceramic) on these symptoms using cell models. Effective doses of lipopolysaccharides (LPS) were added to induce acute episodes of inflammation in murine macrophage (RAW 264.7) and human chondrosarcoma (SW1353) cells. The inducible nitric oxide synthetase (iNOS), cyclo-oxygenase-2 (COX-2), and prostaglandin E2 (PGE2) levels were determined for the cell lines. Biocermic treatment was found to have significant inhibitory effects on COX-2 and PGE2 and a probable effect on iNOS in the cell models of LPS-mediated inflammation. Bioceramic treatment may be an alternative method for palliative pain control to reduce chemical drug dependence for the protection of renal functions in the chronic pain disease population.

A 58-year-old asymptomatic man was scheduled to undergo FDG PET for whole-body cancer screening. Intense, focally linear F-18 FDG uptake was found in the lower buttock. A malignant tumor in the rectum was suspected. However, physical examinations and a rectocolonscopic study were negative. MRI showing an anorectal fistula provided a morphologic diagnosis. Apparent symptoms and signs of perianal abscess appeared 1 month later. At surgery, an anorectal fistula with actinomycosis and abscess formation were found. FDG PET provided information on the functional status of the fistula. An infectious focus in the anorectal region should be kept in mind and carefully considered when FDG PET is used for tumor imaging.