Kaohsiung Journal of Medical Sciences - Articles in Press

Single nucleotide polymorphism barcoding to evaluate oral cancer risk using odds ratio-based genetic algorithms - Corrected Proof

2012-05-16

Abstract: Cancers often involve the synergistic effects of gene–gene interactions, but identifying these interactions remains challenging. Here, we present an odds ratio-based genetic algorithm (OR-GA) that is able to solve the problems associated with the simultaneous analysis of multiple independent single nucleotide polymorphisms (SNPs) that are associated with oral cancer. The SNP interactions between four SNPs—namely rs1799782, rs2040639, rs861539, rs2075685, and belonging to four genes (XRCC1, XRCC2, XRCC3, and XRCC4)—were tested in this study, respectively. The GA decomposes the SNPs sets into different SNP combinations with their corresponding genotypes (called SNP barcodes). The GA can effectively identify a specific SNP barcode that has an optimized fitness value and uses this to calculate the difference between the case and control groups. The SNP barcodes with a low fitness value are naturally removed from the population. Using two to four SNPs, the best SNP barcodes with maximum differences in occurrence between the case and control groups were generated by GA algorithm. Subsequently, the OR provides a quantitative measure of the multiple SNP synergies between the oral cancer and control groups by calculating the risk related to the best SNP barcodes and others. When these were compared to their corresponding non-SNP barcodes, the estimated ORs for oral cancer were found to be great than 1 [approx. 1.72–2.23; confidence intervals (CIs): 0.94–5.30, p < 0.03–0.07] for various specific SNP barcodes with two to four SNPs. In conclusion, the proposed OR-GA method successfully generates SNP barcodes, which allow oral cancer risk to be evaluated and in the process the OR-GA method identifies possible SNP–SNP interactions.

Adrenal myelolipoma: A 10-year single-center experience and literature review - Corrected Proof

Sz-Wen Hsu, Kenneth Shu, Wei-Ching Lee, Yuan-Tso Cheng, Po-Hui Chiang — 2012-04-30

Abstract: Adrenal myelolipoma is a rare, nonfunctioning, and benign tumor. We report our experience of surgically treated patients from a single institute and review the literature. Six patients (three men and three women) were diagnosed and received surgical intervention. A retrospective analysis was done by reviewing medical records. In our series, three patients were diagnosed incidentally and the others were discovered due to symptoms. All received surgery, including laparoscopic adrenalectomy. There was no recurrence. In the literature review, right adrenal gland was dominant and the prevalent age was from the fourth to sixth decades. The most common symptoms were abdominal and flank pain. Adrenal myelolipoma is uncommon and easily confused with malignancy when of large size (≥6 cm). Surgery may be reserved for symptomatic cases and those lesions that cannot reliably be diagnosed. Large tumors (≥6 cm) can be excised surgically or laparoscopically.

The impact of gender and size on the pathology of small renal mass - Corrected Proof

2012-04-23

Abstract: Without surgery, it is hard to predict the histology of small (≦ 4cm) renal masses (SRMs) based on images. This study attempted to investigate whether clinical parameters were correlated with the pathological presence of SRM carcinomas. We conducted a retrospective chart review of 60 patients with 61 suspicious SRMs on radiological examination who received radical nephrectomy (RN) or partial nephrectomy (PN) between January 2003 and February 2011 in the China Medical University Hospital (CMUH). The correlations between patient age, gender, tumor size, and pathological features were calculated and analyzed. Of the 61 SRMs, there were 51 (83.6%) renal cell carcinoma (RCC), seven (11.5%) angiomyolipoma, two (3.3%) oncocytoma, and one (1.6%) metanephric adenoma. Regarding the histological variants of these cases of RCC, 44 were categorized as the clear cell type, two as the papillary type, and five as the chromophobe type. The incidence of benign tumor was greater in females (p=0.014) and tumor size 2cm or less (p=0.02), compared with males and tumor size more than 2cm, respectively. Surgical intervention is generally recommended for medically fit patients.

Potential of D-cycloserine in the treatment of behavioral and neuroinflammatory disorders in Parkinson's disease and studies that need to be performed before clinical trials - Corrected Proof

Cornelius Rainer Pawlak, Fu-Shih Chen, Fu-Ying Wu, Ying-Jui Ho — 2012-04-23

Abstract: Hyperactivation of glutamatergic N-methyl-D-aspartate (NMDA) receptors has been implicated in the excitotoxicity and pathophysiology of Parkinson's disease (PD). NMDA receptor blockers have been used clinically to treat dementia, but their efficacy is controversial. Modulation of NMDA receptors might improve neuroinflammation and cognitive deficits in PD. D-cycloserine (DCS), a partial agonist binding to the glycine binding site of NMDA receptors, has been demonstrated to improve cognitive function in primates and rodents. Our previous study showed that DCS can reduce motor, emotional, and cognitive dysfunctions, as well as neuroinflammation and neurodegeneration in a PD animal model and may therefore have potential for the treatment of neuroinflammation and cognitive dysfunction in patients with PD. In addition, increased expression of cyclooxygenase type-2 (COX-2) has been observed in dopaminergic neurons and activated microglia in the brain of both PD patients and PD animal models. COX-2 inhibitors can suppress activation of microglia and protect dopaminergic neurons from degeneration. Thus, a combination of DCS and COX-2 inhibitors might prove useful in suppressing neuroinflammation and cognitive deficits in PD.

High preoperative ratio of blood urea nitrogen to creatinine increased mortality in gastrointestinal cancer patients who developed postoperative enteric fistulas - Corrected Proof

2012-04-23

Abstract: Development of an enteric fistula after surgery is a major therapeutic complication. In this study, we retrospectively examined the potential relationship between preoperative laboratory data and patient mortality by collecting patient data from a tertiary medical center. We included patients who developed enteric fistulas after surgery for gastrointestinal (GI) cancer between January 2005 and December 2010. Patient demographics and data on preoperative and pre-parenteral nutritional statuses were compared between surviving and deceased patients. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to determine the predictors and cut-off values, respectively. Patients with incomplete data and preoperative heart, lung, kidney, and liver diseases were excluded from the study; thus, out of 65 patients, 43 were enrolled. Logistic regression analysis showed that blood urea nitrogen-to-creatinine (BUN/Cr) ratio [p = 0.007; OR = 0.443, 95% confidence interval (CI), 0.245–0.802] was an independent predictor of mortality in patients who developed enteric fistulas after surgery for GI cancer. In conclusion, the results of our study showed that a high preoperative BUN/Cr ratio increases the risk of mortality in patients who develop enteric fistulas after surgery for GI cancer.

Head and neck extranodal lymphoma in a single institute: A 17-year retrospective analysis - Corrected Proof

2012-04-23

Abstract: The study's purposes are to identify patient characteristics, treatment response and survival rate, and to describe the important prognostic factors for our patients with extranodal head and neck lymphoma. Furthermore, no study has systemically discussed the overall figure of this disease in Taiwan and we analyzed our data on this topic. A retrospective review was performed for 86 patients with extranodal head and neck lymphoma, diagnosed in Kaohsiung Medical University Hospital, between 1990 and 2007. We evaluated the medical records and analyzed the possible factors affecting treatment outcomes, survival rate, and free-from-disease (FFD) survival rate. Forty-nine male and 37 female patients were included with a male:female ratio of 1.32：1. The most frequent histologic type was diffuse large B cell lymphoma, accounting for 41.9% of the total. The most common primary site involved with extranodal head and neck non-Hodgkin's lymphoma was a tonsil with 27 cases (31.4%). Stage, international prognostic index (IPI) score, B symptoms, lactate dehydrogenase (LDH) level, and lymph node status significantly affected treatment response. The overall 5- and 10-year survival rates were 68.0% and 57.8%, respectively. The FFD survival rate was 53.6% and 49.3% at 5 and 10 years, respectively. Factors including stage, lymph node status, LDH level, and IPI score produced significant differences in both overall survival and FFD survival. Our analyzed information is similar to other previously presented studies. Stage, IPI score, B symptoms, LDH level, and neck nodal status can be used to evaluate the treatment outcomes. Neck nodal status and stage are the two significant prognostic factors for overall survival.

An investigation on illness perception and adherence among hypertensive patients - Corrected Proof

Chih-Yin Hsiao, Chueh Chang, Chih-Dao Chen — 2012-04-23

Abstract: Successful blood pressure (BP) control requires good adherence to medication and specific health-related behaviors. However, the BP control rate is not optimal, and limited research has focused on the patient's perspective. This study aimed at investigating the illness perceptions of hypertensive patients and how they relate to drug adherence. One hundred and seventeen hypertensive patients enrolled in this study, and data were collected in a family physician clinic of a medical center located in northern Taiwan. The Illness Perception Questionnaire was administered, and medication adherence and demographic data were also collected. Results showed the patients' perceptions of their hypertension, that it was a chronically severe but stable disease, and the patients were confident in the effectiveness of medical treatments and their ability to control their disease. The participants were divided into three clusters by cluster analysis. There were 46.15% participants in the first cluster; they had less negative belief in their illness consequence and less negative emotional responses, but a low personal sense of control. The second cluster (11.97%) had more negative emotional responses and more negative beliefs in their illness consequence, but these individuals scored highly on their personal sense of control and treatment control beliefs. The third cluster (41.88%) had scores between clusters 1 and 2. Cluster 1 had the best drug adherence, and cluster 2 had the worst drug adherence (χ2 = 7.67, p < 0.05). It may be beneficial for clinical physicians to pay attention to patients' illness perceptions, including their negative emotional response and symptoms, in order to improve their drug adherence.

Laryngeal involvement in Madelung's disease with acute airway compromise - Corrected Proof

Chia-Hsuan Lee, Kun-Tai Kang, Jenq-Yuh Ko, Wei-Hsiu Chang — 2012-04-23

Madelung's disease is a metabolic disorder characterized by multiple fatty accumulations in the neck and upper trunk. After first described by Brodie in 1846, nearly 200 cases have been reported. Most cases were middle-aged European white men with chronic alcoholism. Diagnosis is based on clinical history and physical examination . Madelung's disease is very rare in Eastern populations. Although most cases were asymptomatic, laryngeal involvement of the disease can results in a life-threatening airway problem and warrant immediate surgical intervention . We present a rare oriental patient with Madelung's disease who had laryngeal involvement resulting in airway compromise. We will also discuss disease management strategies.

Maxillary brown tumor as initial presentation of parathyroid adenoma: A case report - Corrected Proof

Hon-Ke Sia, Ming-Chia Hsieh, Li-Heng Yang, Shih-Te Tu — 2012-04-20

Abstract: Brown tumor is a rare late-stage skeletal change caused by long-term stimulation of excess parathyroid hormone. It is not neoplastic, but a reparative cellular process. Common sites of brown tumor are the ribs, clavicle, long bones and pelvic girdle. Solitary maxillary brown tumor as initial presentation of primary hyperparathyroidism is rare; it is often accompanied by brown tumors of the other facial bones. Here, we present the first case of solitary maxillary brown tumor in a 29-year-old ethnic Chinese woman with initial presentation of a large tumor filling the left maxillary sinus. Underlying long-standing primary hyperparathyroidism caused by a large parathyroid adenoma was finally diagnosed. Brown tumor tends to be misdiagnosed as malignancy, and delayed diagnosis of the underlying hyperparathyroidism is common. Our case validates the suggestion that young women have a higher probability of brown tumor. Biopsy of the suspicious bone tumor and blood tests for calcium and parathyroid hormone level are crucial and essential to reach the correct diagnosis. Most brown tumors show spontaneous regression after parathyroidectomy. However, direct excision of the brown tumor may be indicated to avoid the risk of facial deformity and orbital compression at a special anatomical site, as in our case.

Comparison of secondary signs as shown by unenhanced helical computed tomography in patients with uric acid or calcium ureteral stones - Corrected Proof

2012-04-19

Abstract: Unenhanced helical computed tomography (UHCT) has evolved into a well-accepted diagnostic method in patients with suspected ureterolithiasis. UHCT not only shows stones within the lumen of the ureter, it also permits evaluation of the secondary signs associated with ureteral obstruction from stones. However, there we could find no data on how secondary signs might differ in relation to different compositions of ureteral stones. In this study, we compared the degree of secondary signs revealed by UHCT in uric acid stone formers and in patients forming calcium stones. We enrolled 117 patients with ureteral stones who underwent UHCT examination and Fourier transform infra-red analysis of stone samples. Clinical data were collected as follows: age, sex, estimated glomerular filtration rate (eGFR), urine pH, and radiological data on secondary signs apparent on UHCT. The uric acid stone formers had significantly lower urine pH and eGFR in comparison to calcium stone formers, and on UHCT they also had a higher percentage of the secondary signs, including rim sign (78.9% vs. 60.2%), hydroureter (94.7% vs. 89.8%), perirenal stranding (84.2% vs. 59.2%) and kidney density difference (73.7% vs. 50.0%). The radiological difference was statistically significant for perirenal stranding (p=0.041). In conclusion, we found that UHCT scanning reveals secondary signs to be more frequent in patients with uric acid ureteral stones than in patients with calcium stones, a tendency that might result from an acidic urine environment.

A comparison of Trachway intubating stylet and Airway Scope for tracheal intubation by novice operators: A manikin study - Corrected Proof

2012-04-16

Abstract: The Trachway is a recently developed intubation device that resembles an illuminating stylet and incorporates a video-assisted system. This study evaluated the use of this system for tracheal intubation by novice operators. This randomized cross-over study compared the Trachway and the Airway Scope in simulated routine and difficult intubation scenarios. The difficult scenario was simulated by increasing the tongue volume of the manikin. The primary outcome measure in both airway scenarios was the time required for a successful tracheal intubation. For each scenario, the success rate, ease of intubation and operator preference were recorded for the two devices and compared. Average intubation time did not differ significantly between the Trachway and Airway Scope for the normal airway scenario (11.2 ± 6.5 vs. 9.8 ± 4.3 seconds, respectively; p = 0.07), but was significantly longer using the Trachway than with the Airway Scope on the difficult airway scenario (17.1 ± 11.1 vs. 9.5 ± 4.1 seconds, respectively; p < 0.001). The overall success rates of the Trachway and Airway Scope (96.3% and 98.6%, respectively) did not differ significantly (p = 0.13). Preference for the Airway Scope was greater in both scenarios, and particularly in the difficult airway scenario (p < 0.001). Although the devices are comparable in terms of ease of use and intubation time in normal scenarios, the ease of using the Airway Scope makes it more suitable for inexperienced operators in difficult intubation scenarios.

Estimating time to full uterine cervical dilation using genetic algorithm - Corrected Proof

Jeong-Kyu Hoh, Kyung-Joon Cha, Moon-Il Park, Mei-Ling Ting Lee, Young-Sun Park — 2012-04-11

Abstract: The objectives of this study were to provide new parameters to better understand labor curves, and to provide a model to predict the time to full cervical dilation (CD). We studied labor curves using the retrospective records of 594 nulliparas, including at term, spontaneous labor onset, and singleton vertex deliveries of normal birth weight infants. We redefined the parameters of Friedman’s labor curve, and applied a three-parameter model to the labor curve with a logistic model using the genetic algorithm and the Newton–Raphson method to predict the time necessary to reach full CD. The genetic algorithm is more effective than the Newton–Raphson method for modeling labor progress, as demonstrated by its higher accuracy in predicting the time to reach full CD. In addition, we predicted the time (11.4 hours) to reach full CD using the logistic labor curve using the mean parameters (the power of CD = 0.97 cm/hours, a midpoint of the active phase = 7.60 hours, and the initial CD = 2.11 cm). Our new parameters and model can predict the time to reach full CD, which can aid in the forecasting of prolonged labor and the timing of interventions, with the end goal being normal vaginal birth.

Large ureteral fibroepithelial polyp lacking epithelium due to ischemic infarction - Corrected Proof

2012-04-11

Abstract: We describe a woman with flank pain and hydronephrosis. Computed tomography (CT) urography and maximum intensity projection (MIP) reformatted images clearly showed that a long finger-like intraluminal filling defects mass in the left middle ureter. The pathologic biopsy by ureteroscopy revealed that the lesion mainly consists of benign fibrinoid necrosis. A large soft smooth, spindle-like, dark brown mass (approximately 13.5 cm in length) was identified in left middle ureter when open surgery was performed. The segment of the ureter part attached to the stalk of the polyp was excised, then a dismembered ureteroplasty was performed. Pathologic examination revealed that the total polyp was an ischemic infarction, characteristic of cellular swelling, tissue degeneration, fibrinoid necrosis, and thrombosis in its vessels. The surface of the polyp was hardly covered with urothelium, but fibroepithelial polyp was still diagnosed. There was no recurrence during the 3 years of follow-up.

Functional characterization of mammalian Wntless homolog in mammalian system - Corrected Proof

Li-Ting Wang, Shih-Jong Wang, Shih-Hsien Hsu — 2012-04-09

Abstract: Wntless (GPR177) protein is a newly identified regulator of Wnt signals in Drosophila, but its cellular function in mammals is still unclear. In this study, we explored the expression pattern and potential cellular function of Wntless in mammalian cells. Wntless mRNA was expressed in many mouse tissues, including the spleen, lung, kidney, thymus, and stomach, and lower levels of expression were detected in the mouse brain and testis. Expression of Wntless protein analyzed by Western blot and immunohistochemical staining was only detected in the submucosa, muscle, ganglia, and nerve cells of murine large intestines. Both immunofluorescence staining and subcellular fraction extraction analysis revealed that endogenous Wntless protein was expressed predominantly in the cytoplasmic organelles with a morphologically dot-shaped distribution. Furthermore, overexpression of Wntless could be corrected by and may activate the nuclear factor-κB (NF-κB) signaling pathway in cancer (HeLa) cells. These results suggest that Wntless plays a role in signaling regulation during the formation of cancer in addition to its role as a retromer protein in mammalian systems.

Soft catheters reduce the risk of intravascular cannulation during epidural block—A retrospective analysis of 1117 cases in a medical center - Corrected Proof

2012-04-09

Abstract: A wet or bloody tap is an inevitable complication while performing epidural block. The influence of different catheters on the incidence of intravascular cannulation during epidural catheterization has not been reported. We observed an initial, relatively different incidence of intravascular cannulation during the placement of different sorts of epidural catheter; hence, a retrospective review was conducted to explore the possible association. We reviewed 1-year interval anesthetic records of 1117 patients who had undergone epidural anesthesia or received patient-controlled epidural analgesia. Epidural catheter placement was performed by a loss of resistance technique with an 18-G Tuohy needle in lateral position. Patients were divided into two groups according to the different types of epidural catheters used (Perifix One, n=590; Perifix Standard, n=527). Primary outcome measurement was the incidence of intravascular injection. Other analyzed outcomes included dura puncture, failure rate, and low back pain. The incidence of epiduralintravascular cannulation was significantly lower using the Perifix One catheter (1.5%; 9/590) than using the Perifix Standard (4.6%; 24/527), p=0.003. The dura puncture rate did not differ significantly between the Perifix One (1.9%; 11/590) and the Perifix Standard (2.5%; 13/527), p=0.49. Failure rates and low back pain incidence were also comparable between the two groups. Application of the soft epidural catheter (Perifix One) may reduce the incidence of epidural intravascular cannulation. We suggest the use of Perifix One catheter instead of Perifix Standard catheter in daily practice.

Inattention and development of toddlers born in preterm and with low birth weight - Corrected Proof

2012-04-09

Abstract: The objective of this study was to examine the impact of low birth weight and preterm birth on a toddler's inattention and development, including cognitive, language, motor, social–emotional and adaptive behaviors. A total of 105 toddlers enrolled for the study; they were divided into four groups: 40 full-term and normal birth weight (NBW, birth weight greater than 2500 g) toddlers, 24 moderate birth weight (MLBW, birth weight between 2499 and 1500 g) toddlers, 20 very to extremely low birth weight (V-ELBW, 12 between 1000 and 1499 g and 8 lower than 1000 g) toddlers, and 21 term toddlers who were recruited from a clinic of developmental delay as the developmental delay at risk (DDR) group. The Bayley Scales of Infant and Toddler Development—Third Edition (BSID-III) and Disruptive Behavior Rating Scale—Toddler were used. The findings were as follows: (1) DDR group performed worst in BSID-III; (2) although there were no statistical differences among the NBW, MLBW, and V-ELBW groups in BSID-III, the lower the birth weight, the lower the average performance, especially in language, adaptive social behavior, and adaptive practical behavior; and (3) comparing the inattention score, the DDR group was the poorest, normal and V-ELBW groups were the best, and MLBW group was in the middle. In conclusion, low birth weight and preterm delivery affected children's inattention and development of language, adaptive social behavior, and adaptive practical behavior.

Breast carcinoma metastasized to vestibular schwannoma: A rare case of tumor-to-tumor metastasis and literature review - Corrected Proof

Boon-Kee Lua, Ann-Shung Lieu, Shiuh-Lin Hwang — 2012-04-09

Abstract: Tumor-to-tumor metastasis is a well-recognized phenomenon. However, cerebellopontine angle tumor, especially vestibular schwannoma, is a rare location of metastasis, with only six cases being reported previously in English-language literature reviews. We report a case of a 57-year-old woman with underlying breast cancer (T2N3M1, stage IV) who presented with unilateral facial tics, paresthesia and hearing loss, who turned out to have vestibular schwannoma with adenocarcinoma metastasis.

Wide QRS tachycardia with two P wave morphologies: What is the mechanism? - Corrected Proof

Wei-Hua Tang, Kun-Tai Lee, Wei-Chung Tsai, Wen-Ter Lai — 2012-04-09

Idiopathic ventricular tachycardia (VT) with normal heart is not uncommon in our daily practice. However, this VT sometimes cannot be easily differentiated from supraventricular tachycardia with bundle branch block (BBB) if the QRS interval is relatively narrow or the P-QRS relationship is consistent . Here, we present a unique case with wide QRS tachycardia and two consistent P wave morphologies.

Cold Spring Harbor Asia/International Society for Stem Cell Research Conference; Cellular Programs and Reprogramming (October 24–28, 2011) - Corrected Proof

Shang-En Huang, Hsiang-Jung Hsiao, Chia-Chen Ku, Kazunari K. Yokoyama — 2012-04-09

The Cold Spring Harbor annual meeting, “Cellular Programs and Reprogramming”, was held at the Dushu Lake Conference Center, Suzhou, China. The meeting started with welcoming remarks by Ronald D. McKay (National Institute of Health, USA) followed by the opening keynote address delivered by Elaine Fuchs (Rockefeller University, USA; Cell Stem Cell 10, 63-75, 2012; Nat. Rev. Mol. Cell. Biol. 13, 103-114, 2012; Cell 144, 341-352; Cell 92-105, 2011), who summarized her research on skin stem cells and wound repair and cancer. Using H2B-GFP pulse, chase and trace of imaging, she described the determination of how extrinsic signaling to stem cells sets off a cascade of changes in transcription that governs the activation, polarization, and migration of stem cells during tissue development, homeostasis, hair cycling, and wound repair. She demonstrated the cross-talk between the Wnt, BMP, and TGFβ signaling pathways of stem cells and niches during wound repair, quiescence, and the arrest of the generation of new tissue. In nucleus of stem cells, the expression of H3K4me3, H3K79me2, H3K27me3, and polycomb proteins is critical for the determination of stem cell-niche interactions.

Tattooing among high school students in southern Taiwan: The prevalence, correlates and associations with risk-taking behaviors and depression - Corrected Proof

2012-04-05

Abstract: This study aims to examine the prevalence and sociodemographics, family and peer correlates of tattooing among high school students in southern Taiwan, and to examine the associations between tattooing and a variety of adolescent risk-taking behaviors and depression. A total of 9755 high school students (grades 7 to 12) in southern Taiwan were recruited into this study and completed the questionnaires. The prevalence of tattooing among the adolescents was calculated. The responses were analyzed using the logistic regression analysis models. It was found that 1% of high school students in southern Taiwan had 1 or more tattoos on their bodies. The older students who were perceived to have low family monitoring and who had friends who drink regularly, used illicit drugs, had a criminal record or were in a gang were more likely to have a tattoo. Tattooing was also found to be associated with violence, weekly alcohol consumption, illicit drug use, dropping out of school, unprotected sex, suicidal ideation/attempt, and depression. The results indicate that several demographics, family and peer factors are associated with adolescent tattooing. Tattooing may be an indicator of risk-taking behaviors in high school students.

Fluconazole exposure rather than clonal spreading is correlated with the emergence of Candida glabrata with cross-resistance to triazole antifungal agents - Corrected Proof

Tun-Chieh Chen, Yen-Hsu Chen, Yee-Chun Chen, Po-Liang Lu — 2012-04-05

Abstract: The emergence of antifungal resistance in Candida species has raised concern in recent years, especially resistance toward triazole. Several newer triazole antifungal agents have been introduced which have a broader spectrum for fungal infections, such as voriconazole. However, cross-resistance among triazoles is a major concern with regard to their clinical application. Antifungal susceptibility was performed using E-test for 166 clinical isolates (29 blood and 137 nonblood isolates) in 2003 and 2004. We applied pulsed-field gel electrophoresis for genotyping. Ninety isolates of C. albicans, 47 isolates of C. tropicalis, 27 isolates of C. glabrata, and two isolates of C. krusei were included. All isolates were susceptible to amphotericin B. Eleven (40.7%) of the 27 C. glabrata had intermediate resistance to caspofungin. Forty-seven (28.3%) of the 166 isolates were not susceptible to fluconazole, including two C. albicans, 16 C. tropicalis, 27 C. glabrata, and two C. krusei isolates. All except seven of the C. glabrata isolates were susceptible to voriconazole. All the triazole drugs had a positive correlation among their minimum inhibitory concentrations (MICs). Fluconazole MIC was a good predictor for susceptibility to voriconazole, as determined using a receiver operating characteristic curve. Furthermore, a high diversity of pulsotypes for the 27 clinical isolates of C. glabrata was observed. Previous fluconazole exposure within 3 months was associated with reduced triazole susceptibility for C. glabrata. We demonstrated a significant positive correlation of MIC values among the four tested triazole drugs. No amphotericin B and caspofungin resistant isolates were found in this study. The cross-resistance to triazole among C. glabrata isolates was associated with previous fluconazole exposure as opposed to clonal spreading. Selection pressure due to fluconazole use may play a major role in triazole cross-resistance.

The alteration of plasma TGF-β1 levels in patients with brain tumors after tumor removal - Corrected Proof

2012-04-05

Abstract: Transforming growth factor (TGF) β1 may be a candidate for a serologic tumor marker. In this study, the plasma levels of TGF-β1 in patients with brain tumors were measured using enzyme-linked immunosorbent assay before and after tumor removal. Patients were divided into four groups, the control group and the benign, malignant, and metastatic brain tumor groups. All brain tumor groups showed significant increases in the levels of TGF-β1 before tumor removal (6.36 ± 3.94, 17.0 ± 9.7, and 12.2 ± 10.3 ng/ml for the benign, malignant, and metastatic groups, respectively). When compared with the results obtained in the control group (1.12 ± 0.74 ng/ml), significant decreases in TGF-β1 concentrations after total tumor removal were found in both the benign and malignant brain tumor groups (2.55 ± 2.00 and 8.93 ± 5.73 ng/ml, respectively; p = 0.0001 and p = 0.003, respectively). On the other hand, plasma TGF-β1 levels in the metastatic brain tumor group showed a slight but significant increase (14.7 ± 9.3 ng/ml, p = 0.035) after tumor removal. In a case of low-grade astrocytoma, plasma levels of TGF-β1 were found to be 3.6 and 1.1 ng/ml before and after tumor removal, respectively. However, recurrent tumor was noted in this patient 7 months later, and the levels of TGF-β1 were 26.2 and 8.4 ng/ml before and after the second operation, respectively. The data show that plasma TGF-β1 was elevated in the circulation of patients with brain tumors and that significant decreases in TGF-β1 levels were observed after the removal of benign and malignant tumors. The results also suggest that TGF-β1 may be a useful serologic marker for brain tumors.

The physician compliance of red blood cell transfusion by computerized transfusion decision support system - Corrected Proof

2012-04-05

Abstract: “When should we trigger a transfusion?” is always a critical question between the patient’s benefits and risks in red blood cell (RBC) transfusion. A computerized transfusion decision support system (CTDSS) has been used since September 2004 in an academic medical center with 1400 beds. In this study, the factors affecting RBC transfusion were investigated. In total 20,551 RBC-transfusion episodes between January and December 2008 were reviewed. The nearest hemoglobin concentration before transfusion is defined as the transfusion trigger. The physician compliance, the factors associated with the transfusion triggers and posttransfusion hemoglobin increment were investigated. The physician compliance is 83.1%. The transfusion trigger is 8.32±1.84 (mean±standard deviation) g/dL. The transfusion triggers are statistically significant in terms of both different order sources and disease types (p<0.05).The posttransfusion hemoglobin level increased in two-thirds of the episodes. The percentages of hemoglobin increments after transfusion are dependent on the transfusion triggers. Appropriate transfusion practice may reduce the overuse of blood components and improve transfusion quality. CTDSS should be more powerful to intervene in the appropriateness of transfusion practice.

Multiple endocrine neoplasia type 2A - Corrected Proof

Chiung-Tang Huang, Wen-Chi Yang, Sheng-Fung Lin — 2012-04-05

Abstract: Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant inherited cancer syndrome that expresses nonendocrine and endocrine tumors. Here, we describe a 42-year-old man with an initial presentation of low back pain and hypertension. Clinical assessments revealed pheochromocytoma, medullary thyroid carcinoma with bone metastasis, and parathyroid hyperplasia. MEN 2A was diagnosed, and a family history of pheochromocytoma was traced. Surgical resection of the pheochromocytoma of the adrenal gland resulted in a cure of the patient’s hypertension. He received systemic chemotherapy with the “MAID” regimen (mesna, doxorubicin, ifosfamide, and dacarbazine) over three cycles of 3 weeks each, and showed a partial response.

The role of serum testosterone to prostate-specific antigen ratio as a predictor of prostate cancer risk - Corrected Proof

Cenk Gurbuz, Lutfi Canat, Gokhan Atis, Bayram Guner, Turhan Caskurlu — 2012-04-05

Abstract: We analyzed the ratio of serum total testosterone (sTT) to prostate-specific antigen (PSA) as a predictor of prostate cancer risk. One-hundred-four consecutive men with a normal digital rectal examination and a serum PSA level of 2.5–10 ng/ml underwent transrectal ultrasonography-guided biopsy using a 10-core scheme. The sTT level was determined before the procedure using a chemiluminescent assay, and the ratio of sTT to PSA (sTT/PSA) was calculated after transforming sTT measurements from ng/dL to ng/mL. The overall cancer detection rate was 17.3%. The median sTT level was 332 ng/dl in men with cancer and 413 ng/dL in those without (p = 0.032). The median sTT/PSA ratio in these groups was 0.55 and 0.74, respectively (p = 0.035). The receiver operator characteristic (ROC) method was used to evaluate the properties of the sTT/PSA ratio, with testosterone and PSA as predictors of prostate cancer risk. The accuracy of the sTT/PSA ratio in prostate cancer diagnosis, represented by the area under the curve (AUC), was 0.739 (95% CI 0.640–0.823, p < 0.05). Optimizing the sensitivity and specificity of the sTT/PSA ratio using the ROC provided a cutoff point of 0.60, which corresponded to 82% sensitivity and 62% specificity. When the patients were divided into normal- and low-sTT level groups according to testosterone value (300 ng/dl), the probability of detecting prostate cancer was 3.3-fold higher in hypogonadal men as compared with eugonadal men. These results support the use of the sTT-to-PSA ratio for predicting the risk of prostate cancer and increasing the specificity of PSA measurement.

Lymphovascular invasion is a pathological feature related to aggressive cancer behavior and predicts early recurrence in prostate cancer - Corrected Proof

Hao Lun Luo, Po Hui Chiang, Yen Ta Chen, Yuan Tso Cheng — 2012-04-04

Abstract: In order to determine the prognostic impact of lymphovascular invasion (LVI) in patients after radical prostatectomy, the retrospective data from our institution has been analyzed. From 1998 to 2010, 117 patients underwent radical prostatectomy. A total of 87 patients were included in this retrospective study. The relationship between LVI and advanced prostate cancer characteristics was evaluated by χ2 test. The Kaplan-Meier method and meta-analysis were used to describe the impact of LVI invasion upon early biochemical failure after radical prostatectomy. LVI was observed in patients with clinically or pathologically aggressive prostate cancer including patients of higher preoperative risk group, higher preoperative PSA, advanced Gleason grade, and pathological T3 disease. LVI is also associated with early biochemical failure rate both in our report and in the literature. Therefore, LVI is a pathological feature which indicates prognosis correlates with aggressive prostate cancer behavior and results in early biochemical failure after radical prostatectomy.

Acute aortic dissection: An update - Corrected Proof

Iván Alejandro De León Ayala, Ying-Fu Chen — 2012-04-04

Abstract: The aorta, which has a complex intrinsic biology and sophisticated mechanical properties for conducting the blood ejected from the left ventricle to the rest of the systemic arterial bed, is the largest and strongest artery in the body. It carries roughly 200 million liters of blood in an average lifetime. Any process that undermines the architecture threatens the structure, stability, and functionality of the aorta. In this regard, acute aortic dissection (AAD) requires special attention because it is the most catastrophic acute illness of the aorta; it has high morbidity and mortality because of potentially fatal complications. AAD has, therefore, become an important topic of recent research, and knowledge about this disease has improved during the past few years. Up-to-date knowledge about the natural history, epidemiology, presentation, physiopathology, evolution, management, follow-up, and long-term outcomes of AAD are summarized in this review.

Incidence and clinical significance of zygomaticomaxillary complex fracture involving the temporomandibular joint with emphasis on trismus - Corrected Proof

Chia-Ming Chang, Edward C. Ko, Chu-Chiang Kao, Pei-Ying Chang, Michael Y.C. Chen — 2012-04-04

Abstract: Trismus is frequently a sequel of temporomandibular joint (TMJ) involvement in a zygomaticomaxillary complex (ZMC) fracture. Although trismus is commonly observed in patients with ZMC fracture, continuous follow-up examinations of their degree of mouth opening have rarely been documented. The aim of this retrospective study was to determine the incidence and clinical significance of ZMC fracture involving the glenoid fossa or articular eminence of the TMJ with an emphasis on trismus. The medical and computed tomography (CT) imaging data of 28 patients with ZMC fracture treated by oral and maxillofacial surgeons (OMFSs) (OMFS group) and 174 patients with ZMC fracture treated by surgeons other than OMFSs (non-OMFS group) between May 2002 and May 2006 were reviewed. Maximal interincisal opening (MIO) less than 35mm or three-finger width was considered limited mouth opening and indicative of trismus. Preoperative CT imaging data indicated that about 64% (18/28) and 50% (87/174) of the patients in the OMFS and non-OMFS groups, respectively, had a ZMC fracture involving the TMJ. Among these OMFS patients, 17 (94.40%) patients had limited mouth opening (MIO range, 7–33mm) preoperatively, which improved markedly postoperatively. Among the non-OMFS patients with such fractures, 42 (48.3%) patients had trismus preoperatively and two retained trismus postoperatively. Lack of proper preoperative CT images, inadequate postoperative follow-up protocol, and/or neglect by patients and medical staff could influence the outcomes of ZMC fracture involving the TMJ. We make recommendations for reducing the risk of complications subsequent to ZMC fracture involving the TMJ.

Fracture of VerSys fully bead-coated long femoral stems: Report on four fractures in 41 hips - Corrected Proof

Hsueh-Che Lu, Cheng-Li Lin, Chih-Wei Chang, Kuo-An Lai — 2012-04-04

Abstract: The fracture of uncemented, fully porous, coated femoral stems is a rare complication that develops after primary total hip arthroplasty, and it is even rarer after revision surgery. To the best of our knowledge, cases of only 10 broken fully coated stems have been reported. This is the first report on fracture of the VerSys fully bead-coated femoral stem, which is designed for diaphyseal fixation and for application in revision surgery or when a proximal fixation is not feasible. Between 2000 and 2008, we implanted 41 VerSys fully coated stems in 40 patients. We present four cases of femoral stem fractures at 23, 31, 40, and 86 months after surgery. The common risk factors for these four patients were inadequate support for the implant in the proximal femur due to nonunion in this area, a stem diameter ≤12 mm, and a relatively young age.

Giant cell tumor of the parotid gland - Corrected Proof

Cheng-Jung Wu, Sau-Tung Chu, Wei-wen Yu, Pi-Hsiung Wu — 2012-02-20

In their article “Features of parotid gland diseases and surgical results in southern Taiwan,” Kuo et al discussed the features of parotid tumors in southern Taiwan . The most common benign parotid tumor was the pleomorphic adenoma. In malignant parotid tumor disease, the most common tumor was the acinic cell carcinoma. In their study, 25.7% of patients with a malignant parotid tumor received radiotherapy. No patient in the benign group received radiotherapy. We report a new case in which a patient with a benign parotid tumor received radiotherapy following a radical parotidectomy.