Ruptured Tubo-Ovarian Abscess in a Postmenopausal Woman Presenting with Septic Shock: a Case Report and Literature Review

SummaryObjectiveTo report a case of a ruptured tubo-ovarian abscess which induced septic shock in a postmenopausal woman.Case ReportA 53-year-old postmenopausal woman was transferred to our emergency department for drowsiness, hypotension, and lower abdominal discomfort. Transabdominal sonography and computed tomography showed a large pelvic tumor over the left adnexa with some ascites. The uterus and other adnexa were unremarkable. Laboratory data, including blood count and electrolytes, showed leukocytosis and azotemia. Under suspicion of a ruptured adnexal tumor, laparotomy was performed and showed a large ruptured tuboovarian tumor arising from the left adnexa with intra-abdominal pus formation. Subtotal hysterectomy and bilateral salpingo-oophorectomy led to massive bleeding during manipulation of the left adnexa because of the necrotic change in the left infundibulopelvic vessels. Deep vein thrombosis and wound disruption occurred after the operation, but, fortunately, she recovered 1 month later.ConclusionTubo-ovarian abscesses in postmenopausal women are uncommon but should be kept in mind with a pelvic tumor accompanied by septic shock, as this may cause a terrible outcome and other sequelae

Endoscopic dacryocystorhinostomy with short-term, pushed-type bicanalicular intubation vs. pulled-type monocanalicular intubation for primary acquired nasolacrimal duct obstruction

Dacryocystorhinostomy (DCR) has been a primary treatment for adults with nasolacrimal duct obstruction, while the optimal approach and technique remain controversial. With the advancement of endoscopic DCR and the silicone stents, an update of the surgical outcomes and preferable approaches is required. This study aims at comparing the surgical outcomes of endoscopic DCR using pushed bicanalicular intubation (BCI) to pulled monocanalicular intubation (MCI) in adults with primary acquired nasolacrimal duct obstruction (PANDO). Forty five eyes of 45 patients were enrolled, including 22 eyes of 22 patients treated with endoscopic DCR with pulled MCI and 23 eyes of 23 patients with pushed BCI from January 2014 to June 2021. The success rates at stent removal, 1 month and 3 months after removal were 95, 91, and 82%, respectively, in the MCI group, and 100, 87, and 87% in the BCI group. The BCI group had better success rates but failed to reach a significant difference (p = 0.49, p = 0.67, p = 0.24, respectively). After analyzing with binary logistic regression, the implant material was demonstrated as the predictive of surgical success (p = 0.045). There was no significant difference in success rates between patients with dacryocystitis and those without dacryocystitis. We conclude that endoscopic DCR with pushed BCI is easily manipulated and has a promising surgical outcome over pulled MCI. Stent indwelling duration as well as history of dacryocystitis have less influence on the success rates

Mitigating Routing Misbehavior Using Ant-Tabu-Based Routing Algorithm for Wireless Ad-Hoc

Summary Routing is a key factor in the design of modern communication networks, especially in wireless ad-hoc networks (WANs). In WANs, both selfish and malicious nodes are misbehaving nodes and cause severely routing and security problems. Selfish nodes may drop routing and data packets and malicious nodes may redirect the packets to another routing path or launch denial-of-service (DoS) attacks. In this paper, an efficient routing algorithm is proposed, Ant-Tabu-Based Routing Algorithm (ATBRA), to mitigate selfish problem and reduce routing overheads. In ATBRA, both the concepts of ant-based routing algorithm and Tabu search are applied. We compare the performance of the proposed scheme with that of DSR in terms of two performance metrics: successful delivery rate (SDR) and routing overhead (RO). By comparisons, we notice that the proposed algorithm outperforms DSR in all two categories. The simulation results also indicate that the proposed algorithm is more efficient than DSR

Changes in transcriptional orientation are associated with increases in evolutionary rates of enterobacterial genes

<p>Abstract</p> <p>Background</p> <p>Changes in transcriptional orientation (“CTOs”) occur frequently in prokaryotic genomes. Such changes usually result from genomic inversions, which may cause a conflict between the directions of replication and transcription and an increase in mutation rate. However, CTOs do not always lead to the replication-transcription confrontation. Furthermore, CTOs may cause deleterious disruptions of operon structure and/or gene regulations. The currently existing CTOs may indicate relaxation of selection pressure. Therefore, it is of interest to investigate whether CTOs have an independent effect on the evolutionary rates of the affected genes, and whether these genes are subject to any type of selection pressure in prokaryotes.</p> <p>Methods</p> <p>Three closely related enterbacteria, <it>Escherichia coli</it>, <it>Klebsiella pneumoniae</it> and <it>Salmonella enterica serovar Typhimurium</it>, were selected for comparisons of synonymous (<it>dS</it>) and nonsynonymous (<it>dN</it>) substitution rate between the genes that have experienced changes in transcriptional orientation (changed-orientation genes, “COGs”) and those that do not (same-orientation genes, “SOGs”). The <it>dN</it>/<it>dS</it> ratio was also derived to evaluate the selection pressure on the analyzed genes. Confounding factors in the estimation of evolutionary rates, such as gene essentiality, gene expression level, replication-transcription confrontation, and decreased <it>dS</it> at gene terminals were controlled in the COG-SOG comparisons.</p> <p>Results</p> <p>We demonstrate that COGs have significantly higher <it>dN</it> and <it>dS</it> than SOGs when a series of confounding factors are controlled. However, the <it>dN</it>/<it>dS</it> ratios are similar between the two gene groups, suggesting that the increase in <it>dS</it> can sufficiently explain the increase in <it>dN</it> in COGs. Therefore, the increases in evolutionary rates in COGs may be mainly mutation-driven.</p> <p>Conclusions</p> <p>Here we show that CTOs can increase the evolutionary rates of the affected genes. This effect is independent of the replication-transcription confrontation, which is suggested to be the major cause of inversion-associated evolutionary rate increases. The real cause of such evolutionary rate increases remains unclear but is worth further explorations.</p

Genotoxic Klebsiella pneumoniae in Taiwan

Colibactin is a nonribosomal peptide-polyketide synthesized by multi-enzyme complexes encoded by the pks gene cluster. Colibactin-producing Escherichia coli have been demonstrated to induce host DNA damage and promote colorectal cancer (CRC) development. In Taiwan, the occurrence of pyogenic liver abscess (PLA) has been suggested to correlate with an increasing risk of CRC, and Klebsiella pneumoniae is the predominant PLA pathogen in Taiwan

Strategies for Preventing Drug Recidivism Cycle in Taiwan

Drug abuse is currently a worldwide problem and Taiwan is no exception. Drug abuse is a disease that must be treated on the basis of evidence (United Nations Office on Drugs and Crime 2007; World Health Organisation 2004). In order to reduce the damage caused by drug abuse to the nation, society and people, the government not only developed two anti-drug strategies - that of supply eradication and demand reduction - but since May 1994, has mobilised relevant government departments to take assertive action. Some of the actions include law enforcement enhancement, anti-drug enforcement and drug rehabilitation utilisation. In 2005, new anti-drug programs, such as the sterile needle exchange program and substitution therapy program, were also introduced. The cities implementing the Harm Reduction Program (HR Program) showed lower HIV infection rates in comparison to others without the HR Program. The income and employment conditions of drug addicted patients receiving Methadone Maintenance Treatment have been improved. The future drug policies in Taiwan will focus on drug rehabilitation (treatment), anti-drug actions (prevention) and law enforcement (punishment). The educational system, community recovery and aftercare for drug addicts will also be indispensable (WHO/UNODC/UNAIDS 2004)

Crystallization of Adenylylsulfate Reductase from Desulfovibrio gigas: A Strategy Based on Controlled Protein Oligomerization

Adenylylsulfate reductase (adenosine 5′-phosphosulfate reductase, APS reductase or APSR, E.C.1.8.99.2) catalyzes the conversion of APS to sulfite in dissimilatory sulfate reduction. APSR was isolated and purified directly from massive anaerobically grown Desulfovibrio gigas, a strict anaerobe, for structure and function investigation. Oligomerization of APSR to form dimers–α_2β_2, tetramers–α_4β_4, hexamers–α_6β_6, and larger oligomers was observed during purification of the protein. Dynamic light scattering and ultracentrifugation revealed that the addition of adenosine monophosphate (AMP) or adenosine 5′-phosphosulfate (APS) disrupts the oligomerization, indicating that AMP or APS binding to the APSR dissociates the inactive hexamers into functional dimers. Treatment of APSR with β-mercaptoethanol decreased the enzyme size from a hexamer to a dimer, probably by disrupting the disulfide Cys156—Cys162 toward the C-terminus of the β-subunit. Alignment of the APSR sequences from D. gigas and A. fulgidus revealed the largest differences in this region of the β-subunit, with the D. gigas APSR containing 16 additional amino acids with the Cys156—Cys162 disulfide. Studies in a pH gradient showed that the diameter of the APSR decreased progressively with acidic pH. To crystallize the APSR for structure determination, we optimized conditions to generate a homogeneous and stable form of APSR by combining dynamic light scattering, ultracentrifugation, and electron paramagnetic resonance methods to analyze the various oligomeric states of the enzyme in varied environments

Rainfall Estimation of Mesoscale Convective System Using AMSU-A Data During the Mei-Yu Season

This study aims to obtain the rate of rainfall (RR) over ocean areas using satellite data by establishing the relationship between Advanced Microwave Sounding Unit-A (AMSU-A) microwave brightness temperature (Tbs) data and island rain gauge rainfall. This study applied a rain identification technique developed by Grody et al. (1999) using AMSU-A data accepted to screen rain events over ocean areas. Using rain gauge data of Sakishima-shoto in Japan as a ground truth, validation of rain identification was conducted every May and June from 1999 to 2001. Including times of both rainfall and no rainfall, the overall rates of successful recognition were 87.3%, 87%, and 89% for 1999, 2000, and 2001, respectively. As for quantitative validation, the coefficient of determination was 0.72. To obtain further precipitation observations, another rainfall estimation retrieved by the TRMM Microwave Imager (TMI) data onboard the Tropical Rainfall Measuring Mission (TRMM) was compared with the AMSU-A data. The results displayed solid agreement in rainfall patterns and rain distribution. Additionally, when the AMSU-A RRs were multiplied by a factor of approximately 1.5 (particularly for heavy rainfalls), the intensities of the AMSU-A RRs roughly equaled those of the TMI RRs. Combining this data with the other satellite rainfall retrieval data, a series of AMSUA rain maps for sea areas were shown to mitigate the problem of relatively sporadic observations of rainfall at sea