Tonsillar tuberculosis with coexisting lymphoma: A case report

The co-existence of tuberculosis (TB) and lymphoma share similar presentations and both may masquerade each other leading to diagnostic dilemmas. Herein, we would like to report a case of an elderly man with existing TB in whom failing to respond to treatment led to investigations that unveiled the coexistence of a non-Hodgkin lymphoma. A 71-year-old man presented to our department with a one-month history of odynophagia and left submandibular swelling. He was treated with multiple courses of antibiotics but symptoms not resolving. Physical examination showed enlarged tonsils bilaterally with exudates. There was also a left cervical lymph node enlargement. Biopsy taken from both tonsils and histopathological examination (HPE) showed no malignancy. Biopsy was also sent for a Genexpert test for tuberculosis and the result was positive for Mycobacterium tuberculosis. A fine needle aspiration was taken from the neck mass and the result was non-diagnostic. As the result from the Genexpert test was positive, he was started on anti-TB treatment. After three months of treatment, the tonsils were still hypertrophied and the left neck nodes never resolved. Suspicion was raised and a second biopsy was done with an incisional biopsy taken from the left neck nodes. The tonsils biopsy still showed no malignancy but the HPE from the neck nodes showed diffuse large B-cell lymphoma. Patient was counselled for chemotherapy but refused. He succumbed to the disease three months after refusal of chemotherapy. The co-existence of extrapulmonary tuberculosis and lymphoma is rare, which leads to a diagnostic dilemma especially if one was not known to have underlying lymphoma. Tuberculosis will usually be suspected first due to our endemic nature and in this case, further investigations were only done when the symptoms were not resolving with anti-TB treatment. Therefore, suspicion of both conditions occurring concurrently should arise early if treatment was unsuccessful

Mannosyl electrochemical impedance cytosensor for label-free MDA-MB-231 cancer cell detection

A label-free and ultrasensitive electrochemical impedance cytosensor was developed to specifically detect the breast cancer cells MDA-MB-231 via the interaction between the mannosyl glassy carbon electrode (GCE) and the overexpressed mannose receptors on the target cell surface. The mannosyl GCE was prepared through electrografting of the amino-functionalized mannose derivatives on GCE surface in which a covalent bond was formed between carbon of the electrode and the amino group of the mannose derivative. The fluorescent microscopy indicated that the electrode is specific for MDA-MB-231 cells, with good biocompatibility for viable captured cells. The derivative with a shorter alkyl linker, mannose-C2NH2, showed a better sensitivity than that with a longer linker, mannose-C6NH2. GCE modified with amino-functionalized galactose derivative, galactose-C2NH2, shows no function to the detection of MDA-MB-231 cells. The specific interaction between the mannosyl GCE and Con A (a mannose-binding lectin) or MDA-MB-231 breast cancer cells with overexpressed mannose receptors was determined through the change of peak separation in the cyclic voltammogram or the change of charge transfer resistance in the electrochemical impedance spectra (Nyquist plot) in the electrolytes containing a reversible redox couple [Fe(CN)6]3-/[Fe(CN)6]4-. The charge transfer resistance in the Nyquist plots linearly depended on the concentration of MDA-MB-231 cells (1.0 × 10-1.0 × 105 cells mL-1, with 10 cells mL-1 being the lower detection limit). Introducing 0.1% polyethylene glycol-200 (PEG-200) was able to prevent the interference caused by 1.0 × 103 HEK-293T cells mL-1, a non-cancer cell line (control)

Monsoon effect simulation on typhoon rainfall potential - Typhoon Morakot (2009)

A record breaking extreme precipitation event produced 3000 mm day-1 of accumulated rainfall over southern Taiwan in August 2009. The interactions between Typhoon Morakot and the prevailing southwesterly (SW) monsoon are the primary mechanism for this heavy precipitation during 5 - 13 August 2009. This extreme precipitation could be produced by the abundant moisture from the SW monsoon associated with the interaction between typhoon and monsoon wind fields, leading to severe property damage. The accurate mapping of extreme precipitation caused from the interaction between a monsoon and typhoon is critical for early warning in Taiwan. This study simulates the heavy rainfall event is based on the Weather Research and Forecast system model (WRF) using the three nested domain configuration. Using data assimilation with a virtual meteorological field using the 3D-Var system, such as wind field to alter the SW monsoon strength in the initial condition, the impacts of intensified convergence and water vapor content on the accumulated rainfall are analyzed to quantize the intensification of typhoon rainfall potential. The results showed a positive correlation between the enhanced precipitation and the intensity of low-level wind speed convergence as well as water vapor content. For the Typhoon Morakot case study the rainfall for could attain approximately 2 × 104 mm at 6 hours interval in the southern Taiwan area when 10 × 10-6 s-1 convergence intensified at 850 hPa level around the southern part of the Taiwan Strait. These results suggest that low-level wind speed, convergence and water vapor content play key roles in the typhoon rainfall potential coupled with the SW monsoon

Developing a sustainable competitive advantage: absorptive capacity, knowledge transfer and organizational learning

[[abstract]]This study proposes a theoretical model to investigate a sustainable competitive advantage (CA) by developing the absorptive capacity (AC), knowledge transfer (TR), organizational learning (OL) and in Taiwan’s financial and high technology industries. Structural equation modeling is employed to examine the influence between each variable and whether their relationships are varied in these two different industries. The study population comprises the top 100 financial and top 1000 high-technology enterprises in Taiwan published by Common Wealth Magazine in 2012. A total of 345 valid responses were collected. The research results indicate that OL serves as partial and full mediators between AC, TR and CA respectively. In addition, moderating effect exists in different industries on the theoretical model. Finally, discussion and implications are described for concluding research findings.[[notice]]補正完

Forty years of IVF

This monograph, written by the pioneers of IVF and reproductive medicine, celebrates the history, achievements, and medical advancements made over the last 40 years in this rapidly growing field

Ezetimibe added to statin therapy after acute coronary syndromes

BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known. METHODS: We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization ( 6530 days after randomization), or nonfatal stroke. The median follow-up was 6 years. RESULTS: The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P<0.001). The Kaplan-Meier event rate for the primary end point at 7 years was 32.7% in the simvastatin-ezetimibe group, as compared with 34.7% in the simvastatin-monotherapy group (absolute risk difference, 2.0 percentage points; hazard ratio, 0.936; 95% confidence interval, 0.89 to 0.99; P = 0.016). Rates of pre-specified muscle, gallbladder, and hepatic adverse effects and cancer were similar in the two groups. CONCLUSIONS: When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit