A Follow-up Study of Neonatal Interatrial Shunt with Echocardiography until Twelve to Fifteen Months of Age

ObjectiveTo assess the incidence and natural history of full-term neonates with interatrial shunt (IAS).MethodsA follow-up study of 1389 neonates who received screening echocardiography between 2003 and 2006. Babies with IAS at 2 to 4 days of life underwent follow-up echocardiography at 2 to 4 months, 6 to 9 months and 12 to 15 months of age until closure of IAS.ResultsThe ratio of IAS was 68.3% initially. No significant demographic differences were identified between infants with and without initial IAS. Among 949 neonates with initial IAS, 84.5% infants had a left-to-right interatrial shunt, 13.5% had bidirectional shunt and 2% had predominantly right-to-left shunt. The persistence rate of IAS at 12 to 15 months of age was 3.8% (44/1166). The initial size of IAS ranged from 1.2 to 7.7 mm (4.3 ± 1.1 mm) detected by color Doppler flow mapping and cases were divided into three groups: small (≦5 mm), medium (5 to 8 mm) and large group (≧8 mm). There were 74.6% infants in the small group and 25.4% in the medium group initially. The neonates in the initial small group would always see their IAS close or else they would remain in the small group. Those in the final medium and large size groups always came from the initial medium group. The late closure rate of IAS was 93.9% of infants with initial IAS. The closure curves of initial small and medium sized groups were significantly different, and their late closure rates were 95.1% and 90.4%, respectively.ConclusionsIAS was very common during early neonatal stage, but most cases would close after 1 year. The late closure rate of initial IAS was different if using a cutpoint of 5 mm

A Case of Radiation-Induced Multifocal Laryngeal Angiosarcoma Presenting as a Diagnostic Dilemma

Head and neck sarcomas are relatively rare tumors, with angiosarcomas representing a small subset. Angiosarcoma is a malignant endothelial neoplasm characterized by atypical, multilayered, or solid endothelial proliferation with vasoformative architecture. The global incidence of irradiation-associated sarcoma is estimated as between 0.03% and 0.08%. Here we reported the case of an elderly woman previously treated with radiation more than 20 years ago for an unknown primary of head and neck. This interesting case presented as a diagnostic challenge, and multiple biopsies were required to eventually establish the diagnosis of laryngeal angiosarcoma. We additionally have confirmation from our prior radiation records that the patient did, in fact, receive a substantial dose of radiation to the site previously. To our knowledge, this case represents the first report of a documented radiation-induced multifocal laryngeal angiosarcoma

Proactive measures of governmental debt guarantees to facilitate Public-Private Partnerships project

Governmental Debt Guarantees (GDGs) are often used to encourage involvement by promoters and financial institutions in Public-Private Partnerships (PPP) projects. However, even after demonstrating the bankability of a project and reducing debt cost, the success of the project may be prevented by the lack of long-term commitment from shareholders. Equity contributions by promoters in the project company may be recovered from earnings on short-term construction activities. Based on lesson learned from early PPP projects with GDG, the hold-up problem for government in the view of transaction cost economic (TCE) theory may worsen if the designed contractual structure does not adequately manage opportunistic behaviours from promoters. This study empirically examined the effects of a structured GDG mechanism with particular complementary measures applied in joint projects to develop the Taipei Mass Rapid Transit (MRT) stations. A GDG game model was then applied to bridge the theoretical gap based on the Taipei MRT experience. The analysis shows that requiring the promoter to provide sufficient equity and ensuring the commitment of the lender to provide the loan are the appropriate proactive measures. This study demonstrates its practical value for policy makers by combining case study, TCE and game theory in contractual issues

WU-LING-SAN FORMULA PROPHYLAXIS AGAINST RECURRENT CALCIUM OXALATE NEPHROLITHIASIS - A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Wu-Ling-San (WLS) formula has been proved to prevent calcium oxalate nephrolithiasis both in vitro and in vivo. This is the first prospective, randomized and placebo-controlled clinical trial of WLS in calcium oxalate nephrolithiasis prevention. All patients who enrolled were asked to drink enough fluid to urinate at least 2 L daily during the study period. A 24-hour urine collection was performed to establish the baseline levels of multiple urinary parameters before taking the medicine. The patients were randomized and divided into two groups. The medication group took 2 gm WLS formula three times daily for 1 month. The control group took 2 gm placebo three times daily for 1 month. A 24-hour urine collection was performed to evaluate multiple urinary and serum parameters from all patients during the study period. A total of 39 patients were enrolled and 28 patients completed the study. Fourteen patients were allocated to WLS group and 14 patients to placebo group. After treatment, the mean urine output level increased to 2796.4 525.7 ml/day (percentage of change, 13.9 %) in the WLS formula group. With placebo therapy, the mean decreased slightly to 2521.4 762.7ml/day (percentage of change, -5.7 %). The percentage of change was significantly different between the two groups (independent t-test, P=0.02). No patient complained of side effects, such as fatigue, dizziness, musculoskeletal symptoms, or gastrointestinal disturbance. WLS formula is a promising adjunct to surgical and medical management of kidney stones. Active therapy with WLS formula has a positive effect on diuresis without leading to electrolyte imbalance

Cyclin D1 and p16 expression in recurrent nasopharyngeal carcinoma

Abstract Background Cyclin D1 and p16 are involved in the regulation of G1 checkpoint and may play an important role in the tumorigenesis of nasopharyngeal carcinoma (NPC). Previous studies have examined the level of expression of cyclin D1 and p16 in primary untreated NPC but no such information is available for recurrent NPC. We set out in this study to examine the expression level of cyclin D1 and p16 in recurrent NPC that have failed previous treatment with radiation +/- chemotherapy. Patients and methods A total of 42 patients underwent salvage nasopharyngectomy from 1984 to 2001 for recurrent NPC after treatment failure with radiation +/- chemotherapy. Twenty-seven pathologic specimens were available for immunohistochemical study using antibodies against cyclin D1 and p16. Results Positive expression of cyclin D1 was observed in 7 of 27 recurrent NPC specimens (26%) while positive p16 expression was seen in only 1 of 27 recurrent NPC (4%). Conclusion While the level of expression of cyclin D1 in recurrent NPC was similar to that of previously untreated head and neck cancer, the level of p16 expression in recurrent NPC samples was much lower than that reported for previously untreated cancer. The finding that almost all (96%) of the recurrent NPC lack expression of p16 suggested that loss of p16 may confer a survival advantage by making cancer cells more resistant to conventional treatment with radiation +/- chemotherapy. Further research is warranted to investigate the clinical use of p16 both as a prognostic marker and as a potential therapeutic target

Baseband Transceiver Design of a High Definition Radio FM System Using Joint Theoretical Analysis and FPGA Implementation

Advances in wireless communications have enabled various technologies for wireless digital communication. In the field of digital radio broadcasting, several specifications have been proposed, such as Eureka-147 and digital radio mondiale (DRM). These systems require a new spectrum assignment, which incurs heavy cost due to the depletion of the available spectrum. Therefore, the in-band on-channel (IBOC) system has been developed to work in the same band with the conventional analog radio and to provide digital broadcasting services. This paper discusses the function and algorithm of the high definition (HD) radio frequency modulation (FM) digital radio broadcasting system. Content includes data format allocation, constellation mapping, orthogonal frequency division multiplexing (OFDM) modulation of the transmitter, timing synchronization, OFDM demodulation, integer and fraction carrier frequency (integer carrier frequency offset (ICFO) and fractional CFO (FCFO)) estimation, and channel estimation of the receiver. When we implement this system to the field programmable gate array (FPGA) based on a hardware platform, both theoretical and practical aspects have been considered to accommodate the available hardware resources

Factors for poor prognosis of neonatal bacterial meningitis in a medical center in Northern Taiwan

BackgroundBacterial meningitis has long been a severe infectious disease in neonates, as well as a leading cause of adverse outcomes. We designed this study to know the factors for poor prognosis in neonatal bacterial meningitis.MethodsWe enrolled children aged less than 1 month who were admitted to Mackay Memorial Hospital from 1984 to 2008 and had culture-proven bacterial meningitis. The laboratory data and children’s clinical features were recorded. The patients’ outcomes were divided into four groups: death, having sequelae, complete recovery, and loss to follow-up. Patients with the outcomes of death and having sequelae were regarded as having a poor prognosis. Those who were lost to follow-up were excluded from the analysis of outcome. Multivariate analyses were performed to find the risk factors for poor prognosis.ResultsOne hundred fifty-six neonates fulfilled the inclusion criteria. Among these, 96 were boys (61.5%) and 102 (65.4%) had concomitant bacteremia. Group B streptococci (39.1%) and Escherichia coli (20.1%) were the two leading pathogens. Excluding those who were lost to follow-up (4.5%), 22 of 149 patients (14.8%) died, 36 (24.2%) had sequelae, and 91 (61.1%) recovered completely. Cerebrospinal fluid (CSF) protein more than 500 mg/dL at admission {odds ratio (OR): 171.18 [95% confidence interval (CI): 25.6–1000]}, predisposition to congenital heart disease [OR: 48.96 (95% CI: 6.06–395.64)], hearing impairment found during hospitalization [OR: 23.40 (95% CI: 3.62–151.25)], and seizure at admission or during hospitalization [OR: 10.10 (95% CI: 2.11–48.32)] were the factors predicting poor prognosis.ConclusionIn this 25-year study of newborns with bacterial meningitis, approximately one-seventh of the patients died, while two-fifths had sequelae. Nearly two-thirds of these had concomitant bacteremia. Group B streptococci and E. coli remained the two leading pathogens throughout the study period. Several factors for poor prognosis in newborns with culture-proven bacterial meningitis were found: high CSF protein concentration, congenital heart disease, hearing impairment, and seizure

All-Trans Retinoic Acid Induces DU145 Cell Cycle Arrest through Cdk5 Activation

All-trans retinoic acid (ATRA), the active form of vitamin A, plays an important role in the growth arrest of numerous types of cancer cells. It has been indicated that cyclin-dependent kinase 5 (Cdk5) activity can be affected by ATRA treatment. Our previous results demonstrate the involvement of Cdk5 in the fate of prostate cancer cells. The purpose of this study is to examine whether Cdk5 is involved in ATRA-induced growth arrest of the castration-resistant cancer cell line DU145 through up-regulating Cdk inhibitor protein, p27