Actinomycosis of the Gallbladder: A Case Report

Introduction: Actinomycosis of the gallbladder is extremely rare and may mimic a malignancy leading to delayed diagnosis and/or inappropriate treatment.Presentation of case: Here we report the case of an 82-year-old man who presented with right upper abdominal discomfort for one month. Radiographically, an ill-defined mass was found in the gallbladder fossa that invaded the adjacent abdominal wall and liver bed. In addition, a stone was found in the gallbladder lumen. The imaging features suggested a gallbladder carcinoma. An initial CT-guided needle biopsy showed an inflammatory process. The subsequent open cholecystectomy revealed a contracted, thick-walled gallbladder surrounded by a soft tissue mass near the fundus. Histologically, the gallbladder revealed acute and chronic cholecystitis and microabscesses containing sulfur granules in the soft tissue mass, which showed Gram-positive filamentous bacilli. Under the diagnosis of gallbladder actinomycosis, the patient received post-operative antibiotics for 7 weeks and was well 5 months after diagnosis.Conclusion: Our case demonstrated that a gallbladder actinomycosis should be considered in the differential diagnosis in patients with cholelithiasis and cholecystitis presenting an invasive mass in the gallbladder fossa

Levels and values of circulating endothelial progenitor cells, soluble angiogenic factors, and mononuclear cell apoptosis in liver cirrhosis patients

BACKGROUND: The roles of circulating endothelial progenitor cell (EPC) and mononuclear cell apoptosis (MCA) in liver cirrhosis (LC) patients are unknown. Moreover, vascular endothelial growth factor (VEGF) and stromal cell-derived factor (SDF)-1α are powerful endogenous substances enhancing EPC migration into circulation. We assessed the level and function of EPCs [CD31/CD34 (E(1)), KDR/CD34 (E(2)), CXCR4/CD34 (E(3))], levels of MCA, VEGF and SDF-1α in circulation of LC patients. METHODS: Blood sample was prospectively collected once for assessing EPC level and function, MCA, and plasma levels of VEGF and SDF-1α using flow cytometry and enzyme-linked immunosorbent assay (ELISA), respectively, in 78 LC patients and 25 age- and gender-matched healthy controls. RESULTS: Number of EPCs (E(1), E(2), E(3)) was lower (all p < 0.0001), whereas SDF-1α level and MCA were higher (p < 0.001) in study patients compared with healthy controls. Number of EPCs (E(2), E(3)) was higher but MCA was lower (all p < 0.05) in Child's class A compared with Child's class B and C patients, although no difference in VEGF and SDF-1α levels were noted among these patients. Chronic hepatitis B and esophageal varices bleeding were independently, whereas chronic hepatitis C, elevated aspartate aminotransferase (AST), and decompensated LC were inversely and independently correlated with circulating EPC level (all p < 0.03). Additionally, angiogenesis and transwell migratory ability of EPCs were reduced in LC patients than in controls (all p < 0.001). CONCLUSION: The results of this study demonstrated that level, angiogenic capacity, and function of circulating EPCs were significantly reduced, whereas plasma levels of SDF-1α and circulating MCA were substantially enhanced in cirrhotic patients

Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy

Objective Diseases of the craniovertebral junction (CVJ) are commonly associated with deformity, malalignment, and subsequent myelopathy. The misaligned CVJ might cause compression of neuronal tissues and subsequently clinical symptoms. The triangular area (TA), measured by magnetic resonance imaging/images (MRI/s), is a novel measurement for quantification of the severity of compression to the brain stem. This study aimed to assess the normal and pathological values of TA by a comparison of patients with CVJ disease to age- and sex-matched controls. Moreover, postoperative TAs were correlated with outcomes. Methods Consecutive patients who underwent surgery for CVJ disease were included for comparison to an age- and sex-matched cohort of normal CVJ persons as controls. The demographics, perioperative information, and pre- and postoperative 2-year cervical MRIs were collected for analysis. Cervical TAs were measured and compared. Results A total of 201 patients, all of whom had pre- or postoperative MRI, were analyzed. The TA of the CVJ deformity group was larger than the healthy control group (1.62 ± 0.57 cm2 vs. 1.01 ± 0.18 cm2, p < 0.001). Moreover, patients who had combined anterior odontoidectomy and posterior laminectomy with fixation had the greatest reduction in the TA (1.18 ± 0.58 cm2). Conclusion In CVJ deformity, the measurement of the cervical TA could indicate the severity of brain stem compression. After surgery, the TA had a varying degree of improvement, which could represent the efficacy of surgery

Hybrid Surface-Enhanced Raman Scattering Substrate from Gold Nanoparticle and Photonic Crystal: Maneuverability and Uniformity of Raman Spectra

[[abstract]]A novel hybrid surface-enhanced Raman scattering (SERS) substrate based on Au nanoparticles decorated inverse opal (IO) photonic crystal (PhC) is presented. In addition to the enhancement contributed from Au nanoparticles, a desired Raman signal can be selectively further enhanced by appropriately overlapping the center of photonic bandgap of the IO PhC with the wavelength of the Raman signal. Furthermore, the lattice structure of the IO PhC provides excellent control of the distribution of Au nanoparticles to produce SERS spectra with high uniformity. The new design of SERS substrate provides extra maneuverability for ultra-high sensitivity sensor applications.[[notice]]補正完

Application of single-incision transvaginal mesh in a woman undergoing peritoneal dialysis and suffering from refractory advanced stage pelvic organ prolapse

Objective: We would like to provide an option of minimal invasive surgical intervention for a patient with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis, who was at the advanced-stage pelvic organ prolapse (POP) and who also failed to be treated conservatively. Materials and method: We present a case of uterine prolapse stage IV in a woman who underwent continuous ambulatory peritoneal dialysis due to end-stage renal disease. Her severity of POP had only limited improvement after being switched to hemodialysis and vaginal cream use. After her informed consent, we performed a uterus-sparing transvaginal mesh procedure to adjust the anterior, apical, and posterior defects of pelvis. Results: There has been no recurrence of any compartment of POP during the 16-month follow-up period, nor any mesh-related complications. The perineal swelling subsided after switching to nocturnal automated peritoneal dialysis only in the supine position. Conclusion: Patients with POP at an advanced stage during peritoneal dialysis who failed to be treated conservatively may require a surgical intervention. Uterus-sparing transvaginal mesh was a feasible minimal invasive option

Effect of Extended Extinction from Gold Nanopillar Arrays on the Absorbance Spectrum of a Bulk Heterojunction Organic Solar Cell

We report on the effects of enhanced absorption/scattering from arrays of Au nanopillars of varied size and spacing on the spectral response of a P3HT:PCBM bulk heterojunction solar cell. Nanopillar array-patterned devices do show increased optical extinction within a narrow range of wavelengths compared to control samples without such arrays. The measured external quantum efficiency and calculated absorbance, however, both show a decrease near the corresponding wavelengths. Numerical simulations indicate that for relatively narrow nanopillars, the increased optical extinction is dominated by absorption within the nanopillars, rather than scattering, and is likely dissipated by Joule heating

Acoustic Inspection of Bond Strength Between Mortar and Reinforcement

Bond degradation has become a common, and sometimes critical problem for aging concrete bridges. Corrosion due to sea water, water pollution, acid rain as well as high salt content in concrete and its composition are threatening the structure integrity. Among the issues related to corrosion prevention and inspection, bond strength is of great concern [1,2]. The bond strength and fiber pull-out have between fiber and surrounding composite materials have been studied by Cairns and Jones[3], Kim et al. [4] and Naaman et al. [5]. Both bond split and slip are of interests for cement-based matrices and steel reinforcing bars (so called rebar). Current study is part of an investigation aiming to simplify the inspection of corrosion and to improve the analysis of bond strength for steel reinforced concrete structure.</p

A rare presentation of adult T-cell leukemia/lymphoma with generalized cutaneous purpuric lesions

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive malignancy caused by human T-cell lymphotropic virus type 1. The disease is characterized by the presence of pleomorphic lymphocytes and cutaneous purpuric eruptions with skin, lymph node, visceral organs, central nervous system, and bone marrow involvement. We herein present the case of a 70-year-old man diagnosed with ATLL. The patient developed unique generalized cutaneous purpuric eruptions with systemic involvement including the gastrointestinal tract, peripheral blood, and bone marrow. Despite advanced chemotherapeutic treatment, he died about 5 months later due to a rapid progressive clinical course. Therefore, generalized cutaneous purpuric eruptions could be a poorer prognostic factor in the aggressive subtype of acute ATLL