Acute generalized exanthematous pustulosis: A retrospective study of 51 cases in Taiwan

AbstractBackground/ObjectiveAcute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse drug reaction characterized by fever and numerous sterile non-follicular pustules. It is mainly attributed to drugs, although other factors have been implicated. The objective of this study was to evaluate the clinical and histological features of AGEP in a Taiwanese population.MethodsIn this retrospective study, we reviewed patients diagnosed with AGEP with a EuroSCAR (RegiSCAR) validation score more than 4 (>4, probable to definite cases), between 1992 and 2012 at the Chang Gung Memorial Hospital in Taiwan. Demographic, clinical and laboratory data, pathologic findings, and disease causality were analyzed.ResultsA total of 51 patients were included in this study, with 34 (66.7%) patients being diagnosed with AGEP with drug causality, and 17 (33.3%) patients being diagnosed with AGEP without drug causality. Cases of AGEP with drug causality showed an older average age, and a significantly higher rate of previous drug hypersensitivity history compared to cases of AGEP without drug causality (p = 0.0018). None of the patients had a history of psoriasis or had developed psoriasis at the 1-year follow-up. A total of 12 cases (23.5%) had systemic involvement, including liver and kidneys. Penicillin or aminopenicillin (17.6%) and cephalosporins (17.6%) were the most common causative drug groups related to AGEP. In AGEP patients without drug causality, three cases of pathogen infections were identified (1 case of mycoplasma, Coxsackie virus, and Epstein-Barr virus, respectively).ConclusionWe found that beta-lactam antibiotics were the major drug class responsible for inducing AGEP in a Taiwanese population, but that some infectious pathogens may also contribute to AGEP development

The Influence Of Knowledge Management On Market-Related Performance Through Business Process Effectiveness: An Empirical Investigation Of Hospitals And Financial Firms

Knowledge-based resources are critical in service sectors for facing the challenges of dynamic markets and helping organizations manage changes in consumer preference. Knowledge application is needed to improve the business process in order to attain superior market-related performance because there is the unperfected imitation coming from causal ambiguity. However, there is a lack of empirical study in examining the effect of KM and the effect of the business process within the scope of service sectors. This study examines how KM infrastructure supports and KM capabilities influence market-related performance through business processes effectiveness. Data collections of two studies are from 166 hospitals and 106 financial firms. The findings indicate a positive relationship between KM infrastructure and KM capability, and that they have a positive influence on market-related performance through business process effectiveness. For improving this process, the effect of KM infrastructure is greater than the effect of KM capabilities in hospitals. But the effect of KM capabilities is greater than the effect of KM infrastructure in financial firms. The implications of these findings for research and practices in hospitals and financial firms are also discussed

Epidermal growth factor receptor regulates β-catenin location, stability, and transcriptional activity in oral cancer

<p>Abstract</p> <p>Background</p> <p>Many cancerous cells accumulate β-catenin in the nucleus. We examined the role of epidermal growth factor receptor (EGFR) signaling in the accumulation of β-catenin in the nuclei of oral cancer cells.</p> <p>Results</p> <p>We used two strains of cultured oral cancer cells, one with reduced EGFR expression (OECM1 cells) and one with elevated EGFR expression (SAS cells), and measured downstream effects, such as phosphorylation of β-catenin and GSK-3β, association of β-catenin with E-cadherin, and target gene regulation. We also studied the expression of EGFR, β-catenin, and cyclin D1 in 112 samples of oral cancer by immunostaining. Activation of EGFR signaling increased the amount of β-catenin in the nucleus and decreased the amount in the membranes. EGF treatment increased phosphorylation of β-catenin (tyrosine) and GSK-3β(Ser-(9), resulting in a loss of β-catenin association with E-cadherin. TOP-FLASH and FOP-FLASH reporter assays demonstrated that the EGFR signal regulates β-catenin transcriptional activity and mediates cyclin D1 expression. Chromatin immunoprecipitation experiments indicated that the EGFR signal affects chromatin architecture at the regulatory element of cyclin D1, and that the CBP, HDAC1, and Suv39h1 histone/chromatin remodeling complex is involved in this process. Immunostaining showed a significant association between EGFR expression and aberrant accumulation of β-catenin in oral cancer.</p> <p>Conclusions</p> <p>EGFR signaling regulates β-catenin localization and stability, target gene expression, and tumor progression in oral cancer. Moreover, our data suggest that aberrant accumulation of β-catenin under EGFR activation is a malignancy marker of oral cancer.</p

A robust clustering procedure for fuzzy data

AbstractIn this paper we propose a robust clustering method for handling LR-type fuzzy numbers. The proposed method based on similarity measures is not necessary to specify the cluster number and initials. Several numerical examples demonstrate the effectiveness of the proposed robust clustering method, especially robust to outliers, different cluster shapes and initial guess. We then apply this algorithm to three real data sets. These are Taiwanese tea, student data and patient blood pressure data sets. Because tea evaluation comes under an expert subjective judgment for Taiwanese tea, the quality levels are ambiguity and imprecision inherent to human perception. Thus, LR-type fuzzy numbers are used to describe these quality levels. The proposed robust clustering method successfully establishes a performance evaluation system to help consumers better understand and choose Taiwanese tea. Similarly, LR-type fuzzy numbers are also used to describe data types for student and patient blood pressure data. The proposed method actually presents good clustering results for these real data sets

Complementary Therapy with Traditional Chinese Medicine for Neonatal Hypoxic Ischemic Encephalopathy

Hypoxic ischemic encephalopathy (HIE) is one of the most significant causes of morbidity, mortality, and lifelong disability in newborns. The diagnosis of neonatal HIE is based on the dysfunction of neurogenic signs and classification according to the Sarnat staging system, which evaluates conscious level, neuromuscular control, complex reflexes, autonomic function, seizures, electroencephalogram readings, and duration of neurologic sign. There is no standard treatment for neonatal HIE, but it is widely accepted that hypothermia therapy is a safe and effective method for treating neonates with HIE. Traditional Chinese medicine (TCM) has recently been used to treat cases of neonatal HIE, especially herbal medicine prescriptions. Acupuncture is a common method used in TCM and is another promising therapy for neonatal HIE due to its demonstrated effective treatment of the disease in animal models. While there is a lack of direct evidence in clinical practice, we have observed acupuncture to be useful in adult HIE and in animal studies; therefore, we believe a clinical trial designed to evaluate the effectiveness of acupuncture in neonatal HIE treatment is worthwhile. Taken together, TCM is a promising technique that can be integrated into the conventional therapies for neonatal HIE