Primary Tuberculous Abscess of the Spleen in an Immununocompetent Patient Diagnosed by Biochemical Markers and Radiologic Findings

Tuberculous splenic abscess in an immunocompetent patient is extremely rare. We came across a case of middle aged immunocompetent female who presented with abdominal distension, weight loss, and low grade fever. Abdominopelvic computed tomography showed multiple low density lesions in the spleen with ascites. Interferon-gamma release assay was positive and adenosine deaminase level of ascites was significantly high. No primary focus of infection was detected. The patient was diagnosed as having primary multiple tuberculous splenic abscesses with tuberculous peritonitis causing ascites. Follow up computed tomography, after completion of six month course of anti-tubercular therapy, showed splenic abscess and ascites completely disappeared

Myocardial Infarction Thought to be Provoked by Local Epinephrine Injection During Endoscopic Submucosal Dissection

Due to its hemostatic effect, local epinephrine has been used to minimize mucosal bleeding during endoscopic submucosal dissection (ESD), but its clinical benefit remains unclear. On the other hand, several adverse events deemed to be caused by epinephrine have been observed during ESD. A 73-year-old woman developed myocardial infarction after ESD for a large rectal adenoma, and an 80-year-old woman developed abrupt chest tightness during ESD. In both patients, changes on electrocardiogram and elevated cardiac markers provided evidence of myocardial ischemia. The patients were transferred to the cardiac care unit and recovered completely. Up to our knowledge this is the first report of myocardial infarction thought to be provoked by submucosal epinephrine injection during ESD

Development of Pseudomembranous Colitis Four Months after Initiation of Rifampicin

Pseudomembranous colitis (PMC) may develop with long-term antibiotic administration, but is rarely reported to be caused by antitubercular agents. We present a case of PMC that occurred 120 days after starting rifampicin. A 74-year-old man was diagnosed with pulmonary tuberculosis and started on a standard HERZ regimen (isoniazid, ethambutol, rifampicin, pyrazinamide). After 4 months of HERZ, he presented with frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain. Sigmoidoscopy revealed multiple whitish plaques with edematous mucosa that were compatible with PMC. Biopsies from these lesions showed ulcer-related necrotic and granulation tissue. We stopped antitubercular treatment and started the patient on oral metronidazole. His symptoms completely resolved within 2 weeks. Antitubercular treatment was restarted by replacing rifampicin with levofloxacin. The patient did not present with diarrhea or bloody stool throughout the rest of treatment

Genetic variation of aldolase from Korean isolates of Plasmodium vivax and its usefulness in serodiagnosis

Background: The malaria aldolase is widely used as rapid diagnostic test (RDT), but the efficacy in aspect of its serological effectiveness in diagnosis is not known. The genetic variation of Korean isolates was analysed and recombinant aldolase was evaluated as a serological antigen in Plasmodium vivax malaria. Methods: Genomic DNA was purified and the aldolase gene of P. vivax from 25 patients’ blood samples was amplified. The samples came from 5 epidemic areas; Bucheon-si, Gimpo-si, Paju-si of Gyeonggido, Gangwha-gun of Incheon metropolitan city, and Cheorwon of Gangwon-do, South Korea. The antigenicity of the recombinant aldolase was tested by western blot and enzyme-linked immunosorbent assay (ELISA). Results: Sequence analysis of 25 Korean isolates of P. vivax showed that the open reading frame (ORF) of 1,110 nucleotides encoded a deduced protein of 369 amino acids (aa). This ORF showed 100% homology with the P. vivax Sal I strain (XM_00165894) and P. vivax WDK strain (AF247063), 87.4% homology with Plasmodium falciparum (AF179421), 90.6% homology with Plasmodium chabaudi (AF247060), 89.5% homology with Plasmodium vinckei (AF247061), and 96.7% homology with Plasmodium knowlesi. A single nucleotide polymorphism (SNP) at nucleotide 180 (G to A, n = 5) was also observed in the isolates. The expressed recombinant protein had a molecular weight of approximately 31 kDa (monomeric form) and 62 kDa (dimeric form) as analysed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis. Among 109 P. vivax patients, 32 (29.4%) had positive in an enzyme-linked absorbance assay (ELISA). This result showed significant correlation between ELISA and an indirect fluorescent antibody test (IFAT) (P < 0.0001). Conclusions: The aldolase gene from Korean isolates of P. vivax showed one SNP at nucleotide position 180; this SNP mutant was discovered in only the western part of Han River, and included the regions of Ganghwa, Gimpo, and Bucheon. Based on the results, the relationship between antibody production against aldolase and the pattern of disease onset should be more investigated before using aldolase for serodiagnosis

Pattern of distant recurrence according to the molecular subtypes in Korean women with breast cancer

<p>Abstract</p> <p>Background</p> <p>Distant recurrence is one of the most important risk factors in overall survival, and distant recurrence is related to a complex biologic interaction of seed and soil factors. The aim of the study was to investigate the association between the molecular subtypes and patterns of distant recurrence in patients with breast cancer.</p> <p>Methods</p> <p>In an investigation of 313 women with breast cancer who underwent surgery from 1994 and 2000, the expressions of estrogen and progestrone receptor (ER/PR), and human epithelial receptor-2 (HER2) were evaluated. The subtypes were defined as luminal-A, luminal-HER2, HER2-enriched, and triple negative breast cancer (TNBC) according to ER, PR, and HER2 status.</p> <p>Results</p> <p>Bone was the most common site of distant recurrence. The incidence of first distant recurrence site was significantly different among the subtypes. Brain metastasis was more frequent in the luminal-HER2 and TNBC subtypes. In subgroup analysis, overall survival in patients with distant recurrence after 24 months after surgery was significantly different among the subtypes.</p> <p>Conclusions</p> <p>Organ-specific metastasis may depend on the molecular subtype of breast cancer. Tailored strategies against distant metastasis concerning the molecular subtypes in breast cancer may be considered.</p

TSLP Induces Mast Cell Development and Aggravates Allergic Reactions through the Activation of MDM2 and STAT6

Thymic stromal lymphopoietin (TSLP) is known to promote T helper type 2 cell–associated inflammation. Mast cells are major effector cells in allergic inflammatory responses. We noted that the population and maturation of mast cells were reduced in TSLP-deficient mice (TSLP-/-). Thus, we hypothesized that TSLP might affect mast cell development. We found that TSLP induced the proliferation and differentiation of mast cells from bone marrow progenitors. TSLP-induced mast cell proliferation was abolished by depletion of mouse double minute 2 (MDM2) and signal transducers and activators of transcription 6 (STAT6), as an upstream activator of MDM2. TSLP-/-, in particular, had a considerable deficit in the expression of MDM2 and STAT6. Also, the TSLP deficiency attenuated mast cell–mediated allergic reactions through the downregulation of STAT6 and MDM2. In an antibody microarray chip analysis, MDM2 expression was increased in atopic dermatitis patients. These observations indicate that TSLP is a factor for mast cell development, and that it aggravates mast cell–mediated immune responses

Determinants of respiratory symptom development in patients with chronic airflow obstruction

SummaryBackgroundThis study was undertaken to identify the determinants of respiratory symptom development in patients with chronic airflow obstruction (CAO).MethodsCategories of symptomatic and asymptomatic CAO were defined using questionnaire responses and spirometric results. We analyzed data obtained as part of the second South Korean National Health and Nutrition Examination Survey (Korean NHANES II).ResultsAmong 187 patients with CAO, 69 had no respiratory symptoms. CAO patients with symptoms were significantly older than those without symptoms (P=0.026), and hypertension was more common among symptomatic CAO patients than among asymptomatic CAO patients (P=0.005). According to questionnaire responses, symptomatic CAO patients had more difficulty in walking or lifting (P<0.001), required more help with personal care (P=0.01), and had poorer general health than asymptomatic CAO patients (P=0.008). Symptomatic CAO patients had higher fasting blood glucose levels than asymptomatic CAO patients (P=0.028). Symptomatic CAO patients had significantly lower forced expiratory volume in 1s (FEV1) (P=0.001), forced vital capacity (FVC) (P=0.008), and a ratio of FEV1/FVC than asymptomatic CAO patients (P<0.001). Statistically significant predictors of symptom development were as follows: age (odds ratio (OR) 1.04, P=0.028), hypertension (OR 4.41, P=0.008), fasting blood glucose (OR 1.02, P=0.034), FEV1 (OR 0.07, P=0.002), FVC (OR 0.08, P=0.009), FEV1/FVC (OR 0.00, P=0.001). Multiple logistic regression analyses revealed two independent factors associated with symptom development: FEV1/FVC (OR 0.001, P=0.002) and hypertension (OR 5.95, P=0.005).ConclusionsIn CAO, respiratory symptom development is significantly associated with low FEV1/FVC and the presence of hypertension

A wearable multiplexed silicon nonvolatile memory array using nanocrystal charge confinement

Strategies for efficient charge confinement in nanocrystal floating gates to realize high-performance memory devices have been investigated intensively. However, few studies have reported nanoscale experimental validations of charge confinement in closely packed uniform nanocrystals and related device performance characterization. Furthermore, the system-level integration of the resulting devices with wearable silicon electronics has not yet been realized. We introduce a wearable, fully multiplexed silicon nonvolatile memory array with nanocrystal floating gates. The nanocrystal monolayer is assembled over a large area using the Langmuir-Blodgett method. Efficient particle-level charge confinement is verified with the modified atomic force microscopy technique. Uniform nanocrystal charge traps evidently improve the memory window margin and retention performance. Furthermore, the multiplexing of memory devices in conjunction with the amplification of sensor signals based on ultrathin silicon nanomembrane circuits in stretchable layouts enables wearable healthcare applications such as long-term data storage of monitored heart rates.