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

Multi-frame-based Cross-domain Image Denoising for Low-dose Computed Tomography

Computed tomography (CT) has been used worldwide for decades as one of the most important non-invasive tests in assisting diagnosis. However, the ionizing nature of X-ray exposure raises concerns about potential health risks such as cancer. The desire for lower radiation dose has driven researchers to improve the reconstruction quality, especially by removing noise and artifacts. Although previous studies on low-dose computed tomography (LDCT) denoising have demonstrated the effectiveness of learning-based methods, most of them were developed on the simulated data collected using Radon transform. However, the real-world scenario significantly differs from the simulation domain, and the joint optimization of denoising with modern CT image reconstruction pipeline is still missing. In this paper, for the commercially available third-generation multi-slice spiral CT scanners, we propose a two-stage method that better exploits the complete reconstruction pipeline for LDCT denoising across different domains. Our method makes good use of the high redundancy of both the multi-slice projections and the volumetric reconstructions while avoiding the collapse of information in conventional cascaded frameworks. The dedicated design also provides a clearer interpretation of the workflow. Through extensive evaluations, we demonstrate its superior performance against state-of-the-art methods

Mild Hypothermia Attenuates Intercellular Adhesion Molecule-1 Induction via Activation of Extracellular Signal-Regulated Kinase-1/2 in a Focal Cerebral Ischemia Model

Intercellular adhesion molecule-1 (ICAM-1) in cerebral vascular endothelium induced by ischemic insult triggers leukocyte infiltration and inflammatory reaction. We investigated the mechanism of hypothermic suppression of ICAM-1 in a model of focal cerebral ischemia. Rats underwent 2 hours of middle cerebral artery occlusion and were kept at 37°C or 33°C during occlusion and rewarmed to normal temperature immediately after reperfusion. Under hypothermic condition, robust activation of extracellular signal-regulated kinase-1/2 (ERK1/2) was observed in vascular endothelium of ischemic brain. Hypothermic suppression of ICAM-1 was reversed by ERK1/2 inhibition. Phosphorylation of signal transducer and activator of transcription 3 (STAT3) in ischemic vessel was attenuated by hypothermia. STAT3 inhibitor suppressed ICAM-1 production induced by stroke. ERK1/2 inhibition enhanced phosphorylation and DNA binding activity of STAT3 in hypothermic condition. In this study, we demonstrated that hypothermic suppression of ICAM-1 induction is mediated by enhanced ERK1/2 activation and subsequent attenuation of STAT3 action

Early Bile Duct Cancer Detected by Direct Peroral Cholangioscopy with Narrow-Band Imaging after Bile Duct Stone Removal

Cholangioscopy not only enables the direct visualization of the biliary tree, but also allows for forceps biopsy to diagnosis early cholangiocarcinoma. Recently, some reports have suggested the clinical usefulness of direct peroral cholangioscopy (POC) using an ultra-slim endoscope with a standard endoscopic unit by a single operator. Enhanced endoscopy, such as narrow band imaging (NBI), can be helpful for detecting early neoplasia in the gastrointestinal tract and is easily applicable during direct POC. A 63-year-old woman with acute cholangitis had persistent bile duct dilation on the left hepatic duct after common bile duct stone removal and clinical improvement. We performed direct POC with NBI using an ultra-slim upper endoscope to examine the strictured segment. NBI examination showed an irregular surface and polypoid structure with tumor vessels. Target biopsy under direct endoscopic visualization was performed, and adenocarcinoma was documented. The patient underwent an extended left hepatectomy, and the resected specimen showed early bile duct cancer confined to the ductal mucosa

Evaluating the added benefit of CT texture analysis on conventional CT analysis to differentiate benign ovarian cysts

PURPOSEWe aimed to evaluate the benefit of adding CT texture analysis on conventional CT features of benign adnexal cystic lesions, especially in identifying mucinous cystadenoma.METHODSThis retrospective study included patients who underwent surgical removal of benign ovarian cysts (44 mucinous cystadenomas, 32 serous cystadenomas, 16 follicular/simple cysts and 43 endometriotic cysts) at our institution between January 2015 and November 2017. The CT images were independently reviewed by an abdominal radiologist (reviewer 1) and a resident (reviewer 2). Both reviewers recorded the conventional characteristics and performed texture analysis. Based on reviewer 1’s results, two decision trees for differential diagnosis were developed. Reviewer 2’s results were then applied to the decision trees. The diagnostic performances of each reviewer with and without the decision trees were compared.RESULTSSeveral conventional features and texture analysis parameters showed significant differences between mucinous cystadenomas and other benign adnexal cysts. The first decision tree selected septum number and thickness as significant features, whereas the second decision tree selected septum number and the mean values at spatial scaling factor (SSF) 0. Reviewer 1’s performance did not change significantly with or without the use of the decision trees. Reviewer 2’s interpretations were significantly less sensitive than reviewer 1’s interpretations (p = 0.001). However, when aided by the first and second decision trees, Reviewer 2’s interpretations were significantly more sensitive than reviewer 1’s interpretations (86.4%, p < 0.001; 72.7%, p = 0.001).CONCLUSIONThis study suggests the benefit of CT texture analysis on conventional images to differentiate mucinous cystadenoma from other benign adnexal cysts, particularly for less experienced radiologists

Clinical features of Epstein-Barr virus-associated infectious mononucleosis in hospitalized Korean children

PurposeFew studies have been conducted on the recent status of infectious mononucleosis (IM) in Korean children. The aim of this study was to evaluate the recent trend in the clinical manifestations of Epstein-Barr virus (EBV)-associated IM as well as the clinical differences according to age.MethodsA retrospective study was performed on 81 children hospitalized with EBV-associated IM who fulfilled the serological criteria for the diagnosis of EBV infection (viral capsid antigen immunoglobulin M positive). The patients were divided into 3 age groups: <5 years, 5 to 9 years, and ≥10 years. We evaluated the recent trend in clinical manifestations and the differences in clinical and laboratory findings among the 3 age groups.ResultsThirty (37%) children were under 5 years of age, 38 (46.9%) were 5 to 9 years of age, and 13 (16%) were 10 years of age or older. The differences in the symptoms and signs among the 3 age groups were not statistically significant, except for headache. The mean duration of fever was 7.7 days (range, 0 to 18 days). A comparison of liver enzyme elevation among the age groups showed an association with advancing age (26.6%, 63.1%, and 76.9%, respectively, P=0.04)ConclusionThis study showed that EBV-associated IM in Korean children continues to occur mostly in children under 10 years of age. In children with EBV-associated IM, the incidence of headache and liver enzyme elevation, the duration of fever, and the proportion of females to males were all positively associated with advancing age

Development and Implementation of a High-Pressure, Double-Acting, Bi-Directional Loading Cell for Drilled Shafts

Drilled shaft foundation elements provide a cost-effective foundation alternative for the support of building and bridge superstructure loads. Bi-directional pile loading tests (BDPLTs) to evaluate the capacity of drilled shafts have become popular owing to their capacity to save time and effort as compared to the use of top-down loading tests. However, the use of BDPLTs requires that production shafts be post-grouted following testing in order to assure appropriate in-service performance. Commonly used single-acting loading cells and/or loading cell construction details can pose the potential for the development of voids following post-grouting due to their monotonic jacking action and large footprint. This paper described the development and use of high pressure bi-directional loading cells intended to minimize the possibility of post-test construction defects. First, a comparison was made between the single-acting and double-acting loading cells. Second, the results of laboratory calibrations on the pressurized loading cells were performed, as were component testing of the pumps, hoses, and hydraulic fluid synchronization lines. Then, the use of the new high pressure double-acting loading cells in production testing of instrumented shafts was described, and the efficacy of the new loading cells was illustrated. The new loading cells provided the profession with a load cell alternative for conducting BDLTs and should serve to help reduce the risk of post-test grouting defects in drilled shaft foundations.Keywords: field testing, cementing/grouting, deep foundations, site infrastructure and constructio