Open lung biopsy in early-stage acute respiratory distress syndrome

INTRODUCTION: Acute respiratory distress syndrome (ARDS) has heterogeneous etiologies, rapid progressive change and a high mortality rate. To improve the outcome of ARDS, accurate diagnosis is essential to the application of effective early treatment. The present study investigated the clinical effects and safety of open lung biopsy (OLB) in patients with early-stage ARDS of suspected non-infectious origin. METHODS: We undertook a retrospective study of 41 patients with early-stage ARDS (defined as one week or less after intubation) who underwent OLB in two medical intensive care units of a tertiary care hospital from 1999 to 2005. Data analyzed included baseline characteristics, complication rate, pathological diagnoses, treatment alterations, and hospital survival. RESULTS: The age of patients was 55 ± 17 years (mean ± SD). The average ratio of arterial partial pressure of oxygen (PaO(2)) to fraction of inspired oxygen (FiO(2)) was 116 ± 43 mmHg (mean ± SD) at biopsy. Seventeen patients (41%) were immunocompromised. Postoperative complications occurred in 20% of patients (8/41). All biopsies provided a pathological diagnosis with a diagnostic yield of 100%. Specific pathological diagnoses were made for 44% of patients (18/41). Biopsy findings led to an alteration of treatment modality in 73% of patients (30/41). The treatment alteration rate was higher in patients with nonspecific diagnoses than in patients with specific diagnoses (p = 0.0024). Overall mortality was 50% (21/41) and was not influenced by age, gender, pre-OLB oxygenation, complication rate, pathological results, and alteration of treatment. There was no surgery-related mortality. The survival rate for immunocompromised patients was better than that for immunocompetent patients (71% versus 33%; p = 0.0187) in this study. CONCLUSION: Our retrospective study suggests that OLB was a useful and acceptably safe diagnostic procedure in some selected patients with early-stage ARDS

Major Functional Transcriptome of an Inferred Center Regulator of an ER(−) Breast Cancer Model System

We aimed to find clinically relevant gene activities ruled by the signal transducer and activator of transcription 3 (STAT3) proteins in an ER(−) breast cancer population via network approach. STAT3 is negatively associated with both lymph nodal category and stage. MYC is a component of STAT3 network. MYC and STAT3 may co-regulate gene expressions for Warburg effect, stem cell like phenotype, cell proliferation and angiogenesis. We identified a STAT3 network in silico showing its ability in predicting its target gene expressions primarily for specific tumor subtype, tumor progression, treatment options and prognostic features. The aberrant expressions of MYC and STAT3 are enriched in triple negatives (TN). They promote histological grade, vascularity, metastasis and tumor anti-apoptotic activities. VEGFA, STAT3, FOXM1 and METAP2 are druggable targets. High levels of METAP2, MMP7, IGF2 and IGF2R are unfavorable prognostic factors. STAT3 is an inferred center regulator at early cancer development predominantly in TN

Prognostic Implications of Epidermal Growth Factor Receptor and KRAS Gene Mutations and Epidermal Growth Factor Receptor Gene Copy Numbers in Patients with Surgically Resectable Non-small Cell Lung Cancer in Taiwan

IntroductionThe prognostic role of epidermal growth factor receptor (EGFR) mutations in patients with surgically resectable non-small cell lung cancer (NSCLC) without EGFR tyrosine kinase inhibitor treatment has not been well established, because the reports are still few.Materials and MethodsWe analyzed the survival data of 164 patients with surgically resectable (stages I to IIIA) NSCLC of two year groups (1996–1998 and 2002–2004), and compared with EGFR mutations, KRAS mutations, and EGFR gene copy numbers.ResultsComparing the survival of wild-type patients and patients having L858R mutations or exon 19 deletion, the median survival was much longer for patient with EGFR mutations (54.7 months) than wild type (34.9 months). The difference was not statistically significant by univariate analysis (p = 0.1981) but had borderline significance by multivariate analyses (p = 0.0506). In addition, the 3-year survival rates of patients with EGFR mutations were also significantly higher than wild type (p = 0.0232). After exclusion of 18 patients treated by EGFR-tyrosine kinase inhibitor for tumor recurrence, the trends were still the same. Patients with KRAS mutations had shorter median survival (21 months) than wild type (44.4 months). Patients with EGFR polysomy (≧copies) also had longer median survival (56.2 months) than wild type (53.4 months). But the survival differences of these two genetic markers were all not significant statistically.ConclusionIt is intriguing that patients with NSCLC with EGFR mutations had better survival than wild type. Such a tumor biology may confound the survival data in a study without the stratification by EGFR mutation

Clinical Implications of High MET Gene Dosage in Non-Small Cell Lung Cancer Patients without Previous Tyrosine Kinase Inhibitor Treatment

Introduction:Recently, two studies revealed that MET amplification was associated with secondary epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) resistance in non-small cell lung cancer (NSCLC) patients. But it remains uncertain whether MET amplification could be related to primary TKI resistance in NSCLC because of limited data.Materials and Methods:MET gene dosage of the tumor tissues from 208 NSCLC patients was investigated by real time quantitative polymerase chain reaction and compared with molecular and clinical features, including EGFR mutations, KRAS mutations, EGFR gene copy numbers, and patient survivals. Three copies were used as the cutoff. Among them, 25 patients were also evaluable for EGFR TKI responsiveness.Results:The proportion of high MET gene dosage was 10.58% (22/208) with higher incidence in squamous cell carcinoma (11.86%) and smokers (16.18%), although the differences with adenocarcinoma and nonsmokers were nonsignificant. Coexisting EGFR mutations were identified, and the incidence (8.54%) was similar to wild type (12.0%). High MET gene dosage was significantly associated with higher tumor stage (stage I + II versus stage III + IV; p = 0.0254) and prior chemotherapy for stage III + IV adenocarcinoma patients (35.71% versus 7.41%; p = 0.0145) but not correlated with primary TKI resistance. Among the 155 surgically resectable patients (stage I to IIIA), high MET gene dosage was significantly associated with shorter median survival (21.0 months versus 47.1 months; p = 0.042) by univariate analysis.Conclusions:High MET gene dosage was not related to primary TKI resistance and the incidence was increased after chemotherapy, suggesting high MET gene dosage may also be related to chemotherapy resistance

從希臘羅馬神話中之文藝繆司女神到靈感謬思的探尋

[[abstract]]國立台灣師範大學美術研究所碩士論文摘要 研究所別：美術研究所西畫創作組 論文名稱：從希臘羅馬神話中之文藝繆司女神 到靈感謬思的探尋 指導教授：陳景容教授 研究生：謝秀鳳 摘要內容： 每件作品其創作的過程，必先經由內在動力與外在引媒的激發下，並待一切創作要素完備後，且加上創作者在強烈意圖的驅使下，才能完成。 創作品本身具有「形式」與「內容」二大特徵在。本篇論文希望從這二大面向來探究。其中「形式」部份，除油畫之外，亦觸及平面繪畫。「內容」及主題部份則限定在希臘羅馬神話中的「文藝繆司」女神，進而對「謬思」──靈感的源泉，加以了解、分析，與探討，希望能藉此輔以個人之創作，以體認其中之意涵。 本論文研究方向從文獻資料入筆，同時進行個人創作。文獻資料涵蓋延擴到歷史類美術史、專門論著、評論、傳記、美術相關書籍到相關圖片、網頁、畫冊...的參閱。而創作部分，則從資料的蒐集，之後決定取材內容範圍，再到草圖初步繪製，定稿後，加以科技媒體輔助及指導教授的帶領之下逐步完成。 論文內容部分先著眼希臘羅馬神話產生的背景、精神及其起源，再由分析一些藝術家們的創作作品來知悉他們如何詮釋這九位文藝繆司女神。 在他們創作過程中，我們會發現創作「靈感謬思」來源的一些蛛絲馬跡。很多藝術家，都有著相似的創作歷程。從達文西、拉斐爾、米開朗基羅這三位文藝復興的巨擘身上可以察覺到，意蘊的開發，需要獨到的眼光加以深厚的基本功夫。從他們身上反思自己的學創歷程，藝術創作者真要不斷地自我探尋追憶，從師法造化、古人、及其內心著手。即從整個客觀的宇宙世界，他人已有的成就，以及自我的了解、發現、發掘這三大途徑去探尋。創作靈感的來由可以從觀念、生活、寫生、讀書 ... 等方式分別去著手獲得。最後以個人創作歷程來呈現探究的結果。在個人創作作品方面，也從「形式」與「內容」二大面向去進行。「形式」上，在油畫部分則嘗試以各種畫材的使用來表現主題內容。「內容」方面則限定於「人物」為主的文藝繆司所給予我的靈感「謬思」的詮釋。 謝辭 民國八十五年自師大美術系畢業後，即投入國中美術教育的工作環境。平日除忙於教學之餘，雖然有想再去進修，進一步加強繪畫創作實力的念頭，但實則心有餘而力不足。這個念頭一耽擱就是六年的光陰，終於有一天下定決心，努力準備了大約半年的時間，於是幸運地考回母校研究所得以繼續深造。 就讀研究所期間是自己投身於藝術創作的真正開始，也是讓自己下定決心要以畫畫為志業的重新省思階段。回顧學畫的開始、過程與及結果，藝術創作著實讓我的生活更有目標也更多采多姿，也能借此以抒發自我情感，表達個人特質及一些想法。 在念研究所的這三年歲月中，第一年帶職帶薪，往返桃園台北兩地，時間上雖然很緊迫卻感到異常的愉快充實。之後的兩年因為休習學分及考量交通與作畫、看書和寫論文所需要的時間因素，便決定改為留職停薪方式以便能專心在學業與創作上。 進修這三年期間，感謝任教學校桃園縣內壢國中行政人員與同事們的協助，才能夠順利休完學分，也感謝師大教授陳淑華老師在繪畫材料與平面繪畫材料技法上的指導；感謝師大教授也是我高中導師蘇憲法老師及黃進龍老師在繪畫創作專題研究這門課上的指導；感謝師大教授謝孝德老師在風景油畫創作研究這門課上的指導；感謝師大教授劉文緯老師在素描創作研究這門課上的講授與指正；感謝師大教授廖修平老師在版畫創作研究課上一些觀念的釐清與版畫創作靈感的啟發及導引，加以其個人收藏作品的分享，使我視野更加國際化；感謝師大教授王哲雄老師在兩門課課堂上文辭優雅地帶我走進十八、十九世紀法國美術與美國現代美術史的殿堂，瞭解幾百年來兩國美術上的發展的概況。 並感謝師大教授也是我的畢業論文及畢業創作指導教授陳景容老師三年多來的多方指導，先是課堂上大到對於大幅油畫製作的詳細分析、油畫材料的經驗談，小自如何洗筆、洗手以保護自己避免誤食顏料，這些瑣碎卻又重要的日常習慣。除此之外在課中或課餘對於濕壁畫、蛋彩畫、馬賽克、瓷板畫及素描亦無所不談。並對身我研究生的我指導不斷。感謝陳老師以一位真正藝術家的典範，在前方帶領學生走藝術創作之路，從堅持走藝術創作之路生活的實際感受到親自參與其中所獲至的心靈喜樂。 最後感謝在我唸書期間，家人的全力支持與協助。尤其是我老公─奕農，在我創作時，給予的鼓勵與經濟上及精神上的支援，尤其是最後最難忘的一年，我懷著身孕，一邊創作一邊在寫論文，且到最後展覽前那幾個禮拜的一些文宣作業，沒有他的幕後配合，畢業展覽無法如期展出，在此僅以這小小成果與畢業畫展獻給我的至親，感謝他們對我無悔的付出。並感謝在我身旁協助過我點點滴滴的每一個人。

The Extremely Enhanced Photocurrent Response in Topological Insulator Nanosheets with High Conductance

Abstract The photocurrent was performed in topological insulator nanosheets with different conductances. The higher photocurrent is observed in the nanosheet with higher conductance. The responsivity is proportional to the nanosheet conductance over two orders. The responsivity is independent of the light power intensity in vacuum, but responsivity drastically decreases at low power intensity in air. The ratio of the responsivity in air to that in vacuum is negatively proportional to the the inverse of the light power intensity. These behaviors are understood as the statistical photocurrent in a system with blocked molecules. The time constant decreases as the thickness increases. A longer time constant is observed in lower atmosphere pressure