Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure

<p>Abstract</p> <p>Background</p> <p>Scrub typhus, a mite-transmitted zoonosis caused by <it>Orientia tsutsugamushi</it>, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed.</p> <p>Case presentations</p> <p>We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days.</p> <p>Conclusion</p> <p>Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.</p

Differential Proteomic Analysis of Mammalian Tissues Using SILAM

Differential expression of proteins between tissues underlies organ-specific functions. Under certain pathological conditions, this may also lead to tissue vulnerability. Furthermore, post-translational modifications exist between different cell types and pathological conditions. We employed SILAM (Stable Isotope Labeling in Mammals) combined with mass spectrometry to quantify the proteome between mammalian tissues. Using 15N labeled rat tissue, we quantified 3742 phosphorylated peptides in nuclear extracts from liver and brain tissue. Analysis of the phosphorylation sites revealed tissue specific kinase motifs. Although these tissues are quite different in their composition and function, more than 500 protein identifications were common to both tissues. Specifically, we identified an up-regulation in the brain of the phosphoprotein, ZFHX1B, in which a genetic deletion causes the neurological disorder Mowat–Wilson syndrome. Finally, pathway analysis revealed distinct nuclear pathways enriched in each tissue. Our findings provide a valuable resource as a starting point for further understanding of tissue specific gene regulation and demonstrate SILAM as a useful strategy for the differential proteomic analysis of mammalian tissues

Investigations structural transitions of the cobalt on the Si(111) and Ge(111) surfaces and dicarboxylated viologens on the Cu(100) surface

[[abstract]]In this thesis, the investigations include two parts. The first part (Part I) is the research of the magnetic material cobalt on the Si(111) and the Ge(111) surfaces dependent on annealing temperatures studied by ultra high vacuum-scanning tunneling microscopy (UHV-STM) and low energy electron diffraction (LEED). The second part (Part II) is the research of the surface structures and phase transitions of viologens on the Cu(100) and HOPG surfaces dependent on the applied potentials studied by cyclic voltammetry (CV) and electrochemistry scanning tunneling microscopy (EC-STM). The aims of both subjects are focused on the observation of the surface structure and morphology at stable thermal/kinetics conditions. There are two major topics in part I. The first topic describes the Co absorbed on the pure Si(111)-7×7 and Ge(111)-c(2×8) surfaces. The initial reaction of the Co with the Si substrate happens at the temperature range from 126 to 130K. The defects of the Co-Si compounds are different from the intrinsic defects of the Si(111)-7×7 surface. The Co-Si compounds also decrease the brightness of the neighboring adatoms compared to the intrinsic defects of the Si(111)-7×7 surface. Therefore, the Co on the pure Si(111)-7×7 and Ge(111)-c(2×8) surfaces forms the Co-Si and the Co-Ge compounds at room temperature appeared as the dark region of the defect-like feature. The silicon atoms can separate on top of the Si(111)-7×7 surface after annealing to 400oC, and then the Si(111)-7×7 surface structure disappears. The Co5Ge7 alloy is observed on the Co/Ge(111) surface after annealing to 600K. Further, Co atoms can form the √13×√13 R14° periodic surface structure, but the structure is unfavorably formed compared to the Co5Ge7 alloy. The compound formations of the Co-Si and the Co-Ge result in a lower magnetic property than bulk Co. Therefore, the silver buffer layer is introduced on the intermediate layer between the Co and the Si(111) and Ge(111) surfaces as described at the second topic. At low Co coverage, the Co can form periodic surface structures of the √13×√13 R14° and the 2×2 on the Ag/Ge(111)-√3×√3 surface. For the Co/Ag/Si(111) case, the Co forms a cluster shape both on the Ag/Si(111)-√3×√3 and on the flat Ag/Si(111)-1×1 surfaces at low Co coverage. Further, the average size and height of Co clusters on the flat Ag/Si(111)-1×1 surface are almost independent on annealing temperatures from room temperature to 300oC. The reasons for the Co/Ag/Si(111) surface without periodic surface structure are due to the unsaturated states on the Ag/Si(111)-√3×√3 surface and the weaker interaction of the Co with the Si(111) surface than the Ge(111) surface. Dicarboxylated viologens mixed with a 10 mM HCl on the Cu(100) and HOPG surfaces was studied in different redox states. At the beginning, a 0.1 mM violgens on the Cu(100) surface is investigated. The dicationic viologens show the dot array and the oblique row phases. The radical viologens exhibit the metastable phases, a stripe pattern, the closed stacking stripe pattern, and a dimer phase. The stacking configuration of the dicationic viologen core plane is preferred to be face-on on the surface and that of the radical viologen is formed by π-π stacking with the neighboring viologens. Because dicarboxylated viologens bear long alkyl chains and carboxylic acid groups at the ends of the alkyl chains as illustrated by (HOOC-(CH2)7-V-(CH2)7-COOH), the complex interactions are considered to be the reason of forming various phases on the Cu(100) surface. The experiment of a 0.1 mM dicarboxylated viologens on the HOPG surface without the influence of an anion layer is to confirm the existence of a bilayer formation due to the intermolecular interaction of the hydrogen bonding. The high viologen concentration (1.0 mM) on the Cu(100) surface shows the effects of the chloride and bromide anion layers reflecting on phase transition and the multilayer growth behavior due to the hydrogen bonding interaction and the polarizability, respectively. The effect of the anion layers is consistent with by a 0.1 mM viologens mixed with a 10 mM KBr on the Cu(100) surface.

7-Day Nonbismuth-Containing Concomitant Therapy Achieves a High Eradication Rate for Helicobacter pylori in Taiwan

Background. Ten-day concomitant therapy achieves a high eradication rate in Taiwan. Whether shortening the duration of concomitant therapy can still keep a high eradication rate remains unclear. Aim. To assess the eradication rate of 7-day pantoprazole-containing concomitant therapy in Taiwan and to investigate factors influencing the eradication outcome. Methods. From March 2008 to March 2012, 319 H. pylori-infected patients receiving a 7-day pantoprazole-containing concomitant regimen (pantoprazole 40 mg, amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 7 days) were included. Patients were asked to return at the second week to assess drug compliance and adverse effects. Repeated endoscopy or urea breath test was performed at 8 weeks after the end of eradication therapy. Results. The eradication rates according to intention-to-treat and per-protocol analyses were 93.7% (299/319) and 96.4% (297/308), respectively. Adverse events occurred in 13.2% (42/319) of the patients. The compliance rate was 98.4% (314/319). Multivariate analysis disclosed that poor compliance was the only independent factor influencing the efficacy of anti-H. pylori therapy with an odds ratio of 0.073 (95% confidence interval, 0.011–0.483). Conclusion. 7-day concomitant therapy achieved a very high eradication rate for H. pylori infection in Taiwan. Drug compliance was the only clinical factor influencing treatment efficacy

Intestinal metaplasia in follow-up endoscopies among Asian patients with short-segment Barrett's esophagus: Regression, sampling error, and associated factors

Background: The percentage of and factors associated with the regression of Barrett's esophagus (BE) or its characteristic intestinal metaplasia (IM) remain unclear, and conflicting results have been reported because of diverse regression and sampling error definitions. Thus, we investigated the rates of IM regression, sampling error, and associated factors. Methods: Forty-two patients with proven short-segment BE with IM who underwent two follow-up endoscopies with biopsies of Barrett's mucosa were retrospectively analyzed. Additional Alcian blue and MUC2 staining were done on the biopsy specimens without IM in hematoxylin–eosin staining. Only patients with negative hematoxylin–eosin, Alcian blue, and MUC2 staining for IM in both follow-up endoscopies were considered to have true regression. When all three stains were negative for IM in the first, but positive in the second follow-up endoscopy, we considered IM persisting and declared sampling error. Results: Among the 18 patients without IM at the first follow-up endoscopy, only five (11.9%) were judged to have true regression. Prolonged proton-pump inhibitor use was significantly associated with regression. Limited experience of the endoscopist, and insufficient biopsy number were significantly related to sampling error. Receiver operating characteristic (ROC) curve analysis showed the best cut-off value of the biopsy number/maximal-length (cm) ratio to predict sampling error was 2.25. Conclusion: In our patients with short-segment BE, 11.9% experienced regression of IM. Prolonged proton-pump inhibitors treatment was associated with regression. An insufficient biopsy number was related to a missed IM, which may be eliminated by maintaining biopsy number/maximal-length (cm) ratio ≥2.25

Gallbladder function predicts subsequent biliary complications in patients with common bile duct stones after endoscopic treatment?

Abstracts Background In patients with common bile duct stones (CBDS) and intact gallbladder, further management for the gallbladder after the CBDS clearance is still controversial. The relationship between gallbladder motility and the biliary complications were seldom discussed. Our study is to predict the subsequent biliary complications by gallbladder function test using fatty meal sonography (FMS) in patients with CBDS who had been treated by endoscopic retrograde cholangiopancreatography (ERCP). Methods Patients with an intact gallbladder and CBDS after endoscopic clearance of bile duct were enrolled. Patients received a fatty meal sonography after liver function returned to normal. The fasting volume, residual volume, and gallbladder ejection fraction (GBEF) in FMS were measured. Relationships of patients’ characteristics, gallbladder function and recurrent biliary complication were analyzed. Results From 2011 to 2014, 118 patients were enrolled; 86 patients had calculus gallbladders, and 32 patients had acalculous gallbladders. After a mean follow- up of 33 months, 23 patients had recurrent biliary complications. Among 86 patients with calculus gallbladder, 15 patients had spontaneous clearance of gallbladder stones; 14 patients received cholecystectomy due to acute cholecystitis or recurrent colic pain with smooth postoperative courses. In the follow up period, six patients died of non-biliary causes. The GBEF is significant reduced in most patients with a calculus gallbladder in spite of stone color. Calculus gallbladder, alcohol drinking and more than one sessions of initial endoscopic treatment were found to be the risk factors of recurrent biliary complication. Conclusions Gallbladder motility function was poorer in patients with a calculus gallbladder, but it cannot predict the recurrent biliary complication. Since spontaneous clearance of gallbladder stone may occur, wait and see policy of gallbladder management after endoscopic treatment of CBDS is appropriate, but regular follow- up in those patients with risk factors for recurrence is necessary