Primary Splenic Lymphoma Associated with Hemophagocytic Lymphohistiocytosis Complicated with Splenic Rupture

Primary splenic lymphoma (PSL) is a rare disease with ambiguous definition, comprising less than 1% of non-Hodgkin's lymphoma. Even rarer is PSL combined with hemophagocytic lymphohistiocytosis (HLH), which has presentations of fever, cytopenia, hepatosplenomegaly, hyperferritinemia, and phagocytosis of hematopoietic cells in the reticuloendothe-lial system. We report the case of a 77-year-old man who presented with HLH initially. Refusing diagnostic splenectomy, he received chemotherapy. Spontaneous splenic rupture occurred after chemotherapy. In the following emergency operation, PSL was diagnosed. He received another 5 courses of chemotherapy with the R-CNOP regimen (rituximab, cyclophosphamide, mitoxantrone, vincristine, prednisolone). Now he has no residual or relapsed disease. Diagnostic splenectomy for adult HLH patients without definite etiologies may play an important role. [J Chin Med Assoc 2008;71(4):210–213

Discovery of dominant and dormant genes from expression data using a novel generalization of SNR for multi-class problems

<p>Abstract</p> <p>Background</p> <p>The Signal-to-Noise-Ratio (SNR) is often used for identification of biomarkers for two-class problems and no formal and useful generalization of SNR is available for multiclass problems. We propose innovative generalizations of SNR for multiclass cancer discrimination through introduction of two indices, Gene Dominant Index and Gene Dormant Index (GDIs). These two indices lead to the concepts of dominant and dormant genes with biological significance. We use these indices to develop methodologies for discovery of dominant and dormant biomarkers with interesting biological significance. The dominancy and dormancy of the identified biomarkers and their excellent discriminating power are also demonstrated pictorially using the scatterplot of individual gene and 2-D Sammon's projection of the selected set of genes. Using information from the literature we have shown that the GDI based method can identify dominant and dormant genes that play significant roles in cancer biology. These biomarkers are also used to design diagnostic prediction systems.</p> <p>Results and discussion</p> <p>To evaluate the effectiveness of the GDIs, we have used four multiclass cancer data sets (Small Round Blue Cell Tumors, Leukemia, Central Nervous System Tumors, and Lung Cancer). For each data set we demonstrate that the new indices can find biologically meaningful genes that can act as biomarkers. We then use six machine learning tools, Nearest Neighbor Classifier (NNC), Nearest Mean Classifier (NMC), Support Vector Machine (SVM) classifier with linear kernel, and SVM classifier with Gaussian kernel, where both SVMs are used in conjunction with one-vs-all (OVA) and one-vs-one (OVO) strategies. We found GDIs to be very effective in identifying biomarkers with strong class specific signatures. With all six tools and for all data sets we could achieve better or comparable prediction accuracies usually with fewer marker genes than results reported in the literature using the same computational protocols. The dominant genes are usually easy to find while good dormant genes may not always be available as dormant genes require stronger constraints to be satisfied; but when they are available, they can be used for authentication of diagnosis.</p> <p>Conclusion</p> <p>Since GDI based schemes can find a small set of dominant/dormant biomarkers that is adequate to design diagnostic prediction systems, it opens up the possibility of using real-time qPCR assays or antibody based methods such as ELISA for an easy and low cost diagnosis of diseases. The dominant and dormant genes found by GDIs can be used in different ways to design more reliable diagnostic prediction systems.</p

Intra-articular injections of sodium hyaluronate (Hyalgan®) in osteoarthritis of the knee. a randomized, controlled, double-blind, multicenter trial in the asian population

<p>Abstract</p> <p>Background</p> <p>The efficacy and tolerability of 500-730 kDa sodium hyaluronate (Hyalgan^®) for treatment of osteoarthritis (OA) pain has been established in clinical trials, but few data are available in the Asian population. We conducted a randomized, double-blind, multicenter, placebo-controlled study to evaluate the efficacy and tolerability of this preparation in a Taiwanese population.</p> <p>Methods</p> <p>Two hundred patients with mild to moderate OA of the knee were randomized to receive five weekly intra-articular injections of sodium hyaluronate or placebo. The primary efficacy outcome was the change from baseline to Week 25 in patients' evaluation of pain using a 100-mm visual analog scale (VAS) during the 50-foot walking test. Additional outcomes included Western Ontario and McMaster Universities (WOMAC) scores, time on the 50-foot walking test, patient's and investigator's subjective assessment of effectiveness, acetaminophen consumption, and the amounts of synovial fluid.</p> <p>Results</p> <p>The Hyalgan^®treatment group showed a significantly greater improvement from baseline to Week 25 in VAS pain on the 50-foot walking test than the placebo group (p = 0.0020). The Hyalgan^®group revealed significant improvements from baseline to week 25 in WOMAC pain and function score than the placebo group (p = 0.005 and 0.0038, respectively) Other outcomes, such as time on the 50-foot walking test and subjective assessment of effectiveness, did not show any significant difference between groups. Both groups were safe and well tolerated.</p> <p>Conclusions</p> <p>The present study suggests that five weekly intra-articular injections of sodium hyaluronate are well tolerated, can provide sustained relief of pain, and can improve function in Asian patients with osteoarthritis of the knee.</p> <p>Level of Evidence</p> <p>Therapeutic study, Level I-1a (randomized controlled trial with a significant difference).</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01319461">NCT01319461</a></p

Longitudinal Changes in Retinal Nerve Fiber Layer Thickness after Acute Primary Angle Closure Measured with Optical Coherence Tomography

PURPOSE. Longitudinal follow-up of peripapillary retinal nerve fiber layer (RNFL) thickness after an episode of acute primary angle closure (APAC) using Stratus optical coherence tomography (OCT). METHODS. Seventeen patients who had experienced a single unilateral APAC episode (intraocular pressure, Ͼ50 mm Hg) were enrolled. The average and superior, temporal, inferior, and nasal quadrant RNFL thicknesses of the affected and fellow eyes at 1, 4, and 12 weeks after remission were compared by using StratusOCT. The relationship between average RNFL thickness and interval of follow-up were evaluated with regression analysis. RESULTS. The mean duration of the APAC episode was 13.8 hours (range, 3-40). Comparison of the average and four quadrant RNFL thicknesses in the affected eyes longitudinally showed significant differences between 1 and 4, and 1 and 12 weeks, but not between 4 and 12 weeks. The average and four-quadrant RNFL thicknesses for the affected eyes were greater than the analogous values for fellow eyes at 1 week. In contrast, the inferior-and superior-quadrant RNFL thicknesses for the affected eyes were lower at 4 and 12 weeks, whereas the average and nasal quadrant values for the affected eyes were lower than those in fellow eyes at 12 weeks. Average RNFL thickness for the affected eyes was correlated with the interval of follow-up by using inverse regression analysis (P Ͻ 0.001; R 2 ϭ 0.60). Controlling for duration of APAC episode, the interval of follow-up on RNFL thickness reduction remained significant (P Ͻ 0.001, r ϭ Ϫ0.69). CONCLUSIONS. This study demonstrated an initial increase in diffuse RNFL thickness after a single APAC episode, followed by a subsequent decrease. (Invest Ophthalmol Vis Sci. 2007; 48:1659 -1664) DOI:10.1167/iovs.06-0950 A cute primary angle closure (APAC) is an ophthalmic emergency and a potentially blinding disease. Optic nerve damage can occur after the sudden rise in intraocular pressure (IOP) associated with an APAC episode. The optic disc appears edematous during this episode, and pallor with or without cupping may develop after remission. When treatment is delayed, vision may be markedly reduced to hand movement or light perception. 1 Perimetric examination during acute episodes is difficult and usually unreliable. After remission, visual field defects vary greatly in severity and type. 2 Measurement of retinal nerve fiber layer (RNFL) thickness loss after APAC is very important, as it is both objective and sensitive in terms of detection of the optic disc damage with either normal or unreliable visual fields. Scanning laser polarimetry with fixed corneal compensator (SLP-FCC) has been used for quantification of RNFL thickness change after APAC in cross-sectional study, 5 However, the latter investigation included several patients with poor IOP control after an APAC episode, as determined by RNFL measurement at follow-up. Moreover, SLP-FCC has limited functionality in measurement of RNFL thickness because of the lack of correction for variation in corneal polarization axis and corneal curvature. StratusOCT is a powerful imaging technology that can measure RNFL thickness and image tissue structure to an axial resolution of Ͻ10 m. 7 The stronger association with function in StratusOCT RNFL measurement compared with SLP-VCC suggests that the former may be superior for evaluation of glaucoma progression. 8 Therefore, the purpose of this study was to use StratusOCT to detect longitudinal change (1-12 weeks) in RNFL thickness after remission from a single APAC episode. MATERIALS AND METHODS In this prospective study, longitudinal observations were made using RNFL measurements obtained from StratusOCT at 1, 4, and 12 weeks after a single episode of unilateral APAC. Seventeen consecutive patients were recruited while undergoing treatment in the emergency or the ophthalmology outpatient departments of the Chang Gung Memorial Hospital-Kaohsiung Medical Center over a 1-year period. The study and data accumulation were in conformity with all relevant Taiwanese laws, and the investigation was conducted in accordance with the tenets of the Declaration of Helsinki. The APAC definition used for the study consisted of: The inclusion criteria were: (1) duration of episode less than 48 hours (interval from onset of acute symptoms to first hospital presentation); (2) resolution of acute episode and IOP control (Ͻ21 mm Hg) after antiglaucoma medication prescribed on first presentation, with interval between presentation and resolution under 2 hours (patients were treated with intravenous mannitol drip, oral acetazolamide, topical ␤-blocker and pilocarpine; the IOP was then rechecked 30 to 60 minutes after treatment); (3) subsequent laser iridotomy (LI) performed within 2 days of presentation on both affected and fellow eyes; and, (4) IOP Ͻ 21 mm Hg in both eyes for up to 12 weeks after treatment. Antiglaucoma medication was used to control IOP before and after LI in both eyes to prevent elevation (IOP Ͼ 21 mm Hg). The exclusion criteria were: (1) history of previous APAC in the affected or fellow eyes; (2) previous intraocular surgery, coexisting From th

Influence of Y-doped induced defects on the optical and magnetic properties of ZnO nanorod arrays prepared by low-temperature hydrothermal process

One-dimensional pure zinc oxide (ZnO) and Y-doped ZnO nanorod arrays have been successfully fabricated on the silicon substrate for comparison by a simple hydrothermal process at the low temperature of 90°C. The Y-doped nanorods exhibit the same c-axis-oriented wurtzite hexagonal structure as pure ZnO nanorods. Based on the results of photoluminescence, an enhancement of defect-induced green-yellow visible emission is observed for the Y-doped ZnO nanorods. The decrease of E(2)(H) mode intensity and increase of E(1)(LO) mode intensity examined by the Raman spectrum also indicate the increase of defects for the Y-doped ZnO nanorods. As compared to pure ZnO nanorods, Y-doped ZnO nanorods show a remarked increase of saturation magnetization. The combination of visible photoluminescence and ferromagnetism measurement results indicates the increase of oxygen defects due to the Y doping which plays a crucial role in the optical and magnetic performances of the ZnO nanorods

Clonal spread of multidrug-resistant Acinetobacter baumannii in eastern Taiwan

Background and PurposeThis study was conducted to investigate the molecular epidemiology and antimicrobial susceptibility of multidrug-resistant (MDR) Acinetobacter baumannii to three types of antibiotics.MethodsOne hundred and thirty-four specimens of MDR A baumannii were collected from three branches (Taipei, Dalin, and Hualien branches) of Buddhist Tzu Chi Hospital, which are located in northern, southern, and eastern Taiwan, during 2007. Genotyping was performed by pulsed-field gel electrophoresis. Antibiotic susceptibilities to colistin, rifampicin, and tigecycline were determined. The synergistic effects of rifampin and colistin were also evaluated.ResultsAntibiotic susceptibility testing showed that 10.4%, 47.8% and 45.5% of the MDR A baumannii isolates are resistant to colistin, rifampicin, and tigecycline, respectively. A majority of the rifampicin-resistant isolates (62.7%) were found in the Haulien branch, whereas 62.2% of tigecycline-resistant isolates were found in the Taipei branch. The combination of colistin and rifampicin had a synergistic effect on all of the isolates. Genotyping by pulsed-field gel electrophoresis identified 17, 23, and 11 pulsotypes in the Taipei, Dalin, and Haulien branches, respectively. Furthermore, 74.5% of isolates in the Haulien branch were identified as one of three pulsotypes. Among 37 rifampicin-resistant and 22 tigecycline-resistant MDR A baumannii isolates found in the Haulien branch, 51.3% (19/37) and 50% (11/22) of the isolates belonged to the same clone, respectively.ConclusionThis study confirms the high prevalence of resistance to rifampicin and tigecycline in MDR A baumannii in the three hospitals that were studied, and the high proportion of identical strains that exist in eastern Taiwan

Knockdown of PsbO leads to induction of HydA and production of photobiological H2 in the green alga Chlorella sp. DT

Green algae are able to convert solar energy to H2 via the photosynthetic electron transport pathway under certain conditions. Algal hydrogenase (HydA, encoded by HYDA) is in charge of catalyzing the reaction: 2H+ + 2e− ↔ H2 but usually inhibited by O2, a byproduct of photosynthesis. The aim of this study was to knockdown PsbO (encoded by psbO), a subunit concerned with O2 evolution, so that it would lead to HydA induction. The alga, Chlorella sp. DT, was then transformed with short interference RNA antisense-psbO (siRNA-psbO) fragments. The algal mutants were selected by checking for the existence of siRNA-psbO fragments in their genomes and the low amount of PsbO proteins. The HYDA transcription and the HydA expression were observed in the PsbO-knockdown mutants. Under semi-aerobic condition, PsbO-knockdown mutants could photobiologically produce H2 which increased by as much as 10-fold in comparison to the wild type

Activation of Endothelial Cells by Antiphospholipid Antibodies—A Possible Mechanism Triggering Thrombosis in Patients with Antiphospholipid Syndrome

Antiphospholipid syndrome (APS) is an antibody-mediated hypercoagulable state characterized by recurrent venous and arterial thromboembolic events. The presence of serum antibodies are collectively termed as antiphospholipid antibodies (aPL) and is the hallmark of the disease. Interest in the pathogenesis has mostly been focused on the blood coagulation factor. However, endothelial cells might play an important role. When stimulated, cell membrane would flip to expose negatively charged phospholipids and activation markers such as adhesive molecules may appear. We consider that these changes may play an important role in the initiation of the thrombotic process when endothelial cells encounter aPL. In this study, we incubated human umbilical vein endothelial cells (HUVECs) with IgG isolated from patients with APS and found that the HUVECs were activated by the expression of negatively charged phospholipids, as shown by high annexin V binding and negative propidium iodide staining and by an increase in the level of intracellular cell adhesion molecule-1 on the cell surface. The above findings indicate that endothelial cells can be activated on exposure to aPL and trigger the thrombotic event

Functional Biomaterials Modulate Macrophage in the Tumour Micro-environment

The inflammation response requires the cooperation of macrophages with immune cell function and active factors, such as cytokines and chemokines. Through this response, these factors are involved in the immune response to affect physiological activities. Macrophages can be categorized into two types: ‘M1’ and ‘M2’. M1 macrophages destroy the pathogen through phagocytosis activation, ROS production, and antigen-presenting, among other functions. M2 macrophages release cellular factors for tissue recovery, growth, and angiogenesis. Studies have determined that tumour tissue presents with numerous macrophages, termed tumour-associated macrophages. Tumour cells and peripheral stromal cells stimulate the tumour associated with macrophages (M2) to produce factors that regulate angiogenesis. Modulating the balance of the M1 and M2 function has already gained interest as a potentially valuable immune disease therapy. However, applications of the immunotherapy in clinical treatments are still not clear with regard to the cellular working mechanism. Therefore, we summarized the functions of common biomaterials involved in the modulation of the macrophage