Pleural Effusion after Percutaneous Radiofrequency Ablation for Hepatic Malignancies

AbstractBackground and AimsRadiofrequency ablation (RFA) can play an important role in the treatment of primary or metastatic liver tumors. Currently, percutaneous RFA is generally regarded as a safe, effective, and minimally invasive procedure. This study aimed to evaluate the presence and course of pleural effusion after monopolar RFA.MethodsFrom October 2008 to July 2013, a total of 54 patients (28 male and 26 female, mean age 65.2) treated with monopolar RFA were included in our study. 47 patients were diagnosed with hepatocellular carcinoma, 4 patients with hepatic metastasis, and 3 patients had other diagnoses. There were a total of 115 sessions of treatment and 199 liver tumors to be treated (1.73 ± 1.02 tumors treated per session). The tumor size ranged from 0.8 cm to 5.0 cm (mean 2.31 cm, standard deviation 1.04 cm). Thereafter, a follow-up ultrasound was performed within 24 hours subsequent to ablation to evaluate the presence of pleural effusion. The degree of pleural effusion was assessed by chest X-ray.ResultsFifteen (13.0%) treatment sessions in 14 patients showed right-sided pleural effusion after ablations. One patient had a large amount of effusion, while other patients manifested a minimal to small amount of effusion. There were 5 patients that experienced delayed resolution of pleural effusion; one patient (0.87%) had a minimal amount of pleural effusion even after one month. Overall, there was no pneumothorax, or periprocedural morality. Age, gender, tumor numbers, tumor sizes, and complete ablation of target tumors were similar among groups presenting with or without pleural effusion. Tumor locations associated with S78 segments abutting the diaphragm or right lobe of the liver were not associated with development of pleural effusion. Only the duration of ablation time had a marginal trend toward significance (p = 0.051).ConclusionsThe transient appearance of right-sided pleural effusion after percutaneous RFA for hepatic malignancies was not infrequent. However, refractory pleural effusion was rare

Improving Detection Accuracy of Lung Cancer Serum Proteomic Profiling via Two-Stage Training Process

<p>Abstract</p> <p>Background</p> <p>Surface-Enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (SELDI-TOF-MS) is a frequently used technique for cancer biomarker research. The specificity of biomarkers detected by SELDI can be influenced by concomitant inflammation. This study aimed to increase detection accuracy using a two-stage analysis process.</p> <p>Methods</p> <p>Sera from 118 lung cancer patients, 72 healthy individuals, and 31 patients with inflammatory disease were randomly divided into training and testing groups by 3:2 ratio. In the training group, the traditional method of using SELDI profile analysis to directly distinguish lung cancer patients from sera was used. The two-stage analysis of distinguishing the healthy people and non-healthy patients (1^st-stage) and then differentiating cancer patients from inflammatory disease patients (2^nd-stage) to minimize the influence of inflammation was validated in the test group.</p> <p>Results</p> <p>In the test group, the one-stage method had 87.2% sensitivity, 37.5% specificity, and 64.4% accuracy. The two-stage method had lower sensitivity (> 70.1%) but statistically higher specificity (80%) and accuracy (74.7%). The predominantly expressed protein peak at 11480 Da was the primary splitter regardless of one- or two-stage analysis. This peak was suspected to be SAA (Serum Amyloid A) due to the similar m/z countered around this area. This hypothesis was further tested using an SAA ELISA assay.</p> <p>Conclusions</p> <p>Inflammatory disease can severely interfere with the detection accuracy of SELDI profiles for lung cancer. Using a two-stage training process will improve the specificity and accuracy of detecting lung cancer.</p

The generic design of a high-traffic advanced metering infrastructure using ZigBee

A multi-interface ZigBee building area network (MIZBAN) for a high-traffic advanced metering infrastructure (AMI) for high-rise buildings was developed. This supports meter management functions such as Demand Response for smart grid applications. To cater for the high-traffic communication in these building area networks (BANs), a multi-interface management framework was defined and designed to coordinate the operation between multiple interfaces based on a newly defined tree-based mesh (T-Mesh) ZigBee topology, which supports both mesh and tree routing in a single network. To evaluate MIZBAN, an experiment was set up in a five-floor building. Based on the measured data, simulations were performed to extend the analysis to a 23-floor building. These revealed that MIZBAN yields an improvement in application-layer latency of the backbone and the floor network by 75% and 67%, respectively. This paper provides the design engineer with seven recommendations for a generic MIZBAN design, which will fulfill the requirement for demand response by the U.S. government, i.e. a latency of less than 0.25 s.http://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=9424hb201

AluScan: a method for genome-wide scanning of sequence and structure variations in the human genome

<p>Abstract</p> <p>Background</p> <p>To complement next-generation sequencing technologies, there is a pressing need for efficient pre-sequencing capture methods with reduced costs and DNA requirement. The Alu family of short interspersed nucleotide elements is the most abundant type of transposable elements in the human genome and a recognized source of genome instability. With over one million Alu elements distributed throughout the genome, they are well positioned to facilitate genome-wide sequence amplification and capture of regions likely to harbor genetic variation hotspots of biological relevance.</p> <p>Results</p> <p>Here we report on the use of inter-Alu PCR with an enhanced range of amplicons in conjunction with next-generation sequencing to generate an Alu-anchored scan, or 'AluScan', of DNA sequences between Alu transposons, where Alu consensus sequence-based 'H-type' PCR primers that elongate outward from the head of an Alu element are combined with 'T-type' primers elongating from the poly-A containing tail to achieve huge amplicon range. To illustrate the method, glioma DNA was compared with white blood cell control DNA of the same patient by means of AluScan. The over 10 Mb sequences obtained, derived from more than 8,000 genes spread over all the chromosomes, revealed a highly reproducible capture of genomic sequences enriched in genic sequences and cancer candidate gene regions. Requiring only sub-micrograms of sample DNA, the power of AluScan as a discovery tool for genetic variations was demonstrated by the identification of 357 instances of loss of heterozygosity, 341 somatic indels, 274 somatic SNVs, and seven potential somatic SNV hotspots between control and glioma DNA.</p> <p>Conclusions</p> <p>AluScan, implemented with just a small number of H-type and T-type inter-Alu PCR primers, provides an effective capture of a diversity of genome-wide sequences for analysis. The method, by enabling an examination of gene-enriched regions containing exons, introns, and intergenic sequences with modest capture and sequencing costs, computation workload and DNA sample requirement is particularly well suited for accelerating the discovery of somatic mutations, as well as analysis of disease-predisposing germline polymorphisms, by making possible the comparative genome-wide scanning of DNA sequences from large human cohorts.</p

Comparison of coplanar and noncoplanar intensity-modulated radiation therapy and helical tomotherapy for hepatocellular carcinoma

<p>Abstract</p> <p>Background</p> <p>To compare the differences in dose-volume data among coplanar intensity modulated radiotherapy (IMRT), noncoplanar IMRT, and helical tomotherapy (HT) among patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT).</p> <p>Methods</p> <p>Nine patients with unresectable HCC and PVT underwent step and shoot coplanar IMRT with intent to deliver 46 - 54 Gy to the tumor and portal vein. The volume of liver received 30Gy was set to keep less than 30% of whole normal liver (V30 < 30%). The mean dose to at least one side of kidney was kept below 23 Gy, and 50 Gy as for stomach. The maximum dose was kept below 47 Gy for spinal cord. Several parameters including mean hepatic dose, percent volume of normal liver with radiation dose at X Gy (Vx), uniformity index, conformal index, and doses to organs at risk were evaluated from the dose-volume histogram.</p> <p>Results</p> <p>HT provided better uniformity for the planning-target volume dose coverage than both IMRT techniques. The noncoplanar IMRT technique reduces the V10 to normal liver with a statistically significant level as compared to HT. The constraints for the liver in the V30 for coplanar IMRT vs. noncoplanar IMRT vs. HT could be reconsidered as 21% vs. 17% vs. 17%, respectively. When delivering 50 Gy and 60-66 Gy to the tumor bed, the constraints of mean dose to the normal liver could be less than 20 Gy and 25 Gy, respectively.</p> <p>Conclusion</p> <p>Noncoplanar IMRT and HT are potential techniques of radiation therapy for HCC patients with PVT. Constraints for the liver in IMRT and HT could be stricter than for 3DCRT.</p

Association between the risk of heart failure hospitalization and end-stage renal disease with digoxin usage in patients with cardiorenal syndrome: A population-based study

BackgroundThe management of the coexistence of heart disease and kidney disease is increasingly challenging for clinicians. Chronic kidney disease (CKD) is not only a prevalent comorbidity of patients with heart failure but has also been identified as a noteworthy risk factor for all-cause mortality and poor clinical outcomes. Digoxin is one of the commonest treatments for heart disease. There are few trials investigating the role of digoxin in patients with cardiorenal syndrome (CRS). This study aims to examine the association between digoxin usage and clinical outcomes in patients with CRS in a nationwide cohort.MethodWe conducted a population-based study that included 705 digoxin users with CRS; each patient was age, sex, comorbidities, and medications matched with three non-users who were randomly selected from the CRS population. Cox proportional hazards regression analysis was conducted to estimate the effects of digoxin on the incidence of all-cause mortality, congestive heart failure (CHF) hospitalization, coronary artery disease (CAD) hospitalization, and end-stage renal disease (ESRD).ResultsThe all-cause mortality rate was significantly higher in digoxin users than in non-users (adjusted hazard ratio [aHR] = 1.26; 95% confidence interval [CI] = 1.09–1.46, p = 0.002). In a subgroup analysis, there was significantly high mortality in the 0.26–0.75 defined daily dose (DDD) subgroup of digoxin users (aHR = 1.49; 95% CI = 1.23–1.82, p&lt;0.001). Thus, the p for trend was 0.013. With digoxin prescription, the CHF hospitalization was significantly higher [subdistribution HR (sHR) = 1.17; 95% CI = 1.05–1.30, p = 0.004], especially in the &gt;0.75 DDD subgroup (sHR = 1.19; 95% CI = 1.01–1.41, p = 0.046; p for trend = 0.006). The digoxin usage lowered the coronary artery disease (CAD) hospitalization in the &gt; 0.75 DDD subgroup (sHR = 0.79; 95% CI = 0.63–0.99, p = 0.048). In renal function progression, more patients with CRS entered ESRD with digoxin usage (sHR = 1.34; 95% CI = 1.16–1.54, p&lt;0.001). There was a significantly greater incidence of ESRD in the &lt; 0.26 DDD and 0.26–0.75 DDD subgroups of digoxin users (sHR = 1.32; 95% CI = 1.06–1.66, p = 0.015; sHR = 1.44; 95% CI = 1.18–1.75; p for trend&lt;0.001).ConclusionDigoxin should be prescribed with caution to patients with CRS

Evaluation of Oral Antiretroviral Drugs in Mice With Metabolic and Neurologic Complications

Antiretroviral (ART) drugs has previously been associated with lipodystrophic syndrome, metabolic consequences, and neuropsychiatric complications. ART drugs include three main classes of protease inhibitors (PIs), nucleoside analog reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Our previous work demonstrated that a high risk of hyperlipidemia was observed in HIV-1-infected patients who received ART drugs in Taiwan. Patients receiving ART drugs containing either Abacavir/Lamivudine (Aba/Lam; NRTI/NRTI), Lamivudine/Zidovudine (Lam/Zido; NRTI/NRTI), or Lopinavir/Ritonavir (Lop/Rit; PI) have the highest risk of hyperlipidemia. The aim of this study was to investigate the effects of Aba/Lam (NRTI/NRTI), Lam/Zido (NRTI/NRTI), and Lop/Rit (PI) on metabolic and neurologic functions in mice. Groups of C57BL/6 mice were administered Aba/Lam, Lam/Zido, or Lop/Rit, orally, once daily for a period of 4 weeks. The mice were then extensively tested for metabolic and neurologic parameters. In addition, the effect of Aba/Lam, Lam/Zido, and Lop/Rit on lipid metabolism was assessed in HepG2 hepatocytes and during the 3T3-L1 preadipocyte differentiation. Administration with Aba/Lam caused cognitive and motor impairments in mice, as well as their metabolic imbalances, including alterations in leptin serum levels. Administration with Lop/Rit also caused cognitive and motor impairments in mice, as well as their metabolic imbalances, including alterations in serum levels of total cholesterol, and HDL-c. Treatment of mice with Aba/Lam and Lop/Rit enhanced the lipid accumulation in the liver, and the decrease in AMP-activated protein kinase (AMPK) phosphorylation and/or its downstream target acetyl-CoA carboxylase (ACC) protein expression. In HepG2 hepatocytes, Aba/Lam, Lam/Zido, and Lop/Rit also enhanced the lipid accumulation and decreased phosphorylated AMPK and ACC proteins. In 3T3-L1 pre-adipocyte differentiation, Aba/Lam and Lop/Rit reduced adipogenesis by decreasing expression of transcription factor CEBPb, implicating the lipodystrophic syndrome. Our results demonstrate that daily oral administration of Aba/Lam and Lop/Rit may produce cognitive, motor, and metabolic impairments in mice, regardless of HIV-1 infection

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Diversity of novel and emerging pathogenic fungi in Hong Kong

The incidence of mycotic infections, especially in immunocompromised individuals, is on the rise. The application of molecular identification has recognised a number of fungi, particularly those previously considered nonpathogenic, as emerging causes of mycoses. Yet, the aetiology for quite a number of fungal infections remains unknown. In the present study, it was hypothesised that novel and emerging pathogenic fungi could be identified using the consolidated species recognition method. The aim of the current project was to characterise the clinical spectrum of these novel and emerging fungal pathogens in Hong Kong. A total of 54 clinical, veterinary, and associated environmental fungi were retrieved and included in this work. These fungi, together with 45 related reference strains, were studied by phenotypic characterisation (including the examination of macro- and micromorphologies, growth test, and/or biochemical profiling), molecular phylogenetics (based on the internal transcribed spacer region, 18S and/or 26S/28S nuclear ribosomal DNAs, and/or other housekeeping protein-coding genes), matrix-assisted laser desorption/ionisation–time-of-flight mass spectrometry (MALDI–TOF MS), and/or antifungal susceptibility test. This polyphasic approach revealed that 38 of these 54 fungal strains represented 23 different described species across three different ascomycetous classes. Many of these species are uncommon aetiological agents of fungal infections, yet their clinical significance should not be underestimated. One of these species, Engyodontium album, was found to be phylogenetically and chemotaxonomically distantly related to its parent genus. Three of the remaining strains (HKU35T, HKU39T, and HKU49T) exhibited morphological features different from any other known fungal species and were found to occupy phylogenetic and/or chemotaxonomic positions distinct from other closely related species. New genera and/or species were proposed to describe these fungal taxonomic novelties. The novel fungi Hongkongmyces pedis genus novum et species nova and Phialemoniopsis hongkongensis species nova were recognised as causes of subcutaneous phaeohyphomycoses. The opportunistic pathogen Engyodontium album was transferred to Parengyodontium genus novum, and the new name Parengyodontium album combinatio nova was erected. A third previously unknown species, Aspergillus hongkongensis species nova, was also described as the aetiological agent of onychomycosis. Moreover, several other Aspergillus species (including Aspergillus flavus, Aspergillus sydowii, Aspergillus terreus, Aspergillus tubingensis, Aspergillus unguis, and Aspergillus welwitschiae), 14 nondermatophytic moulds (including Acremonium sclerotigenum–Acremonium egyptiacum complex, Cephalotheca foveolata, Chaetomium globosum, Cladosporium halotolerans, Cladosporium lebrasiae, Didymella gardeniae, Exophiala oligosperma, Microascus gracilis, Nigrospora sphaerica, Pithomyces maydicus, Purpureocillium lilacinum, Rhinocladiella similis, Sagenomella keratitidis, and Simplicillium obclavatum), and six additional potentially novel fungal species (of the families Amorosiaceae, Sympoventuriaceae, or Trichomeriaceae; or of the genera Arthrinium, Paracremonium, or Pyrenochaetopsis) were found to be emerging agents of nail infections. The emergence of Trichomonascus ciferrii as causes of human granular myringitis and Fusarium solani species complex as causes of systemic infections in elasmobranchs was also recognised. There was a large variation in the antifungal susceptibility profiles amongst the clinical/veterinary fungal isolates tested, highlighting the importance of accurate species identification for the determination of suitable treatments for patient management. In conclusion, a diverse spectrum of less well-known fungi has been recognised as emerging infectious agents. Three novel pathogenic fungi were also discovered and described.published_or_final_versionMicrobiologyDoctoralDoctor of Philosoph