Retroperitoneal Metastatic Adenocarcinoma Complicated with Necrotizing Fasciitis of the Thigh in a Patient with Advanced Rectal Colon Cancer

Background: Necrotizing fasciitis of the thigh due to colon cancer has not been previously reported, especially during radiotherapy. Case Presentation: A 73-year-old woman admitted to our hospital was diagnosed with sigmoid colon cancer that had spread to the left psoas muscle; radiotherapy was performed. Three months after the initiation of radiotherapy, the patient developed gait disturbance, poor appetite and high fever and was therefore admitted to the emergency department of our hospital. Blood examination revealed generalized inflammation with a high white blood cell count and C-reactive protein level. Computed tomography of the abdomen revealed fluid and gas tracking from the retroperitoneum into the intramuscular plane of the grossly enlarged right thigh. Consequently, emergent debridement was not performed and conservative therapy was done. The patient died. Conclusion: Necrotizing fasciitis of the thigh due to the spread of rectal colon cancer is unusual, but this fatal complication should be considered during radiotherapy in patients with unresectable colorectal cancer

Nuclear Receptor Interaction Protein (NRIP) expression assay using human tissue microarray and immunohistochemistry technology confirming nuclear localization

Background: A novel human nuclear receptor interaction protein (NRIP) has recently been discovered by Chen SL et al , which may play a role in enhancing the transcriptional activity of steroid nuclear receptors in prostate (LNCaP) and cervical (C33A) cancer cell lines. However, knowledge about the biological functions and clinical implications of NRIP, is still incomplete. Our aim was to determine the distribution of NRIP expression and to delineate the cell types that express NRIP in various malignant tumors and healthy non-pathological tissues. This information will significantly affect the exploration of its physiological roles in healthy and tumor cells. Methods: By using tissue microarray (TMA) technology and an anti-NRIP monoclonal antibody immunohistochemical (IHC) survey, NRIP expression was examined in 48 types of tumors and in a control group of 48 matched or unmatched healthy non-neoplastic tissues. Results: Our survey results showed that ten cases were revealed to express the NRIP in six malignancies (esophageal , colon, breast, ovarian, skin, and pancreatic cancers), but not all of these specific tumor types consistently showed positive NRIP expression. Moreover, malignant tumors of the stomach, prostate, liver, lung, kidney, uterine cervix, urinary bladder, lymph node, testis, and tongue revealed no NRIP expression. Among the control group of 48 matched and unmatched nonneoplastic tissues, all of them demonstrated IHC scores less than the cut-off threshold of 3. In addition , ten cores out of thirty-six carcinomatous tissues revealed positive NRIP expression, which indicated that NRIP expression increases significantly in carcinoma tissue cores , comparing to the matched controlled healthy tissues. Conclusion: This is the first study to use a human TMA and IHC to validate the nuclear localization for this newly identified NRIP expression. In considering the use of NRIP as a potential diagnostic tool for human malignancies survey , it is important to note that NRIP expression carries a sensitivity of only 23%, but has a specificity of 100%. There is also a significant difference in positive NRIP expression between primary carcinomatous tissues and matched controlled healthy tissues. Although further large-scale studies will merit to be conducted to evaluate its role as a potential adjunct for cancer diagnosis, data from this study provides valuable references for the future investigation of the biological functions of NRIP in humans

Brain computerized tomography reading in suspected acute ischemic stroke patients: what are essentials for medical students?

Background Few systematic methods prioritize the image education in medical students (MS). We hope to develop a checklist of brain computerized tomography (CT) reading in patients with suspected acute ischemic stroke (AIS) for MS and primary care (PC) physicians. Methods Our pilot group generated the items indicating specific structures or signs for the checklist of brain CT reading in suspected AIS patients for MS and PC physicians. These items were used in a modified web-based Delphi process using the online software “SurveyMonkey”. In total 15 panelists including neurologists, neurosurgeons, neuroradiologists, and emergency department physicians participated in the modified Delphi process. Each panelist was encouraged to express feedback, agreement or disagreement on the inclusion of each item using a 9-point Likert scale. Items with median scores of 7–9 were included in our final checklist. Results Fifty-two items were initially provided for the first round of the Delphi process. Of these, 35 achieved general agreement of being an essential item for the MS and PC physicians. The other 17 of the 52 items in this round and another two added items suggested by the panelists were further rated in the next round. Finally, 38 items were included in the essential checklist items of brain CT reading in suspected AIS patients for MS and PC physicians. Conclusions We established a reference regarding the essential items of brain CT reading in suspected AIS patients. We hope this helps to minimize malpractice and a delayed diagnosis, and to improve competency-based medical education for MS and PC physicians

Characterization of Granulations of Calcium and Apatite in Serum as Pleomorphic Mineralo-Protein Complexes and as Precursors of Putative Nanobacteria

Calcium and apatite granulations are demonstrated here to form in both human and fetal bovine serum in response to the simple addition of either calcium or phosphate, or a combination of both. These granulations are shown to represent precipitating complexes of protein and hydroxyapatite (HAP) that display marked pleomorphism, appearing as round, laminated particles, spindles, and films. These same complexes can be found in normal untreated serum, albeit at much lower amounts, and appear to result from the progressive binding of serum proteins with apatite until reaching saturation, upon which the mineralo-protein complexes precipitate. Chemically and morphologically, these complexes are virtually identical to the so-called nanobacteria (NB) implicated in numerous diseases and considered unusual for their small size, pleomorphism, and the presence of HAP. Like NB, serum granulations can seed particles upon transfer to serum-free medium, and their main protein constituents include albumin, complement components 3 and 4A, fetuin-A, and apolipoproteins A1 and B100, as well as other calcium and apatite binding proteins found in the serum. However, these serum mineralo-protein complexes are formed from the direct chemical binding of inorganic and organic phases, bypassing the need for any biological processes, including the long cultivation in cell culture conditions deemed necessary for the demonstration of NB. Thus, these serum granulations may result from physiologically inherent processes that become amplified with calcium phosphate loading or when subjected to culturing in medium. They may be viewed as simple mineralo-protein complexes formed from the deployment of calcification-inhibitory pathways used by the body to cope with excess calcium phosphate so as to prevent unwarranted calcification. Rather than representing novel pathophysiological mechanisms or exotic lifeforms, these results indicate that the entities described earlier as NB most likely originate from calcium and apatite binding factors in the serum, presumably calcification inhibitors, that upon saturation, form seeds for HAP deposition and growth. These calcium granulations are similar to those found in organisms throughout nature and may represent the products of more general calcium regulation pathways involved in the control of calcium storage, retrieval, tissue deposition, and disposal

[[alternative]]The Effects of Internal Marketing, Relationship Quality and Salary Welfare on Employee's Resignation Tendency in Insurance Industry

[[abstract]]本研究採用實證調查方式，探討保險業採行內部行銷、強化關係品質及改善薪酬福利措施，對降低保險業員工離職傾向之影響；同時分析薪酬福利對內部行銷及關係品質與離職傾向間影響關係之調節效果。研究結果發現：企業組織中內部行銷機制對離職傾向具有負向顯著的影響，其中又以訓練與賦能對離職傾向最具影響效果；而關係品質對離職傾向亦具有負向顯著關係，其中又以信任與承諾對離職傾向之負向影響最鉅。薪酬福利滿意程度亦對離職傾向具有負向顯著影響，同時也會顯著調節內部行銷及關係品質對員工離職傾向的影響關係。[[abstract]]The current study conducted an empirical study to explore the effects of internal marketing, relationship quality and salary welfare on resignation tendency. Besides, the moderating effects of salary welfare were investigated. The results indicated that both corporate internal marketing mechanisms and employee’s relationship quality could significantly affect employee’s resignation tendency, while training and empower had the most significant effect on resignation tendency. Besides, the degree of satisfaction on salary welfare had significant negative influence on employee’s resignation tendency, while the effect of trust and commitment was most significant. Moreover, the degree of satisfaction on salary welfare could moderate the effects of internal marketing and relationship quality on employee’s resignation tendency significantly

Abstract Parallel computational algorithms for generalized Chinese remainder theorem

Recently, the residue number system (RNS) has been intensively studied. The Chinese remainder theorem (CRT) is a solution to the conversion problem of a number to RNS with a general moduli set. This paper introduces the generalized CRT (GCRT) with parallel algorithms used for the conversion. The GCRT differs from the CRT because it has the advantage of having more applications than does the CRT. The GCRT, however, has a disadvantage in computational performance. To remedy this shortcoming, this paper proposes algorithms that calculate concurrently for some non-related program fragments of GCRT computation. These proposed algorithms also allow the GCRT to compute more efficiently

Masked Priming of the Syllable in Mandarin Chinese Speech Production

International audienceThe syllable's role in Chinese (Mandarin.) speech production was investigated using masked syllable priming combined with a word naming task. In three experiments, the prime (shown in the form of a Chinese character but masked) shared the first few segments with the beginning of the disyllabic target word. The segmental overlap either corresponded to a syllable or it did not. Aside from a neutral prime, there were two types of related primes: a CV or a CVG syllable, and two types of targets: a CV-GV or a CVG-CVX word, where numbers stand for tones. In Experiment 1, when the prime-target overlap corresponded to a syllable, the tones and the orthographies were also the same. In Experiment 2, the syllable overlap included the tone but not the orthography. In Experiment 3, the syllable overlap was restricted to the syllable only, the tone and the orthography being different. A crossover interaction of the prime by target type was observed not only in Exp. 1 but also in Exp. 2 and Exp. 3, the effect being larger in Exp. 1 and about the same in Exps. 2 and 3. The crossover interaction effects from the last two experiments support the view that the syllable is a stored phonological chunk and plays an independent role as a planning unit in Chinese word production

The frequency of heparin-induced thrombocytopenia in Taiwanese patients undergoing cardiopulmonary bypass surgery

There are few studies on heparin-induced thrombocytopenia (HIT) reported from Taiwan and Asian countries. We conducted a prospective study to investigate the frequency of HIT in patients undergoing cardiopulmonary bypass surgeries. Methods: A cohort of 54 patients was enrolled from January 01, 2010 to October 31, 2011. Patients' clinical information was obtained for 4T score classification. Plasma (2–4 mL) was also collected before surgery and on Days 5 and 10 following heparin administration during the bypass procedure. This was tested for anti-heparin/PF4 antibodies and functional assay using flow cytometry (FC). Results: The mean platelet count for this cohort followed the expected pattern in the postoperative setting. Seven of the 54 (13%) patients had positive antibodies assays before bypass surgery. This increased to 32% on Day 5 and was markedly elevated to 63% on Day 10 after surgery. Only one of the 54 patients (1.8%) was found to have both positive antibody assay and platelet activation, but no clinical HIT/thrombosis developed. Conclusion: Our study is the first report on the rates of HIT in the setting of cardiopulmonary bypass surgery in Taiwan and demonstrated no clinical HIT occurrence, despite the high frequency of HIT antibody in our cohort

R1933X mutation in the MYH9 gene in May-Hegglin anomaly mimicking idiopathic thrombocytopenic purpura

May-Hegglin anomaly (MHA) is a rare autosomal dominant disorder characterized by the triad of thrombocytopenia, giant platelets, and inclusion bodies in leukocytes. Recent evidence links MHA to mutations in the MYH9 gene. MHA has not been reported in Taiwan before. We report a 25-year-old Taiwanese man who presented with prolonged bleeding after dental extraction. Examination of peripheral blood smear revealed thrombocytopenia (platelet = 35,000/μL), giant platelets, and Döhle-like cytoplasmic inclusions in neutrophils. A strong family history of thrombocytopenia favored hereditary macrothrombocytopenia over idiopathic thrombocytopenic purpura (ITP). Electron microscopy revealed a spindle shape and parallel order of filaments in the inclusions, consistent with the diagnosis of MHA. We performed mutational analysis using polymerase chain reaction followed by direct sequence of the MYH9 gene for the patient, his maternal uncle and cousin, and all showed the same heterozygous R1933X mutation in exon 40. MHA should be considered when a young patient has thrombocytopenia, frequently misdiagnosed as ITP. Morphological examination of peripheral blood smear, family history tracing and genetic studies are required to make an accurate diagnosis and avoid unnecessary and even harmful therapies such as corticosteroids and splenectomy