Septic Shock after Conservative Management for Placenta Accreta

SummaryObjectiveThe rate of placenta accreta has risen in the last three decades due to the increasing rate of cesarean section. Placenta accreta usually results in severe postpartum hemorrhage requiring massive blood transfusion and postpartum hysterectomy. Conservative treatment is an alternative in selected patients to preserve fertility and decrease postpartum hemorrhage, but the risks of conservative treatment have seldom been described.Case ReportA 39-year-old woman with placenta accreta diagnosed during cesarean section was treated conservatively. Persistent puerperal fever with leukocytosis developed during the postpartum period in spite of long-term antibiotic treatment. Evacuation of the retained placenta resulted in septic shock, which occurred immediately after dilatation and curettage. An uneventful recovery was achieved after use of strong antibiotics and fluid challenge.ConclusionAt present, there is no consensus about the optimal treatment for placenta accreta. Conservative treatment appears to be an alternative in selected patients, but the complications such as sepsis should be carefully identified and appropriately managed

Detach and Adapt: Learning Cross-Domain Disentangled Deep Representation

While representation learning aims to derive interpretable features for describing visual data, representation disentanglement further results in such features so that particular image attributes can be identified and manipulated. However, one cannot easily address this task without observing ground truth annotation for the training data. To address this problem, we propose a novel deep learning model of Cross-Domain Representation Disentangler (CDRD). By observing fully annotated source-domain data and unlabeled target-domain data of interest, our model bridges the information across data domains and transfers the attribute information accordingly. Thus, cross-domain joint feature disentanglement and adaptation can be jointly performed. In the experiments, we provide qualitative results to verify our disentanglement capability. Moreover, we further confirm that our model can be applied for solving classification tasks of unsupervised domain adaptation, and performs favorably against state-of-the-art image disentanglement and translation methods.Comment: CVPR 2018 Spotligh

Multicentric reticulohistiocytosis in a Taiwanese woman with Sjögren syndrome

AbstractMulticentric reticulohistiocytosis is a rare, non-Langerhans cell histiocytosis characterized by specific skin lesions and destructive arthritis. Clinically, it generally presents with multiple reddish-brown papulonodules over the hands, face, and trunk. The associated destructive arthropathy tends to be severe, with 50% of patients developing arthritis mutilans. Approximately 25–30% of patients present with neoplasia. Coexisting autoimmune diseases are also commonly reported. Here we report the case of a 59-year-old Taiwanese woman with underlying Sjögren syndrome who presented with the typical skin manifestations of multicentric reticulohistiocytosis and early interphalangeal joint involvement. The patient later showed partial response to methotrexate treatment

New primers for methylation-specific polymerase chain reaction enhance specificity of detecting STAT1 methylation

AbstractObjectiveSignal transducer and activator of transcription (STAT)1 is a key tumor suppressor, which is always methylated in a variety of human cancers. However, nonspecific primers for the detection of specific promoter hypermethylation of STAT1 gene can lead to false-positive or false-negative results for gene methylation.Materials and MethodsWe designed new primers for the detection of STAT1 methylation and compared the sensitivities and specificities of these new primers with prior published primers by methylation-specific polymerase chain reaction (PCR) from ovarian clear cell carcinomas. The mRNA expression levels of STAT1 in these cancerous tissues were also evaluated by reverse-transcriptase PCR and correlated with the results of promoter methylation of STAT1 gene.ResultsNine (39%) of the 23 samples detected by the new primers and 13 samples (56%) detected by prior published primers showed STAT1 methylation. A direct DNA sequencing test revealed that four of the 13 samples (30.8%) showed false positivity for STAT1 methylation using the prior published primers. In contrast, none of the nine samples was false-positive for the detection of STAT1 methylation using the new primers. The new primers for the detection of STAT1 methylation showed 100% specificity and 100% sensitivity without false positivity.ConclusionSpecific primers for methylation-specific PCR are mandatory for the accurate detection of STAT1 gene methylation. Besides, specific primers can generate correct interpretation of STAT1 gene methylation, and its correlation with the clinicopathological characteristics and outcome of cancer patients

Exploring the value co-destruction model for on-line deviant behaviors of hotel customers

© 2019 Elsevier Ltd This study aims to build a value co-destruction model by exploring the online deviant behavior of hotel customers. Desire for revenge and desire for recovery are considered mediators. Hotel guests in notable Taiwan locations were surveyed via the Internet (no. = 601 valid responses). This study finds that negative emotion indirectly impacts negative electronic word of mouth (eWOM) with desire for revenge as a mediator. Furthermore, desire for recovery has the potential to mitigate the impact of negative emotion on negative eWOM. However, the desire for recovery is less intense than the desire for revenge. Based on these findings, this study concludes that emotion, by itself, does not result in action. Respondents only commit negative eWOM because they want to hurt the firm that wronged them. Respondents are also willing to entertain the idea of service recovery. However, desire for revenge is a stronger mediating factor

Triggering Apoptotic Death of Human Malignant Melanoma A375.S2 Cells by Bufalin: Involvement of Caspase Cascade-Dependent and Independent Mitochondrial Signaling Pathways

Bufalin was obtained from the skin and parotid venom glands of toad and has been shown to induce cytotoxic effects in various types of cancer cell lines, but there is no report to show that whether bufalin affects human skin cancer cells. The aim of this investigation was to study the effects of bufalin on human malignant melanoma A375.S2 cells and to elucidate possible mechanisms involved in induction of apoptosis. A375.S2 cells were treated with different concentrations of bufalin for a specific time period and investigated for effects on apoptotic analyses. Our results indicated that cells after exposure to bufalin significantly decreased cell viability, and induced cell morphological changes and chromatin condensation in a concentration-dependent manner. Flow cytometric assays indicated that bufalin promoted ROS productions, loss of mitochondrial membrane potential (ΔΨm), intracellular Ca2+ release, and nitric oxide (NO) formations in A375.S2 cells. Additionally, the apoptotic induction of bufalin on A375.S2 cells resulted from mitochondrial dysfunction-related responses (disruption of the ΔΨm and releases of cytochrome c, AIF, and Endo G), and activations of caspase-3, caspase-8 and caspase-9 expressions. Based on those observations, we suggest that bufalin-triggered apoptosis in A375.S2 cells is correlated with extrinsic- and mitochondria-mediated multiple signal pathways

Bevacizumab Dose Affects the Severity of Adverse Events in Gynecologic Malignancies

In this retrospective study, we investigated adverse events and outcomes in patients treated with bevacizumab for ovarian, fallopian tube, or primary peritoneal cancers at a single hospital. We determined the cumulative incidences of various bevacizumab-related adverse events and the correlation between dose and adverse event incidences. We analyzed data from 154 patients that received 251 rounds of bevacizumab as first-line, first salvage, >2 salvage treatments. Adverse events of any grade were observed in 121 (78.6%) patients; at least one grade 3 or 4 adverse event occurred in 32 (20.8%) patients. The two most common events were proteinuria (38.3%) and hypertension (33.8%). The first-line treatment group displayed significantly higher frequencies of hypertension (52.7% vs. 18.9% vs. 15.5%, p < 0.001), wound complications (9.1% vs. 0% vs. 1.2%, p = 0.010), arthralgia (29.1% vs. 11.3% vs. 8.3%, p = 0.003), and reduced range of joint motion (14.5% vs. 5.7% vs. 3.6%, p = 0.046), compared to those in the first and >2 lines salvage groups, respectively (Kruskal–Wallis test). The cumulative incidences of all grades and grades 3/4 of hypertension cumulative incidence plateaued at around 30% for all grades and 10% for grades 3 and 4, at bevacizumab doses above 8080 and 3510 mg, respectively. The proteinuria cumulative incidence plateaued at around 35% for all grades and 3% for grades 3 and 4, at bevacizumab doses above 11,190 and 4530 mg, respectively. We concluded that, in this realistic clinical population, different kinds and higher cumulative incidences of adverse events were observed compared to those reported in previous clinical trials. Moreover, bevacizumab doses showed cumulative toxicity and plateau effects on hypertension and proteinuria

Successful treatment of an early invasive oral squamous cell carcinoma with topical 5-aminolevulinic acid-mediated photodynamic therapy

Our previous studies showed successful treatment of a series of 36 oral verrucous hyperplasia lesions and of an extensive oral verrucous carcinoma with a topical 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (topical ALA-PDT) protocol (with a fluence rate of 100 mW/cm2 and a light exposure dose of 100 J/cm2) using a 635-nm light-emitting diode (LED) light source. In this case report, we tested whether an enhanced topical ALA-PDT protocol (with a fluence rate of 200 mW/cm2 and a light exposure dose of 200 J/cm2) could be used to treat an early invasive oral squamous cell carcinoma (OSCC) with a verrucous appearance of the left lower posterior edentulous alveolar mucosa of a 67-year-old male former areca-quid chewer and ex-smoker. The main verrucous lesion showed complete regression after eight treatments with PDT. However, 10 extra treatments were needed to eradicate the multiple residual leukoplakia lesions on the edentulous alveolar mucosa. Moderate to severe post-PDT pain was noted during the initial eight treatments, and the patient needed analgesics (codeine phosphate, 30 mg three times daily) to control the pain. No recurrence of the OSCC lesion was found after a follow-up period of 4 years. We suggest that our enhanced topical ALA-PDT protocol may have good potential to be used as a treatment of choice for a superficially invasive OSCC without regional or distant metastasis before the commencement of other effective therapies

The Inhibitory Effect of Ellagic Acid on Cell Growth of Ovarian Carcinoma Cells

Ellagic acid (EA) is able to inhibit the growth of several cancer cells; however, its effect on human ovarian carcinoma cells has not yet been investigated. Ovarian carcinoma ES-2 and PA-1 cells were treated with EA (10~100 μM) and assessed for viability, cell cycle, apoptosis, anoikis, autophagy, and chemosensitivity to doxorubicin and their molecular mechanisms. EA inhibited cell proliferation in a dose- and time-dependent manner by arresting both cell lines at the G1 phase of the cell cycle, which were from elevating p53 and Cip1/p21 and decreasing cyclin D1 and E levels. EA also induced caspase-3-mediated apoptosis by increasing the Bax : Bcl-2 ratio and restored anoikis in both cell lines. The enhancement of apoptosis and/or inhibition of autophagy in these cells by EA assisted the chemotherapy efficacy. The results indicated that EA is a potential novel chemoprevention and treatment assistant agent for human ovarian carcinoma