Selective sentinel lymph node dissection in breast cancer: experiences from Taiwan

The significance of the sentinel lymph node (SLN) was examined in 58 Chinese breast cancer patients. The method of technetium-99m sulfur colloid injection and the intraoperative gamma probe was found to be very useful for identifying the SLN. The positive predictive value was 64.5%, and the negative predictive value was 93.2%. Findings suggest that lymph node dissection is not necessary in breast cancer patients with a negative SLN.

The change in the distribution of Tc-99m human serum albumin radioaerosols in asthma after a 1-week course of corticosteroid inhalation treatment

This study evaluated the effects of corticosteroid inhalation on the deposition pattern of Tc-99m HSA radioaerosols in 24 patients with asthma. The homogeneous degree of depositing radioaerosol was quantitatively evaluated using a modified standard score system over both lungs. The baseline scores were calculated before inhalation therapy of 0.05 mg beclomethasone dipropionate four times daily for 1 week. The studies were then repeated after treatment to evaluate the effects of inhalation therapy. After treatment, the scores decreased in 16 of 24 cases (67%), which means that the degree of the bronchial obstruction decreased. The statistical results revealed significant differences in the total homogeneity score (P < 0.001) before and after therapy. Thus, a 1-week course of beclomethasone dipropionate inhalation therapy improves the bronchial obstruction in asthma patients as shown by the quantitative homogeneity score system of the Tc-99m HSA radioaerosol inhalation lung scintigraphy.

Tc-99m HMPAO brain SPECT findings in pediatric viral encephalitis

Two children were diagnosed with viral encephalitis, due to Epstein-Barr virus infection in one case and to herpes simplex virus infection in the other. Tc-99m HMPAO brain SPECT was arranged to detect changes in regional cerebral blood flow (rCBF) secondary to viral encephalitis. During the acute episode, Tc-99m HMPAO brain SPECT showed that the two cases had increased rCBF. After the acute episode, follow-up brain SPECT was arranged 6 months later. The rCBF in one case was restored to normal on the second brain SPECT, and that in the other case was decreased. The child with normal rCBF in the follow-up brain SPECT had better learning ability and intelligence than the other child with decreased rCBF.

Abnormal gastric emptying and Helicobacter pylori infection in patients with cirrhosis of the liver

Thirty-seven patients aged 36-75 years with cirrhosis of the liver secondary to chronic hepatitis were included in the study. They were divided into three groups according to the modified Child's classification for cirrhotic severity, where A = good, B = fair and C = poor. In addition, the patients were divided according to the presence or absence of each of the following: ascites, splenomegaly and oesophageal varices. Radionuclide-labelled solid meals were used to evaluate gastric emptying and the 14C-urea breath test was used to detect Helicobacter pylori infection. Gastric emptying was represented by the gastric retention ratio of the solid meal at 90 min (RR90) and calculated using the following formula: the residual radioactivity within the region of interest (ROI) covering the whole stomach at 90 min divided by the initial radioactivity within the ROI at 0 min. We found that 75.7% (28/37) of the patients had abnormal gastric emptying and 45.9% (17/37) had H. pylori infection. No significant correlation was found between abnormal gastric emptying and H. pylori infection. There were no significant differences among the three groups regarding gastric emptying or H. pylori infection according to the modified Child's classification. However, the highest rates of abnormal gastric emptying and H. pylori infection were in patients in Child's class C. The differences in RR90 among patients with and without ascites, and patients with and without splenomegaly, were not significant (P > 0.05). However, there was a significant difference between the patients with and without oesophageal varices (P < 0.05). In addition, poor correlations (R2 < 0.01) were found between RR90 and serum levels of bilirubin and albumin.

[Clinical analysis of 21 cases with short fetal femur in the third trimester]

Objective: To analyze the clinical features and to explore the etiology of short fetal femur during the third trimester. Methods: From January 2010 to June 2016, 21 singleton pregnancies with short fetal femur detected by ultrasonography during the third trimester were referred to the Chinese PLA General Hospital. Clinical data were collected, karyotype or single nucleotide polymorphism microarray was carried out to detect chromosomal abnormalities, and FGFR3 c.1138G>A mutation detection was carried out to detect achondroplasia (ACH) via invasive procedure, respectively. The deviation of femur length from the mean value of the gestational age in ultrasonography was expressed as the Z-score. The difference between ACH and isolated short femur (ISF, in the absence of associated structure abnormality or genetic abnormality) was then explored. Results: In the 21 fetuses, 11 had abnormal genetic test results(52%, 11/21), including 9 cases of ACH, 1 case of Ellis-van Creveld Syndrome and 1 case of Pallister-Killian syndrome. In the 10 ISF fetuses (48%, 10/21), 3 cases were fetal growth restriction, 1 was normal small for gestational age infant and 6 cases were unexplained. The median Z-scores for 9 cases of ACH and 10 cases of ISF in the third trimester were -5.04, -3.20, respectively. The short femur in ACH was more severe than in ISF (P=0.005) in the third trimester. Conclusions: The etiology of short fetal femur is complicated, including skeletal dysplasia, chromosomal abnormality, fetal growth restriction, as well as normal variants during fetal development. Genetic test should be considered during the antenatal consultation.

Ultrafast insulator–metal phase transition in vanadium dioxide studied using optical pump–terahertz probe spectroscopy

We studied the ultrafast dynamic behavior of the photoinduced insulator–metal phase transition in VO2 thin film using optical pump–terahertz probe spectroscopy with different excitation fluences and at different temperatures. We observed two processes in the insulator–metal phase transition in VO2: a fast process and a slow process. The fast process is a nonthermal process, which is ascribed to the nucleation of the metal phase, while the slow process is strongly affected by temperature and is ascribed to the thermally driven growth and coalescence of metal domains in VO2. The transient complex conductivity spectra at different delay times are also investigated.

Infantile spasm induced by hemispheric pachygyria ultrasound, MRIand Tc-99m HMPAO SPECT

We report a case of infantile spasm induced by hemisphere pachygria in which ultrasound and MRI provided precise anatomic information of hemisphere pachygria and Tc-99m HMPAO SPECT scintigraphy supplied an accurate assessment regional cerebral blood flow of infantile spasm during a seizure.

Serial changes in regional blood flow in the cerebrum and cerebellum of stroke patients imaged by 99Tcm-HMPAO SPET

Luxury perfusion is a well-known phenomenon that can mask ischaemic lesions in patients with cerebral infarction, thus making diagnosis difficult. In this study, we evaluated the incidence of luxury perfusion over a 3-week period following a stroke episode. The usefulness of crossed cerebellar diaschisis (CCD) as a complementary feature in the diagnosis of cerebral infarction was also evaluated using 99Tcm-hexamethylpropyleneamine oxime (99TcmHMPAO) brain single photon emission tomography (SPET). Twelve patients diagnosed as having a hemispheric ischaemic stroke of the middle cerebral arterial territory were enrolled in the study. Each patient underwent a total of four 99Tcm-HMPAO brain SPET examinations, 1 day, 1 week, 2 weeks and 3 weeks following the stroke episode. Our results show that the incidence of luxury perfusion was 67% (8/12) after 1 week, 75% (9/12) after 2 weeks and 83% (10/12) after 3 weeks. The incidence of CCD was 33% (4/12) after 1 day, 50% (6/12) after 1 week, 42% (5/12) after 2 weeks and 33% (4/12) after 3 weeks. We conclude that the detection of cerebral infarction is difficult 2 weeks or more after a stroke episode. The interval between the stroke episode and examination must be considered when reading the 99Tcm-HMPAO image. In addition, CCD may be helpful for the diagnosis of cerebral infarction within the first week after a stroke episode, especially in cases of an unidentified ischaemic region on the 99Tcm-HMPAO hemispheric image. However, the value of CCD is limited 2 weeks or more following the stroke episode.

Masseter silent period: a study of magnetic stimulation

We employed magnetic stimulation to study the masseter silent period (SP) in 16 healthy volunteers. Cutaneous perception threshold (CPT or 1 T) was determined. SP threshold was 30% M (maximal output) in each subject, equivalent to 1.5-3 T, and as intensity increased, SP durations prolonged. The correlation was higher with units of % M (r = 0.89) than CPT (r = 0.39). The recommended intensity was 60% M because of least variation of SP durations. Conclusively, magnetic stimulation is a new and painless method to study masseter SP. CPT is less effective in studying masseter SP with magnetic stimulation as the input effectiveness correlates best with % M rather than CPT.

[A prospective study of the efficacy and safety of maintenance therapy with recombinant human thrombopoietin in patients with primary immune thrombocytopenia: a multicenter study]

Objective: To evaluate the efficacy and safety of maintenance therapy with reduced dose of rhTPO in the patients with primary immune thrombocytopenia (ITP) who attained stable platelet (PLT) counts after daily administration of rhTPO. Methods: Treatment was started with a daily administration of rhTPO (300 U/kg) for 2 consecutive weeks. Patients who attained stable PLT≥50×10(9)/L were enrolled to maintenance therapy starting with every other day administration of rhTPO, then adjusted dose interval to maintain platelet count (30-100) ×10(9)/L. Results: A total of 91 eligible patients were enrolled. Fourteen patients discontinued the study due to noncompliance (12/14) and investigator decision (2/14) . Among 77 patients who completed the study, 38 patients with the administration of rhTPO at every other day or less could maintain PLT≥30×10(9)/L for 12 weeks. The percentage of patients with a platelet response (PLT≥30×10(9)/L) at 4(th) week, 8(th) week and 12(th) week of maintain therapy was 92.6% (63/68) , 82.7% (43/52) and 85.0% (34/40) , respectively. Median platelet counts remained in the range of (70-124) ×10(9)/L. The overall incidence of rhTPO-related adverse events was 7.7%. All the adverse events were generally mild. Conclusion: Extending the dose interval of rhTPO is feasible to maintain stable platelet count in the patients with ITP, but the optimal dose interval is uncertain and might vary with individuals.

Creutzfeldt-Jakob disease. Report of a case of the panencephalopathic type and experiences of a teaching hospital in Taiwan

We report a case of the unusual panencephalopathic type of Creutzfeldt-Jakob disease (CJD) in Taiwan. This 59-year-old woman presented in 1983 with typical clinical manifestations of CJD and died 16 months later. Postmortem examination revealed severe neuronal loss, spongiosis and gliosis extensively in cerebral cortex and striatum as well as in the white matter. We also report 6 other CJD patients seen from 1983 to 1991 at Veterans General Hospital-Taipei.

Isolation of Haemophilus parahaemolyticus in a patient with cryptogenic brain abscess

Haemophilus parahaemolyticus rarely causes disease in humans. We present the case of a 68-y-old man who suffered from a brain abscess over the right-side thalamus and midbrain. Stereotactic aspirates grew H. parahaemolyticus. No portal of entry for the microorganism was identified in this case. The patient made a good recovery after treatment.

Familial Mediterranean fever--linkage studies with genetic markers on chromosome 6

Familial Mediterranean Fever (FMF) is an autosomal recessive disease manifested by recurrent short episodes of fever associated with polyserositis. Although the biochemical defect is unknown, there are several immunologic abnormalities which have been described in this disease. To examine critically whether there is linkage between FMF and the immunogenetic region (major histocompatibility complex-MHC) on chromosome 6, including the HLA, BF, and GLO1 loci, blood samples from members of 13 nuclear Armenian families were tested for these genetic markers. These 13 families included 28 affected and 42 unaffected family members. Linkage could be excluded at 7.5% recombination with the HLA ABC and D loci. Linkage could be excluded at 2.5% recombination for GLO1. Linkage could not be excluded with BF individually, but can be rejected based on the haplotype data. No association was found with either BF, GLO1, and HLA DQ alleles. HLA DR4 was found more often in affected cases than in controls; however, after adjusting for the number of antigens tested this was not significant. Our results would appear to exclude the immunogenetic region on chromosome 6 from linkage with FMF in the Armenian population.

Regulation of plasminogen activator inhibitor activity by plasmin in endothelial cells

The fibrinolytic activity in endothelial cells was regulated by balance of plasminogen activators and plasminogen activator inhibitors. Plasmin can specifically inhibit the biosynthesis of tissue-type plasminogen activator (t-PA), but not plasminogen activator inhibitor, type 1 (PAI-1) in endothelial cells. The PAI activity in the conditioned medium of endothelial cells was low and remained constant in 24 hours. However, the PAI activity in the conditioned medium of the plasmin-pretreated cells increased linearly in 24 hours. Pretreatment with protein kinase C inhibitors, H-7 or staurosporine, partially suppressed the PAI activity induced by plasmin. Pretreatment of endothelial cells with a G-protein inhibitor pertussis toxin resulted in an inhibition of the plasmin-induced PAI activity. The phospholipase A2 inhibitor mepacrine specifically eliminated the effect of plasmin stimulation on PAI activity. Cyclooxygenase and lipoxygenase inhibitors also partially inhibited the plasmin-stimulated PAI activity in endothelial cells. All these inhibitors did not affect the biosynthesis of the PAI-1 antigen in the presence or absence of plasmin. The results indicate that plasmin increased the PAI activity of endothelial cells via pathways in which protein kinase C, G protein, and phospholipase A2 may be involved.

Labeled WBC cardiac imaging and two-dimensional echocardiography to evaluate high-dose gamma globulin treatment in Kawasaki disease

Twenty-eight children (5 girls, 23 boys; age, 20.3 +/- 16.2 months) with Kawasaki disease (KD) were included in this study. The children were treated with aspirin plus intravenous injection of gamma globulin (IVGG). Both Tc-99m HMPAO labeled WBC heart imaging (Tc-WBC) and two-dimensional echocardiograms (2D-Echo) were used to evaluate the effects of IVGG on the most common cardiac presentations--carditis and dilated coronary arteries--in KD. After IVGG therapy, the results showed that 32.1% (9/28) carditis patients had improved; 39.3% (11/28) of patients had no significant change; 28.6% (8/28) of patients had severe changes, and there was no significant difference among the three groups by the evidences of Tc-WBC. Dilated coronary arteries (CA) became smaller in 32.1% (9/28) of patients; 53.6% (15/28) of patients had no definite change; 14.3% (4/28) of patients had dilated LCA that became larger; and borderline difference existed among the three groups, proved by 2D-Echo. Between the Tc-WBC and 2D-Echo, 35.7% (10/28) of patients had similar changes, and 64% (18/28) of patients showed incongruous changes; and there was little difference. In conclusion, Tc-WBC and 2D-Echo provide strong evidence of the existence of carditis and dilated coronary arteries in certain patients, even after IVGG treatment. The improvements of carditis and dilated coronary arteries were not correlated with each other after IVGG therapy.

[Efficacy and safety of oseltamivir in children with suspected influenza: a multicenter randomized open-label trial]

Objective: To evaluate the efficacy and safety of oseltamivir in the treatment of suspected influenza in children. Method: A multicenter, randomized and open-label trial was conducted among 229 individuals with suspected influenza which were collected from the clinic of 5 hospitals in Guangdong province (Guangzhou Women and Children's Medical Center, Shenzhen Baoan District Maternity and Child Care Service Center, the Second Affiliated Hospital of Shantou University Medical College, Dongguan Maternity and Child Care Service Centre, Yuexiu District Children's Hospital of Guangzhou) from April to July 2015. They were randomized either to oseltamivir group (oseltamivir 30-75 mg, twice daily for 5 days) or control group who were given symptom relief medicines for 5 days. Result: No significant difference was found between two groups in influenza symptoms of the patients before the treatment(P>0.05). Altogether 229 individuals (114 in oseltamivir group, 115 in control group) were analyzed for efficacy, in which 73 individuals (42 oseltamivir, 31 control), 31.9%, were identified as influenza-infected through laboratory test. No significant difference was found between the two groups in the duration of fever although shortened. In the 229 individuals , the cumulative alleviation proportion between oseltamivir and control group was not significantly different (P>0.05): the median duration of illness was 69.9 hours (95% CI 65.3-91.5) in oseltamivir group and 75.4 hours (95%CI 63.9-91. 7) in control group; the median duration of fever was 40.4 hours (95%CI 31.5-53.4) in oseltamivir group and 44.0 hours (95%CI 33.2-50.0) in control group. In the 73 individuals, the cumulative alleviation proportion between oseltamivir and control group was significantly different (P<0.05). The median duration of illness was 61.2 hours (95%CI 48.0-121. 0) in oseltamivir group, being significantly shorter than that of 116.0 hours (95%CI 91.5-175.0) in control group. But it was not significantly different that the median duration of fever was 32.8 hours (95%CI 24.0-47.0 ) in oseltamivir group and 55.8 hours (95%CI 43.6-78.3 ) in control group (P>0.05). And the median duration of fever in 60 individuals (38 oseltamivir, 22 control) was significantly different between two groups(P<0.05), who had finished a course of taking oseltamivir in the 73 individuals, 34.8 hours (95%CI 24.0-48.5 ) in oseltamivir group being significantly shorter than that of 53.3 hours (95%CI 43.6-104.0 ) in control group. There was certain difference in side effects rate between the two groups (oseltamivir 10%, control 2%, P<0.05). The main side-effects were gastrointestinal symptoms (stomachache, diarrhea, poor appetite, vomiting). Conclusion: The duration of illness and fever in suspected influenza patients treated with oseltamivir was shorter than those in the patients treated with no oseltamivir, the difference was not statistically significant, when 31.9% was confirmed with positive result of virus test in suspected influenza in children. But in these patients with positive result of virus test, the duration of illness was significantly shortened with treatment with oseltamivir as compared with no treatment with oseltamivir, and it would be better if full oseltamivir course was completed for reducing the duration of fever. Oseltamivir treatment was safe with mild side effects.

Low dose of gamma irradiation enhanced boronophenylalanine uptake in head and neck carcinoma cells for boron neutron capture therapy

This study attempted to increase the boron uptake of human head and neck carcinoma SAS cells for BNCT by using a gamma dose of 0.1 Gy for combined treatment. Intracellular boron concentrations in 25 μgB/mL medium of BPA treated and BPA combined gamma-irradiation treated SAS cells were 73.8±1.73 and 95.15±1.36 ppm, respectively. After neutron irradiation, the G2/M-phase cell populations of untreated, BPA treated and BPA combined gamma-irradiation treated SAS cells were 19.31±1.71%, 52.47±2.25% and 59.19±2.63%, respectively. Experimental results indicate that the low dose gamma radiation with combination BPA treatment has the highest killing rate after neutron irradiation. Capable of significantly increasing the G2/M arrest after neutron irradiation, the combined treatment of a low dose of gamma irradiation with 25 μg B/mL medium of BPA also provided a higher killing effect for BNCT.

The Rat Genome Database (RGD) facilitates genomic and phenotypic data integration across multiple species for biomedical research

Model organism research is essential for discovering the mechanisms of human diseases by defining biologically meaningful gene to disease relationships. The Rat Genome Database (RGD, ( https://rgd.mcw.edu )) is a cross-species knowledgebase and the premier online resource for rat genetic and physiologic data. This rich resource is enhanced by the inclusion and integration of comparative data for human and mouse, as well as other human disease models including chinchilla, dog, bonobo, pig, 13-lined ground squirrel, green monkey, and naked mole-rat. Functional information has been added to records via the assignment of annotations based on sequence similarity to human, rat, and mouse genes. RGD has also imported well-supported cross-species data from external resources. To enable use of these data, RGD has developed a robust infrastructure of standardized ontologies, data formats, and disease- and species-centric portals, complemented with a suite of innovative tools for discovery and analysis. Using examples of single-gene and polygenic human diseases, we illustrate how data from multiple species can help to identify or confirm a gene as involved in a disease and to identify model organisms that can be studied to understand the pathophysiology of a gene or pathway. The ultimate aim of this report is to demonstrate the utility of RGD not only as the core resource for the rat research community but also as a source of bioinformatic tools to support a wider audience, empowering the search for appropriate models for human afflictions.

Effects of phenytoin on the amygdala neurons in vitro

The present study was aimed at elucidating the possible mechanisms underlying the anticonvulsant efficacy of phenytoin using intracellular recording techniques in the in vitro amygdalar slice preparation. Synaptic response mediated by the N-methyl-D-aspartate (NMDA) receptor (EPSPNMDA) was isolated pharmacologically by application of a solution containing non-NMDA receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (10 mumol/l) and gamma-aminobutyric acidA receptor antagonist bicuculline (20 mumol/l). Phenytoin inhibits the amplitude of EPSPNMDA without affecting the postsynaptic depolarization induced by exogenous application of NMDA. In addition, phenytoin increases the magnitude of paired-pulse facilitation which is consistent with a presynaptic mode of action. These results suggest that inhibition of transmitter release due to presynaptic blockade of Na+ and/or Ca2+ channels may account largely for the anticonvulsant efficacy of phenytoin.