Extraocular muscle injury during endoscopic sinus surgery: a series of 10 cases at a single center

BACKGROUND

Extraocular muscle (EOM) injury is a rare but serious complication of endoscopic sinus surgery (ESS). The aim of this study is to describe the clinical characteristics and course of EOM injury occurring during ESS.

DESIGN

Retrospective case series.

METHODS

Medical records and CT images of patients who suffered from EOM injury after ESS between 2006 and 2012 were retrospectively reviewed. Patient demographics, endoscopic anatomy, type of surgery (primary or revision), predisposing risk factors, site and extent of injury on CT imaging, and associated complications were evaluated. In addition, data regarding ophthalmologic management and clinical outcomes were collected.

RESULTS

Ten patients with EOM injuries after ESS were included in this study. One patient was undergoing revision ESS. All patients sustained medial rectus muscle injury and one patient suffered concurrent ipsilateral inferior rectus muscle injury. A microdebrider was used in nine cases. Right-sided injury (90% of patients) was more prevalent than left-sided injury, and 70% of injured medial rectus muscles were completely transected. After subsequent strabismus surgery, 8/9 patients regained binocular single vision in primary gaze despite residual diplopia in some gaze positions.

CONCLUSION

Although proper ophthalmologic surgery after EOM injury may improve deviation in the primary gaze position, none of the patients regained normal EOM movement. Therefore, prevention of this complication through adequate surgical technique and precautions is important.

Relationship among attention-deficit hyperactivity disorder, dietary behaviours and obesity

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood and can be associated with obesity. The aim of this study was to reveal the connection between ADHD symptoms, food habits and obesity.

METHODS

We examined 12 350 children (6010 boys, 6340 girls) from 27 elementary schools in Cheonan, the Republic of Korea. The study subjects were 5- to 13-year-old children (9.4 ± 1.7 years). Parents completed the DuPaul ADHD Rating Scale. Food habits were measured by a questionnaire adapted from the Korea Youth Risk Behavior Web-based Survey and a validated mini-dietary assessment tool. The full set of hypothesized associations was tested using covariance structural modelling.

RESULTS

The prevalence of ADHD was 7.6% and that of obesity was 4.5% in our study population. The data was well fit by the model. ADHD was associated with body mass index (BMI; standardized β = 0.086, P < 0.001). Bulimic dietary behaviours was related to BMI (standardized β = 0.548, P < 0.001). Socio-economic status was associated with BMI (standardized β = -0.017, P = 0.027).

CONCLUSION

Our analysis suggested that ADHD was a risk factor for obesity through dietary behavioural change and socio-economic status.

Estimated long-term dietary exposure to lead, cadmium, and mercury in young Korean children

BACKGROUND

Controlling for day-to-day variation is a key issue in estimating long-term dietary exposure to heavy metals using 24-hour recall (24HR) data from a relatively small number of days.

OBJECTIVES

This study was conducted to estimate long-term dietary exposure to lead, cadmium and mercury among Korean children using the Iowa State University (ISU) method and to assess the contributions of different food groups to heavy metal intake.

METHODS

We analyzed 2 days of 24HR data from 457 children between 0 and 6 years of age in 2010. Using bootstrapped concentration data for 118 representative foods, 93.5% of total intake was included in the exposure estimates in this study. Using the 2-day exposure data, we estimated long-term exposure by controlling for within-individual variation using the ISU method.

RESULTS

The long-term dietary exposure estimates (mean±standard deviation) for lead, cadmium, and mercury were 0.47±0.14, 0.38±0.20, and 0.22±0.08 μg/kg bw/day, respectively. For lead and cadmium, the percentages of children whose exposure was greater than the reference value were 35 and 42%, respectively. Fruits were an important source of lead exposure, and cereal and fish and shellfish made the greatest contributions to the total cadmium and mercury exposure.

CONCLUSIONS

Our findings also suggest that the long-term exposure to lead and cadmium was somewhat greater than the reference values, whereas mercury exposure was well below than the reference value in this population. Further studies may be necessary to evaluate the food items contributing to heavy metal exposure, and continuous monitoring is needed to ensure the safety of food intake and dietary patterns among vulnerable groups in Korea.

Motion-free all optical inspection system for nanoscale topology control

We present a novel all optical method for nanoscale pattern inspection. This method uses the chromatic aberration in an imaging optical system and a tunable light source. Such an approach allows stable and precise inspection of nanoscale objects based on an analysis of their defocused diffraction patterns without any external mechanical influence on the sample or optical system. We demonstrate the efficiency of a low cost light source tunable in the range of a light emitting diode bandwidth of ~30 nm (FWHM) for providing the required defocusing. The proposed method is tested using calibrated lines (height 50 nm, length 100 μm, critical dimension (СD) value range 40-150 nm with 10 nm steps) on a monocrystalline silicon substrate with demonstrated measurement accuracy better than 10 nm. A comparison of this all optical method with a mechanical scanning inspection system is discussed.

Seasonal occurrence and habitat of two pennellids (Copepoda, Siphonostomatoida) infecting marine ranched black scraper and Korean rockfish in Korea

The seasonal occurrence and habitat of two parasitic copepods, Peniculus minuticaudae (Shiino, 1956) and Peniculus truncatus (Shiino, 1956) (Siphonostomatoida, Pennellidae) infecting the fins of black scraper Thamnaconus modestus and Korean rockfish Sebastes schlegelii, respectively were investigated. The fishes were collected from Tongyeong marine living resources research and conservation center, southern coast of Korea as five per month for two years from July 2011 to June 2013. In total, 391 copepods of P. minuticaudae were collected in two years, in contrast to P. truncatus. Prevalence was 85%, mean intensity was 3.25, and maximum intensity was 33. Season wise, the infestation was observed as the highest in autumn (September-November) season, and the lowest in winter (December- February). It was infested only on fins of black scrapers. Abundance of P. minuticaudae was found on the pectoral fin (43.5%), followed by anal (22.5%), second dorsal (20.5%) and caudal fins (13.5%). Statistically significant interactions were observed between season, infestation and infected regions (P<0.001). It is also reported for the first time in Korea from the fins of wild threadsail filefish Stephanolepis cirrhifer from Busan, Jeju, Tongyeong and Yeosu fish markets. It can be a new record on its host and localities. A total of 51 P. truncatus were collected with the prevalence of 37.5%, mean intensity of 0.37 and maximum intensity of 6. Season wise, infestation was observed as the highest in summer (June-August), and the lowest in winter. Attachment site was the dorsal fin and not found from any other fins of rockfish. Statistically significant interaction was observed between season and infestation (P<0.05). This is the first report on the ecology of these two pennellids.

Distinctive role of 6-month teriparatide treatment on intractable bisphosphonate-related osteonecrosis of the jaw

The administration of teriparatide (TPTD) in conjunction with periodontal care could provide faster and more favorable clinical outcomes in previously refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) cases compared to conventional dental care, combination of surgery and antimicrobial treatment. We also found that underlying vitamin D levels might influence the response to TPTD treatment.

INTRODUCTION

Treatment of BRONJ is quite challenging and there are no standard treatment modalities. In this retrospective, longitudinal study, we examined whether additional TPTD administration could be beneficial for the resolution of BRONJ lesions compared to conservative management, such as antimicrobial treatment with or without surgery, and also studied the factors influencing the response to TPTD.

METHODS

Twenty-four cases of intractable BRONJ were included: 15 subjects were assigned to the TPTD group and the other 9 subjects, who refused TPTD administration, were assigned to the non-TPTD group. All subjects in both groups continued calcium and vitamin D supplementation and the TPTD group additionally received a daily subcutaneous injection of 20 μg TPTD for 6 months.

RESULTS

While 60.0% of the non-TPTD group showed one stage of improvement in BRONJ, 40.0% of the group did not show any improvement in disease status. In the TPTD group, 62.5% of the treated subjects showed one stage of improvement and the other 37.5% demonstrated a marked improvement, including two stages of improvement or complete healing, and there was not a single case that did not improve. The clinical improvement of BRONJ was statistically better in the TPTD group after the 6-month treatment (p < 0.05). Moreover, patients with higher baseline serum 25(OH)D levels showed better clinical therapeutic outcomes with TPTD.

CONCLUSIONS

We observed the beneficial effects of TPTD on BRONJ, and subjects with optimal serum vitamin D concentrations seemed to reap the maximum therapeutic effects of TPTD. A prospective, randomized, controlled trial should be needed to further evaluate the therapeutic efficacy of TPTD in the resolution of BRONJ.

Method for optical inspection of nanoscale objects based upon analysis of their defocused images and features of its practical implementation

A microscopic method to inspect isolated sub 100 nm scale structures made of silicon is presented. This method is based upon an analysis of light intensity distributions at defocused images obtained along the optical axis normal to the sample plane. Experimental measurements of calibrated lines (height 50 nm, length 100 μm, and widths of 40-150 nm in 10 nm steps) on top of a monocrystalline silicon substrate are presented. Library of defocused images of calibrated lines is obtained experimentally and numerically with accordance to experimental setup parameters and measurements conditions. Processing of the measured defocused images and comparison with simulated ones from library allow one to distinguish between objects with a 10 nm change in width. It is shown that influence of optical system aberrations must be taken into account in order to achieve coincidence between simulation and measured results and increase accuracy of line width inspection accuracy. The limits of accuracy for object width measurements using this optical method are discussed.

Extranodal natural killer/T-cell lymphoma from skin or soft tissue: suggestion of treatment from multinational retrospective analysis

BACKGROUND

Clinical features and outcomes of extranodal natural killer/T-cell lymphoma (ENKL) arising from extranasal sites are not fully understood. The purpose of this study was to study the prognosis and treatment outcome of skin/soft tissue primary ENKL.

PATIENTS AND METHODS

This multicenter retrospective study included 48 patients with skin/soft tissue primary ENKL diagnosed from 1993 to 2010.

RESULTS

Patients with Ann Arbor stage I, T1-2N0M0 by International Society for Cutaneous Lymphomas-European Organization of Research and Treatment of Cancer TNM (tumour-node-metastasis) stage, International prognostic index score of 0-1, and a Korean prognostic index (KPI) score of 0-1 were associated with better survival. Four of five patients with T1-2N0M0 disease achieved complete response with radiation alone. In disseminated disease, only 6 of 13 patients responded to anthracycline-containing chemotherapy, and all the two patients receiving SMILE showed response.

CONCLUSION

In conclusion, we identified the prognostic value of KPI, and we suggest a treatment recommendation according to the TNM (tumour-node-metastasis) stage. Radiotherapy with/without chemotherapy seemed to be optimal in localized disease. In advanced stages, a more aggressive treatment regimen with newer agents should be sought.

Cardiac displacement-induced hemodynamic instability during off-pump coronary artery bypass surgery and its predictors

BACKGROUND

Emergent conversion to an on-pump procedure during an off-pump coronary artery bypass surgery (OPCAB) due to hemodynamic instability is associated with increased morbidity and mortality. The aim of this study was to evaluate the predictors of hemodynamic instability associated with mechanical heart displacement during OPCAB and the fate of these patients.

METHODS

Data of 494 patients who underwent elective, isolated OPCAB between December 2006 and April 2010 were reviewed. Hemodynamic instability was defined as mixed venous oxygen saturation (SvO(2) ) <60% during grafting. Pre-operative variables including the presence of diastolic dysfunction and mitral regurgitation (MR) were evaluated for their predictive value for hemodynamic instability by logistic regression analysis. Outcome variables were also compared between patients who developed hemodynamic instability and those who did not.

RESULTS

In univariate analysis, body mass index, diabetes mellitus, chronic obstructive pulmonary disease (COPD), left ventricular ejection fraction, diastolic dysfunction, MR ≥ grade 1, higher creatinine and the use of diuretics were identified as risk factors. In multivariate analysis of these variables, COPD and creatinine remained as independent risk factors for hemodynamic instability. These patients also had significantly lower cardiac output and SvO(2) after sternum closure and a higher incidence of composite morbidity end points.

CONCLUSION

COPD and pre-operative creatinine level were identified as independent risk factors of mechanical heart displacement-induced hemodynamic instability during OPCAB. As these patients were associated with significantly lower SvO(2) even at the end of surgery and with adverse outcome, consideration may be given to initiate preemptive measures to increase SvO(2) before or during grafting.

Cbl-b regulates airway mucosal tolerance to aeroallergen

BACKGROUND

As an E3 ubiquitin ligase and a molecular adaptor, Cbl-b controls the activation threshold of the antigen receptor and negatively regulates CD28 costimulation, functioning as an intrinsic mediator of T cell anergy that maintains tolerance. However, the role of Cbl-b in the airway immune response to aeroallergens is unclear.

OBJECTIVE

To determine the contribution of Cbl-b in tolerance to aeroallergens, we examined ovalbumin (OVA)-induced lung inflammation in Cbl-b-deficient mice.

METHODS

Cbl-b(-/-) mice and wild-type (WT) C57BL/6 mice were sensitized and challenged with OVA intranasally, a procedure normally tolerated by WT mice. We analysed lung histology, bronchoalveolar lavage fluid total cell counts and differential, cytokines and chemokines in the airway, and cytokine response by lymphocytes after re-stimulation by OVA antigen.

RESULTS

Compared with WT mice, OVA-challenged Cbl-b(-/-) mice showed significantly increased neutrophilic and eosinophilic infiltration in the lung and mucus hyperplasia. The serum levels of IgG2a and IgG1, but not IgE, were increased. The levels of inflammatory mediators IFN-γ, IL-10, IL-12, IL-13, IP-10, MCP-1, MIP-1α, eotaxin, and RANTES, but not IL-17A or IL-6, were elevated in the airway of Cbl-b(-/-) mice. Lymphocytes from Cbl-b(-/-) mice released increased amount of IFN-γ, IL-10, IL-13, and IP-10 in response to OVA re-stimulation. However, no significant changes were noted in the CD4(+) CD25(+) T regulatory cell populations in the lung tissues after OVA stimulation and there was no difference between WT and Cbl-b(-/-) mice.

CONCLUSION

These results demonstrate that Cbl-b deficiency leads to a breakdown of tolerance to OVA allergen in the murine airways, probably through increased activation of T effector cells, indicating that Cbl-b is a critical factor in maintaining lung homeostasis upon environmental exposure to aeroallergens.

Titrated propofol induction vs. continuous infusion in children undergoing magnetic resonance imaging

BACKGROUND

Propofol is the popular intravenous (i.v.) anaesthetic for paediatric sedation because of its rapid onset and recovery. We compared the efficacy and safety of a single dose and conventional infusion of propofol for sedation in children who underwent magnetic resonance imaging (MRI).

METHODS

This was a double-blind, randomized-controlled study. One hundred and sixty children were assigned to group I (single dose) or II (infusion). Sedation was induced with i.v. propofol 2 mg/kg, and supplemental doses of propofol 0.5 mg/kg were administered until adequate sedation was achieved. After the induction of sedation, we treated patients with a continuous infusion of normal saline at a rate of 0.3 ml/kg/h in group I and the same volume of propofol in group II. In case of inadequate sedation, additional propofol 0.5 mg/kg was administered and the infusion rate was increased by 0.05 ml/kg/h. Induction time, sedation time, recovery time, additional sedation and adverse events were recorded.

RESULTS

Recovery time was significantly shorter in group I compared with group II [0 (0-3) vs. 1 (0-3), respectively, P<0.001]. Group I (single dose) had significantly more patients with recovery time 0 compared with group II (infusion) (65/80 vs. 36/80, respectively, P<0.001). Induction and sedation times were not significantly different between groups. There was no significant difference in the frequency of additional sedation and adverse events between groups.

CONCLUSION

A single dose of propofol without a continuous infusion can provide appropriate sedation in children undergoing MRI for <30 min.

Synthesis of Cu-CNT nanocomposite powder by ball milling

In this paper, to improve the poor wettability between the Carbon nanotubes (CNTs) and metal matrix, the mechanical alloying (MA) technique by the ball milling method was employed. Also, the CNTs were pre-coated to improve the agglomeration of the CNTs with copper powder. The main aim of this work is the fabrication of Cu-CNT nanocomposite powder using the MA by ball milling. The as-received dendritic copper powders change their shape sequentially to flaky, disk-typed particles and finally, to globular type particles. Also, the tendency of globular formation was prominent in the milled Cu-Cu coated MWNTs (multi-walled carbon nanotubes) powder and the grain size of the sintered Cu coated MWNTs specimen decreased more than that of the pure copper specimen. Finally, the homogeneous Cu-CNT nanocomposite intermetallic particles having fine grains was produced by the MA method of ball milling.

When do we need central nervous system prophylaxis in patients with extranodal NK/T-cell lymphoma, nasal type?

BACKGROUND

The incidence and risk factors of central nervous system (CNS) invasion is still unclear in extranodal natural killer (NK)/T-cell lymphoma, nasal type.

PATIENTS AND METHODS

We analyzed 208 patients to study the clinical features and outcomes of CNS disease in extranodal NK/T-cell lymphoma.

RESULTS

Twelve patients (5.76%, 12/208) experienced CNS disease during treatment or follow-up period (median 11.62 months, range 0.2-123.2 months). The clinical variables associated with CNS disease were Ann Arbor stage III/IV (15.87%, P <0.001), regional lymph node involvement (10.41%, P = 0.006), group III/IV of NK/T-cell lymphoma prognostic index (NKPI; 10.20%, P = 0.003), high/high-intermediate international prognostic index (9.30%, P = 0.072) and extra-upper aerodigestive primary sites (9.75%, P = 0.008). In multivariate analysis, NKPI retained the strongest statistical power to predict CNS disease (P = 0.007, relative risk 9.289, 95% confidence interval 1.828-47.212) in extranodal NK/T-cell lymphoma.

CONCLUSIONS

Despite extranodal NK/T-cell lymphoma frequently involves paranasal sinus, a routine CNS evaluation and prophylaxis do not seem to be necessary in NKPI group I or II patients due to a very low incidence. Nevertheless, CNS prophylaxis should be considered in NKPI groups III and IV.

A phase II trial of S-1 and cisplatin in patients with metastatic or relapsed biliary tract cancer

BACKGROUND

Optimal chemotherapy for advanced biliary tract cancer (BTC) is yet to be defined. We carried out this study to evaluate the efficacy and toxicity of combination chemotherapy with S-1 and cisplatin in metastatic or relapsed BTC.

PATIENTS AND METHODS

Patients with pathologically proven BTC were eligible. The chemotherapy regimen consisted of S-1 (40 mg/m(2) p.o. b.i.d. from D1-14) and cisplatin (60 mg/m(2) on D1), repeated every 3 weeks.

RESULTS

Fifty-one BTC patients (metastatic:relapsed = 37:14, Gall-bladder:intrahepatic bile ducts:extrahepatic bile ducts = 16:25:10) were enrolled from January 2005 to December 2006. Median age was 57 years (range, 31-71) and most patients had a good performance status. The overall response rate was 30% [95% confidence interval (CI), 17.3-42.7] and complete response was observed in two patients (4%), partial response in 13 (26%), stable disease in 21 (42%), and progressive disease in 9 (18%). With a median follow-up of 12.4 months, the median time to progression was 4.8 months (95% CI, 3.3-6.3) and median overall survival was 8.7 months (95% CI, 6.0-11.4). Major toxic effects were grade 3/4 neutropenia (8.9% of all cycles) and febrile neutropenia was observed in six cycles (2.7% of all cycles).

CONCLUSION

Combination chemotherapy with S-1 and cisplatin was a moderately effective outpatient-based regimen in BTC patients. Toxic effects were moderate but manageable.

Prognostic value of expression of ERCC1, thymidylate synthase, and glutathione S-transferase P1 for 5-fluorouracil/oxaliplatin chemotherapy in advanced gastric cancer

BACKGROUND

The aim of this study was to determine whether expressions of the excision repair cross-complementing (ERCC1), thymidylate synthase (TS), and glutathione S-transferase P1 (GSTP1) predict clinical outcome in patients with advanced gastric cancer treated with fluorouracil (5-fluorouracil)/oxaliplatin chemotherapy.

PATIENTS AND METHODS

The study population consisted of 64 advanced gastric cancer patients (median age 51 years). Patients were treated with oxaliplatin 85 mg/m(2) as a 2-h infusion at day 1 plus leucovorin 20 mg/m(2) over 10 min, followed by 5-FU bolus 400 mg/m(2) and 22-h continuous infusion of 600 mg/m(2) at days 1-2. Treatment was repeated in 2-week intervals. The expressions of ERCC1, TS, and GSTP1 of primary tumors were examined by immunohistochemistry.

RESULTS

The positive rates of ERCC1, TS, and GSTP1 were 70.3%, 29.7%, and 50.0%, respectively. The patients without ERCC1 expression were more likely to respond to chemotherapy (P = 0.045). There were no significant differences between response and TS or GSTP1 expression pattern (P = 0.813, P = 0.305, respectively). Median overall survival (OS) was significantly longer in patients without ERCC1 expression (P = 0.0396). TS or GSTP1 expression were not related to survival (P = 0.4578, P = 0.8121, respectively). Multivariate analysis revealed that ERCC1 expression significantly impacted on OS (hazard ratio 1.92, P = 0.037).

CONCLUSION

Immunohistochemical studies for ERCC1 may be useful in prediction of the clinical outcome in advanced gastric cancer patients treated with 5-FU and oxaliplatin.

New clinical grading system for chronic GVHD predicts duration of systemic immunosuppressive treatment and GVHD-specific and overall survival

We investigated outcomes according to a new clinical grading system for chronic graft-versus-host disease (chronic GVHD) in 38 patients who developed chronic GVHD after an allogeneic hematopoietic stem cell transplantation. We categorized the patients into three grade groups, namely, grade I, grade II and grade III, according to the presence of three risk factors: extensive skin involvement, thrombocytopenia (TP) and progressive type of onset. Sixteen patients were classified into grade 1, 19 into grade II and three into grade III. The probability of withdrawal of systemic immunosuppression (IST) at 1, 2 and 3 years was 61, 76 and 87%, respectively. Patients with grades 2 or 3 chronic GVHD had prolonged duration of systemic IST compared to grade 1 (P=0.043). The probability of GVHD-specific survival (GSS) at 5 years was 52%. Twenty-two of 38 patients with chronic GVHD were still alive and the estimated 3-year overall survival (OS) rate was 60%, whereas that for the group with chronic GVHD grade I and grade II+III was 64 and 48% (P<0.05). Multivariate analysis showed that prior occurrence of acute GVHD, chronic GVHD grade, serum bilirubin over 1.5 mg/dl, date of diagnosis of chronic GVHD (<day 150 versus >day 150) and transplantation-risk factor were independent prognostic factors for GSS and OS.

Phase II trial of irinotecan plus oxaliplatin and 5-fluorouracil/leucovorin in patients with untreated metastatic gastric adenocarcinoma

BACKGROUND

This nonrandomized open label phase II study evaluated the efficacy and safety of FOLFOXIRI in metastatic or recurrent gastric cancer patients.

PATIENTS AND METHODS

Patients with histologically proven, metastatic gastric adenocarcinoma, aged 18-70 years, performance status zero to two, no prior chemotherapy, and with signed written informed consent were eligible. Treatment consisted of irinotecan 150 mg/m2 day 1, oxaliplatin 85 mg/m2 day 1, leucovorin 100 mg/m2 day 1, and 5-fluorouracil 2000 mg/m2 as a 48-h continuous infusion starting on day 1, which was repeated every 2 weeks.

RESULTS

From August 2004 to August 2005, 48 patients were prospectively enrolled. The median age was 54 years (24-69). In total, 386 cycles were administered with a median of nine cycles per patient (range 1-12 cycles) and 45 of 48 patients were assessable for treatment response. An independent review of tumor responses resulted in overall response rate of 66.7% (95% confidence interval=53.4% to 80.0%) by intent-to-treat analysis with one complete response and 31 partial responses. The median survival of all patients was 14.8 months and the median time to progression was 9.6 months. Most common grade 3/4 toxic effects were neutropenia (12% of all cycles) and emesis (8% of all cycles). Grade 2 peripheral neuropathy occurred in five patients. One (2%) patient had severe tumor bleeding and five (10%) patients experienced grade 3 diarrhea.

CONCLUSIONS

The modified FOLFOXIRI combination chemotherapy showed a very promising preliminary antitumor activity and was generally well tolerated as a first-line treatment of patients with metastatic gastric cancer.

High-dose chemotherapy with autologous stem cell transplantation in extranodal NK/T-cell lymphoma: a retrospective comparison with non-transplantation cases

To determine the role of high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) in extranodal NK/T-cell lymphoma patients, we conducted a retrospective analysis. In our previous study, we searched for patients who had received HDC/ASCT and identified 16 eligible patients and compared the treatment outcome with historical control group (n=246). Nine patients received HDC/ASCT in the first (CR1) or second complete remission (CR2), while seven patients received HDC/ASCT as salvage. Twelve of 16 patients achieved or maintained CR after HDC/ASCT. Among the 12 patients, five patients relapsed. Estimated 2-year overall survival (OS) and relapse-free survival (RFS) rates were 71.3+/-12.4% and 25.8+/-14.3%, respectively. There was a tendency of better survival in patients who received HDC/ASCT as compared to those who did not (P=0.091). In subset analysis, patients who underwent HDC/ASCT at CR (P=0.049) and patients with stage III or IV (P=0.001) had a favorable outcome. Patients with NKIPI 3,4 or EUNKTL, who underwent HDC/ASCT had more prolonged survival without statistical significance (P=0.055 and 0.056). In conclusion, HDC/ASCT may be considered as a treatment option for patients with extranodal NK/T-cell lymphoma, especially those in CR, with advanced disease (stage III/IV or EUNKTL) and high NKIPI scores.

Proteome analysis of human amnion and amniotic fluid by two-dimensional electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

Proteome analysis by 2-DE and PMF by MALDI-TOF MS was performed on human amnion and amniotic fluid at term. Ninety-two soluble and nineteen membrane proteins were identified from amnion. Thirty-five proteins were identified from amniotic fluid. Calgranulin A and B were found in all patients infected with Ureaplasma urealyticum, but not in any of the patients without infection, indicating that they are potential markers of intrauterine infection. Identity of calgranulin A and B was confirmed by MALDI-TOF/TOF MS. This study represents the first extensive analysis of the human amnion and amniotic fluid proteome at term and demonstrates that 2-DE and MALDI-TOF MS is a useful tool for identifying clinically significant biomarkers of problematic pregnancies.

Normal C1 inhibitor mRNA expression level in type I hereditary angioedema patients: newly found C1 inhibitor gene mutations

BACKGROUND

C1 esterase inhibitor (C1INH) plays a key role in the classical pathway of the complement cascade. Mutations in this gene cause a decreased level of antigenic (type I hereditary angioedema, HAE) or functional (type II HAE) C1INH.

OBJECTIVE

To find novel mutations in C1INH and evaluate the expression of C1INH gene in HAE patients.

METHODS

Direct sequencing mutation analysis was performed for genomic DNA from three unrelated families (14 HAE patients and 18 family members). Genomic DNA from one family was also analyzed for larger genomic rearrangements, using Southern blotting analysis. We used real-time quantitative polymerase chain reaction (PCR) to evaluate C1INH mRNA expression level.

RESULTS

Four mutations in exons (2,311 T-->C, 14,034 G-->A, 16,830 G-->A, and 16,979-16,980 G insertion) and four in introns (738 G-->A, 8,531 A-->G, 14,254 A-->G, and 14,337-14,378 TT deletion) were found. Interestingly, all of the nine patients in one family share the same mutation of Gly345Arg (14,034 G-->A) in the seventh exon. In another family, a single base mutation near the splice site (14,254 A-->G) was found in all of the three patients. In the last family, although a significant mutation was not found by direct sequencing, patients showed an abnormal 16 kb fragment in addition to the normal allele (21 kb Bcl I fragment). The C1INH mRNA expression of HAE patients in two families was not significantly different compared with that of normal controls.

CONCLUSION

The two novel exonal mutations (G-->A and A-->G) and one large gene deletion were associated with the clinical phenotypes of HAE. Considering the normal C1INH mRNA levels but below normal protein levels in two families, their phenotypes would be associated with the post-translational defect.

Zero-valent iron treatment of RDX-containing and perchlorate-containing wastewaters from an ammunition-manufacturing plant at elevated temperatures

The use of zero-valent iron for treating wastewaters containing RDX and perchlorate from an army ammunition plant (AAP) in the USA at elevated temperatures and moderately elevated temperature with chemical addition was evaluated through batch and column experiments. RDX in the wastewater was completely removed in an iron column after 6.4 minutes. Increasing the temperature to 75 degrees C decreased the required retention time to 2.1 minutes for complete RDX removal. Perchlorate in the wastewater was completely removed by iron at an elevated temperature of 150 degrees C in batch reactors in 6 hours without pH control. Significant reduction of perchlorate by zero-valent iron was also achieved at a more moderate temperature (75 degrees C) through use of a 0.2 M acetate buffer. Based on the evaluation results, we propose two innovative processes for treating RDX-containing and perchlorate-containing wastewaters: a temperature and pressure-controlled batch iron reactor and subsequent oxidation by existing industrial wastewater treatment plant; and reduction by consecutive iron columns with heating and acid addition capabilities and subsequent oxidation.

Cellular responses to mild heat stress

Since its discovery in 1962 by Ritossa, the heat shock response has been extensively studied by a number of investigators to understand the molecular mechanism underlying the cellular response to heat stress. The most well characterized heat shock response is induction of the heat shock proteins that function as molecular chaperones and exert cell cycle regulatory and anti-apoptotic activities. While most investigators have focused their studies on the toxic effects of heat stress in organisms such as severe heat stress-induced cell cycle arrest and apoptosis, the cellular response to fever-ranged mild heat stress has been rather underestimated. However, the cellular response to mild heat stress is likely to be more important in a physiological sense than that to severe heat stress because the body temperature of homeothermic animals increases by only 1-2 degrees C during febrile diseases. Here we provide information that mild heat stress does have some beneficial role in organisms via positively regulating cell proliferation and differentiation, and immune response in mammalian cells.

Conceptual comparison of pink water treatment technologies: granular activated carbon, anaerobic fluidized bed, and zero-valent iron-Fenton process

Pink water, explosive-laden wastewater produced in army ammunition plants is often treated using expensive and non-destructive granular activated carbon (GAC) adsorption. This paper compares GAC adsorption and two alternative treatment technologies, anaerobic GAC fluidized bed reactor and zero-valent iron-Fenton process. The bench-scale demonstration of the zero-valent iron-Fenton process with real pink water is reported. The features of three technologies are compared and their advantages and drawbacks are discussed.

Enhancing oxidation of TNT and RDX in wastewater: pre-treatment with elemental iron

Munitions manufacturing wastewater is commonly treated by adsorption to activated carbon. We are proposing a new munitions manufacturing wastewater treatment system consisting of a reductive pre-treatment process and subsequent Fenton's oxidation to mineralize energetic compounds such as TNT and RDX. The pre-treatment involves reduction of electron-withdrawing nitro groups of TNT and RDX with elemental iron. The iron-treated explosives are then oxidized by Fenton's reagent through the addition of H2O2. The objective of this work is to investigate the feasibility of using elemental iron to convert TNT and RDX to reduction products which may be more oxidizable in subsequent Fenton's oxidation. Results of batch reduction experiments with elemental iron showed complete removal of TNT and RDX and formation of the reduction products within 60 minutes. Results of column experiments showed a rapid and complete removal of TNTand RDX within 9.7 minutes retention time. Fitting observed effluent concentrations to a one-dimensional advection-dispersion equation, we were able to predict the concentration profiles of TNT and RDX in the iron column and calculate the iron column length required for the desired removal. The results of Fenton's oxidation experiments showed that iron pre-treatment enhanced both the rate and extent of TNT and RDX mineralization by Fenton's oxidation.