Bilateral traumatic carotid-cavernous fistulae: Strategies for endovascular treatment

BACKGROUND

Most traumatic carotid-cavernous fistula/e (TCCF) are unilateral, and simultaneous bilateral TCCF are uncommon. The purpose of this study was to evaluate the angiographic architecture of bilateral TCCF and report our experience with their endovascular management.

METHOD

Over 15 years, 252 consecutive patients with TCCF were referred to our institute for endovascular treatment. Bilateral TCCF occurred in 5 men and 2 women with a mean age of 31 years. The angiographic architectures of bilateral TCCF were evaluated with cerebral angiography. All patients underwent a single session of transarterial embolisation by using various permanent embolic materials and were followed up clinically or with angiography for a mean of 22 months (range 9-36 months).

FINDINGS

All patients presented with neuro-ophthalmic symptoms and signs. No new instances of cerebrovascular ischemia or intracranial haematoma resulted from bilateral TCCF. All fistulae were associated with partial arterial steal and were successfully occluded by using a detachable balloon and/or a detachable coil with or without a liquid adhesive. Of 14 TCCF, 9 were completely obliterated with preserved flow of the internal carotid artery (ICA). In the other 5 fistulae, the ICA had to be sacrificed to achieve occlusion because the anatomy of the fistula was complex. All fistula related symptoms resolved immediately or gradually during clinical follow up. No clinically significant procedure related neurological complications or recurrent fistulae were observed.

CONCLUSIONS

All bilateral TCCF were associated with a partial arterial steal phenomenon. Single session endovascular treatment using various embolic materials was effective in managing these high-flow fistulae. In all patients, it was possible to preserve one or both ICAs.

Review article: drug hepatotoxicity

BACKGROUND

Drug toxicity is the leading cause of acute liver failure in the United States. Further understanding of hepatotoxicity is becoming increasingly important as more drugs come to market.

AIMS

(i) To provide an update on recent advances in our understanding of hepatotoxicity of select commonly used drug classes. (ii) To assess the safety of these medications in patients with pre-existing liver disease and in the post-liver transplant setting. (iii) To review relevant advances in toxicogenomics which contribute to the current understanding of hepatotoxic drugs.

METHODS

A Medline search was performed to identify relevant literature using search terms including 'drug toxicity, hepatotoxicity, statins, thiazolidinediones, antibiotics, antiretroviral drugs and toxicogenomics'.

RESULTS

Amoxicillin-clavulanic acid is one of the most frequently implicated causes of drug-induced liver injury worldwide. Statins rarely cause clinically significant liver injury, even in patients with underlying liver disease. Newer thiazolidinediones are not associated with the degree of liver toxicity observed with troglitazone. Careful monitoring for liver toxicity is warranted in patients who are taking antiretrovirals, especially patients who are co-infected with hepatitis B and C. Genetic polymorphisms among enzymes involved in drug metabolism and HLA types may account for some of the differences in individual susceptibility to drug hepatotoxicity.

CONCLUSIONS

Drug-induced hepatotoxicity will remain a problem that carries both clinical and regulatory significance as long as new drugs continue to enter the market. Future results from ongoing multicentre collaborative efforts may help contribute to our current understanding of hepatotoxicity associated with drugs.

Characterization of an H5N1 avian influenza virus from Taiwan

In 2003, an avian influenza (AI) virus of H5N1 subtype (A/Duck/China/E319-2/03; Dk/CHN/E319-2/03) was isolated from a smuggled duck in Kinmen Island of Taiwan. Phylogenetic analysis and pairwise comparison of nucleotide and amino acid sequences revealed that the virus displayed high similarity to the H5N1 viruses circulating in Asia during 2004 and 2005. The hemagglutinin (HA) protein of the virus contained multiple basic amino acid residues (-RERRRKR-) adjacent to the cleavage site between the HA1 and HA2 domains, showing the highly pathogenic (HP) characteristics. The HP phenotype was confirmed by experimental infection of chickens, which led up to 100% mortality within 24-72h postinfection. The virus replicated equally well in the majority of organs of the infected chickens with titers ranging from 10(7.5) to 10(4.7) 50% embryo lethal dose (ELD50) per gram of tissue. In a mouse model the virus exhibits low pathogenic characteristics with a lethal infection observed only after applying high inoculating dose (>or=10(7.6) ELD50) of the virus. The infectious virus particles were recovered only from the pulmonary system including trachea and lungs. Our study suggests that ducks infected with H5N1 AIV of HPAI pathotype showing no disease signs can carry the virus silently and that bird smuggling represent a serious risk for H5N1 HPAI transmission.

Percutaneous vertebroplasty for patients with osteoporosis: a one-year follow-up

PURPOSE

To evaluate changes in height and wedge angle of treated vertebral bodies and kyphosis angle 1 year after vertebroplasty.

MATERIAL AND METHODS

We reviewed radiographs of 95 vertebral bodies treated with vertebroplasty in 60 patients with osteoporosis. Only vertebral bodies with imaging evidence of a new fracture or avascular necrosis received vertebroplasty. Images were obtained for evaluation before vertebroplasty (B), within 2 weeks after vertebroplasty (T), and after 1 year (T1).

RESULTS

The mean wedge angle decreased by 5.4 degrees from B to T1. Mean of the anterior, central, and posterior heights of the fractured bodies increased by 12.6%, 9.6%, and 3.1%, respectively, from B to T1. The kyphosis angle improved by 3.2 degrees initially from B to T, but the improvement later disappeared. In 48% of these patients, a new fracture developed after vertebroplasty, and 63% of the fractures were adjacent to a vertebroplasty-treated vertebral body.

CONCLUSION

The increase in height and wedge angle of the vertebral bodies generally lasted at least 1 year. Improvement in kyphosis angles was lost 1 year after vertebroplasty because new fractures occurred in 48% of these patients. Prevention of new fractures after vertebroplasty remains an important task.

Androgenic and antiandrogenic effects and expression of androgen receptor in mouse embryonic stem cells

OBJECTIVE

To investigate the effects of androgen and antiandrogen and the expression of androgen receptor on mouse embryonic stem cells (ESCs) and the inner cell mass.

DESIGN

Controlled laboratory study.

SETTING

Academic university hospital.

ANIMAL(S)

Blastocysts from mice developed at the Institute for Cancer Research and 129/Sv mice embryonic stem cell line.

INTERVENTION(S)

Cultured mouse ESCs were exposed to testosterone (T), dihydrotestosterone (DHT), or the antiandrogen nilutamide.

MAIN OUTCOME MEASURE(S)

Immunohistochemistry for androgen receptor (AR), quantitative real-time polymerase chain reaction analysis, cell colorimetric assays, and Western blot analysis.

RESULT(S)

Androgen receptor messenger RNA (mRNA) was first detected both in the inner cell mass from blastocysts and in undifferentiated ESCs. It increased stage-dependently during ESC differentiation. Although both T and DHT had marginal effects on AR mRNA expression level and cell growth in vitro, the nonsteroidal antiandrogen nilutamide significantly stimulated ESC growth and induced Akt expression. The enhancing effects of nilutamide on mouse ESCs indicated that the Akt pathway may be involved in nilutamide-promoted ESC growth.

CONCLUSION(S)

These findings provide the first evidence of the existence of AR in ESCs. During differentiation, the expression level of AR was increased in a stage-dependent but not a ligand-dependent manner. Nilutamide promoted cell growth and increased Akt expression in ESCs.

α-Synuclein promoter RsaI T-to-C polymorphism and the risk of Parkinson’s disease

Increased alpha-synuclein expression may be involved in the pathogenesis of Parkinson's disease (PD). We investigated the association of Rep1 microsatellite and RsaI T-to-C substitution in the alpha-synuclein promoter region with the risk of PD by a case-control study. The RsaI C/C genotype and C allele were found less frequently in PD patients than in controls. A reduced risk of the Rep1-RsaI 0-C haplotype (OR = 0.57, 95% CI = 0.36-0.90) with PD was evident. The quantitative real-time PCR study showed that the alpha-synuclein mRNA expression was increased (although not significantly) in PD patients with RsaI T/T genotype or Rep1-RsaI 0-T haplotype as compared to T/C genotype or 0-C haplotype. Reporter constructs containing the RsaI C allele drove significantly lower transcriptional activity compared with the RsaI T allele in both IMR32 and 293 cells. The findings suggest that the RsaI T-to-C substitution may have a functional relevance to the susceptibility to PD.

Endoscopic ultrasound-guided fine needle aspiration of the pancreas: cytomorphological evaluation with emphasis on adequacy assessment, diagnostic criteria and contamination from the gastrointestinal tract

OBJECTIVE

Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has been proved to be safe, efficient and reliable in the diagnosis of pancreatic lesions. This study evaluated specimen adequacy, diagnostic criteria of various pancreatic neoplasms and contamination from the gastrointestinal (GI) tract.

METHODS

EUS-guided FNA of the pancreas and subsequent surgical resections performed at the University of California Irvine Medical Center during February 1996-October 2000 were retrospectively selected. Modified Papanicolaou staining method was used for immediate evaluation and cell block prepared.

RESULTS

A total of 267 cases were available for review, including 147 (55.1%) positive/suspicious, 10 (3.7%) atypical, 96 (36.0%) negative and 14 (5.2%) unsatisfactory cases. Eighty-six (58.5%) positive/suspicious cases had histological confirmation and 12 (8.3%) had lymph node or distant metastases by cytology. Three atypical, two negative, and two unsatisfactory cases proved to have adenocarcinoma. Contamination from duodenum, stomach or pancreas was found in 77 positive/suspicious, three atypical and 90 negative cases. The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values were 94.6%, 100%, 95.6%, 100%, 82% respectively.

CONCLUSIONS

EUS FNA is efficient and accurate in the diagnosis of pancreatic neoplasms in adequate samples. Contamination from the GI tract should be well recognized to avoid misinterpretation.

Carotid blowout treated by direct percutaneous puncture of internal carotid artery with temporary balloon occlusion

SUMMARY

Direct percutaneous puncture of a cervical carotid pseudoaneurysm for coil placement or acrylic embolization is described for the endovascular management of acute carotid blowout. However, direct puncture of the internal carotid artery (ICA) for the endovascular management of carotid blowout has not been described. We report a difficult case of acute carotid blowout syndrome in a patient who had radiation- induced occlusion of the right common carotid artery with vasculopathy and pseudoaneurysm in the right cervical ICA. Collaterals from the branches of the controlateral external carotid artery (ECA) anastomosed with branches of right ECA supplied the vasculopathy. We performed direct percutaneous puncture of the bulb of the right ICA using a spinal needle and placed fiber coils to occlude antegrade flow of the artery. During the injection of a mixture of N-butyl cyanoacrylate and lipiodol oil for embolization of the remaining carotid bulb, we transiently inflated an occlusion balloon in the controlateral common carotid artery to further arrest antegrade flow in the ICA. The vasculopathy and pseudoaneurysm of the right cervical ICA were successfully embolized, with preservation of the distal branches of the right ICA.

A CD14 monocyte receptor polymorphism and genetic susceptibility to Parkinson's disease for females

Recent studies suggest that inflammation may play an important role in the pathogenesis of Parkinson's disease (PD). Because the C(-260) --> T polymorphism in the promoter of the CD14 monocyte receptor gene (pCD14) could affect the predisposition to the inflammatory response, we conducted a case-control study to investigate a possible genetic susceptibility of the pCD14 polymorphism in patients with PD. This study included 200 sporadic PD patients and 200 controls, matched by sex and case-control pairs for age at onset in the case. All observed genotype frequencies were in Hardy-Weinberg equilibrium. Results revealed that the CD14-T allele of the pCD14 polymorphism in the female PD patients existed statistically significant difference from that of the female controls (OR = 1.262, P = 0.038), but not for male. Female individuals with homozygote CD14-TT genotype were significantly increased risk of PD by 1.28 time (P = 0.027). Furthermore, a logistic regression analysis confirmed that the homozygote CD14-TT genotype was an independent risk factor for PD (OR = 1.576, P = 0.030). In conclusion, results of this study indicate the pCD14 polymorphism to be a genetic risk factor for PD in females.

Improved analysis of membrane protein by PVDF-aided, matrix-assisted laser desorption/ionization mass spectrometry

Characterization of membrane proteins remains an analytical challenge because of difficulties associated with tedious isolation and purification. This study presents the utility of the polyvinylidene difluoride (PVDF) membrane for direct sub-proteome profiling and membrane protein characterization by matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS). The hydrophobic adsorption of protein, particularly membrane proteins, on the PVDF surface enables efficient on-PVDF washing to remove high concentrations of detergents and salts, such as up to 5% sodium dodecyl sulfate (SDS). The enhanced spectrum quality for MALDI detection is particularly notable for high molecular weight proteins. By using on-PVDF washing prior to MALDI detection, we obtained protein profiles of the detergent-containing and detergent-insoluble membrane fractions from Methylococcus capsulatus (Bath). Similar improvements of signal-to-noise ratios were shown on the MALDI spectra for proteins electroblotted from SDS-polyacrylamide gel electrophoresis (SDS-PAGE) onto the PVDF membrane. We have applied this strategy to obtain intact molecular weights of the particulate methane monooxygenase (pMMO) composed of three intrinsic membrane-bound proteins, PmoA, PmoB, and PmoC. Together with peptide sequencing by tandem mass spectrometry, post-translational modifications including N-terminal acetylation of PmoA and PmoC and alternative C-terminal truncation of PmoB were identified. The above results show that PVDF-aided MALDI-MS can be an effective approach for profiling and characterization of membrane proteins.

Successful heart transplantation after 13 hours of donor heart ischemia with the use of HTK solution: a case report

INTRODUCTION

For heart transplantation (HTx), the recommended ischemic time (IT) for donor heart is not to exceed 6 hours. Though Dr Christiaan Barnard used a donor heart with IT of 16 hours, 50 minutes with a portable hypothermic perfusion system in 1981, the recorded IT of donor hearts reported recently is 8 hours, with no adverse effects.

CASE REPORT

The patient, a 14-year-old boy of blood type O, was diagnosed with cardiomyopathy at age 12. In early September 2003, the patient was recommended for HTx. His condition deteriorated 18 days later with low CO, elevated pulmonary vascular resistance, and frequent ventricular tachycardia, further complicated by pneumonia and multiorganism infections, which were contraindications for HTx. On September 22, 2003, a donor heart of blood type O was available 370 km away. Another patient of blood type B with severe heart failure was matched for the HTx. During the intervening time, another donor heart of blood type B became available locally. We matched the type B donor heart to the type B recipient. Since the type O donor heart seemed to be wasted, we performed HTx for the boy. Though preserved for 12 hours in cold cardioplegia, the donor heart was implanted with biatrial anastomosis that took 1 hour. The total IT of this donor heart was 13 hours. The recipient recovered and was discharged 3 months later.

CONCLUSIONS

The IT of 13 hours for this donor heart is believed to be a world record. Our experience demonstrates that preservation time of donor heart may exceed 6 hours.

Successful heart transplantation after 13 hours of donor heart ischemia with the use of HTK solution: a case report

INTRODUCTION

For heart transplantation (HTx), the recommended ischemic time (IT) for donor heart is not to exceed 6 hours. Though Dr Christiaan Barnard used a donor heart with IT of 16 hours, 50 minutes with a portable hypothermic perfusion system in 1981, the recorded IT of donor hearts reported recently is 8 hours, with no adverse effects.

CASE REPORT

The patient, a 14-year-old boy of blood type O, was diagnosed with cardiomyopathy at age 12. In early September 2003, the patient was recommended for HTx. His condition deteriorated 18 days later with low CO, elevated pulmonary vascular resistance, and frequent ventricular tachycardia, further complicated by pneumonia and multiorganism infections, which were contraindications for HTx. On September 22, 2003, a donor heart of blood type O was available 370 km away. Another patient of blood type B with severe heart failure was matched for the HTx. During the intervening time, another donor heart of blood type B became available locally. We matched the type B donor heart to the type B recipient. Since the type O donor heart seemed to be wasted, we performed HTx for the boy. Though preserved for 12 hours in cold cardioplegia, the donor heart was implanted with biatrial anastomosis that took 1 hour. The total IT of this donor heart was 13 hours. The recipient recovered and was discharged 3 months later.

CONCLUSIONS

The IT of 13 hours for this donor heart is believed to be a world record. Our experience demonstrates that preservation time of donor heart may exceed 6 hours.

Signal transduction pathways of nitric oxide release in primary microglial culture challenged with gram-positive bacterial constituent, lipoteichoic acid

Between one-third and one-half of all cases of sepsis are known to be caused by gram-positive microorganisms through the cell wall component, e.g. lipoteichoic acid (LTA). Gram-positive bacteria are also known to induce encephalomyelitis and meningeal inflammation, and enhance the production of nitric oxide (NO) via expression of inducible nitric oxide synthase (iNOS) in murine tissue macrophages. It remains to be explored if LTA could activate microglia considered to be resident brain macrophages. We report here that LTA derived from gram-positive bacteria (Staphylococcus aureus) significantly induces NO release and iNOS expression in primary microglia. LTA-induced NO accumulation was detected at 2 h in microglial culture and was significantly attenuated by pretreatment with anti-CD14, complement receptor type 3 (CR3) or scavenger receptor (SR) antibodies. LTA activated mitogen-activated protein kinases (MAPKs) such as extracellular signal-regulated kinase, p38 MAPK or c-Jun N-terminal kinase in cultured microglia. LTA-elicited microglial NO production was also drastically suppressed by SB203580 (p38 MAPK inhibitor) or pyrrolidine dithiocarbamate (an inhibitor of nuclear factor kappaB), indicating that p38 MAPK and nuclear factor kappaB were involved in microglial NO release after LTA challenge. These results suggest that gram-positive bacterial product such as LTA can activate microglia to release NO via the signal transduction pathway involving multiple LTA receptors (e.g. CD14, CR3 or SR), p38 MAPK and nuclear factor kappaB. The in vivo study further confirmed that administered intracerebrally LTA induced considerable noticeable iNOS, phospho-IkappaB and phospho-p38 MAPK expression in microglia/macrophages.

Spatiotemporal Hopfield neural cube for diagnosing recurrent nasal papilloma

Gadolinium-enhanced magnetic resonance imaging (MRI) is widely used to detect recurrent nasal tumours. A specifically designed two-layer Hopfield neural network, called the spatiotemporal Hopfield neural cube (SHNC), is presented, to be used for detecting recurrent nasal papilloma. Differing from conventional, two-dimensional Hopfield neural networks, the SHNC extends the one-layer, two-dimensional Hopfield network in the original image plane into a two-layer, three-dimensional (3D) Hopfield network with pixel classification implemented in its third dimension. With extended 3D architecture, the network is able to use each pixel's spatial information in a pixel labelling procedure. Because the SHNC takes pixel spatial information into consideration, the effects of tiny detail or noise are removed. As a result, the drawback of disconnected fractions can be avoided. Furthermore, owing to the incorporation of competitive learning rules to update neuron states, to avoid the problem of having to satisfy strong constraints, the convergence of the network was improved. In addition, a more accurate signal-time curve, the relative intensity change (RIC), was adopted to represent the gadolinium-enhanced MRI temporal information, and the RIC curves of recurrent nasal papilloma were incorporated into the SHNC. The experimental results showed that the SHNC could obtain a more appropriate, precise position of recurrent nasal papilloma than the k-means, principal components analysis (PCA) or Eigenimage-filtering methods. The average sensitivity and specificity of the 26 cases were 0.9998 and 0.9961, respectively. These values demonstrate the effectiveness of the proposed technique.

Heart transplant coronary artery disease in Chinese recipients

BACKGROUND

Transplant coronary artery disease is the principle limiting factor for long-term survival of heart transplantation (HTx) recipients. We reviewed our data to assess the incidence of this disorder among Chinese HTx recipients and to compare it with the results of Western studies.

MATERIAL AND METHODS

From July 1988 to May 2002, 182 patients received 184 orthotopic HTx. One hundred sixty-three recipients survived for at least 1 year with available SPECT scans or coronary angiogram studies. The data set included donor characteristics, recipient characteristics, active cytomegalovirus (CMV) infection rate, rejection episodes, immunosuppressants, and human leukocyte antigen (HLA) mismatches.

RESULTS

Surgical mortality in our program was 4.3% and the actuarial freedom from coronary artery disease at 1, 3, and 5 years was 99%, 95%, and 92%, respectively. Angiogram results were stratified into coronary artery disease (n = 15) or absence of the disorder (n = 148) groups. Only older donor age showed statistical significance between the groups. Compared with the Western series, the present data show higher actuarial survival rates and freedom from coronary artery disease. There were statistically significant differences in regard to graft ischemia time, proportion of male recipients, ischemic heart disease, rejection episodes during the first year, and incidence of CMV infection.

CONCLUSIONS

SPECT scan can detect coronary artery disease before there is significant stenosis of the coronary artery with acceptable survival rates. Chinese HTx recipients show a lower incidence of the disorder, lower rates of ischemia heart disease, lower proportion of male gender, lower incidence of CMV infection, fewer rejection episodes during the first year, and less ischemic time than Western recipients, which maybe the contributing factors to their better survival.

Reappraisal of left-sided gallbladder and its accompanying anomalies: a report of two cases and literature review

We report two cases of coexistent left-sided gallbladder and right-sided ligamentum teres with portal vein anomalies documented by magnetic resonance imaging (MRI) and three-dimensional (3D) computed tomography during arterial portography (CTAP). Reformatted 3D MR and CTAP images provide an informative illustration of the accompanying portal vein anomalies. This important anatomical information is useful in preoperative work-up of hepatobiliary surgery.

The influences of weather on patients with different ovarian responses in the treatment of assisted reproductive technology

PURPOSE

The purpose of this study was to evaluate the influences of tropical weather on patients with different ovarian responses in the treatment of assisted reproductive technology.

METHODS

Six-hundred fourty-seven women underwent their first treatment cycles were retrospectively analyzed. Patients received embryo transfer either 3 days or 5 days after oocyte retrieval, depending on the number and quality of embryos on day-2.

RESULTS

Significant correlations were demonstrated in the top quality embryo rates of day-3 and day-5 embryo transfers with temperature, humidity, and atmosphere pressure. The cumulative light hours negatively correlated with the implantation and pregnancy rates of day-3 embryo transfer (-.282 and -.282, respectively), while they positively correlated with those of day-5 embryo transfer (.225 and .224, respectively).

CONCLUSIONS

These results clearly suggest that weather may exert influences on the outcome of assisted reproductive technology. Patients with different ovarian responses or blastocyst culture and transfer may modify weather influences.

Energy demand in sludge dewatering

This work investigates the energy required to dewater a suspension, i.e., activated sludge dewatered by centrifugation or consolidation. Total energy input to the suspension from the dewatering device, bond strength between adjacent water and solid surface, and intra-cake friction loss were evaluated for original and flocculated sludges. In centrifugal dewatering, most energy input during the initial stage was consumed by overcoming process irreversibility other than intra-cake friction, and, thereby, had a low energy efficiency. To increase centrifuge speed or to flocculate the sludge at optimal flocculant dosage would yield a high-energy input. In the consolidation test, most energy input at the initial stage was consumed in breaking down the bond strength until the moisture content reduced to less than the critical content. During subsequent dewatering stages, friction loss became the dominant source of energy loss. Dewatering sludge with high-energy efficiency is beneficial to optimally operate a dewatering process.

Expression of steroid receptors, their cofactors, and aromatase in human luteinized granulosa cells after controlled ovarian hyperstimulation

OBJECTIVE

To examine expression of androgen receptor (AR), AR cofactors, estrogen (E) receptor alpha, E receptor beta, progesterone receptor, steroid receptor coactivator-1, and aromatase in human luteinized granulosa cells collected during oocyte retrieval.

DESIGN

Prospective real-time reverse transcriptase-polymerase chain reaction study.

SETTING

Academic medical center.

PATIENT(S)

A total of 198 samples were brought into the study.

INTERVENTION(S)

Patients underwent the long protocol for assisted reproductive technology. Luteinized granulosa cells were collected transvaginally with ultrasound guidance. Quantitative reverse transcriptase-polymerase chain reaction was performed to quantify the mRNA expression of the investigated genes.

MAIN OUTCOME MEASURE(S)

The expression levels were determined as ratios between the studied genes and the reference gene beta-actin.

RESULT(S)

There is little AR expression in human luteinized granulosa cells immediately preceding ovulation under controlled ovarian hyperstimulation. All aspirated follicles, despite their antral size, displayed a similar mRNA expression of the investigated genes in the luteinized granulosa cells.

CONCLUSION(S)

This study supports the possibility of a transition of androgen action from being an enhancer of follicular differentiation (through the AR) to being a substrate of E synthesis (through aromatase) at the time of oocyte retrieval. The present study also demonstrates no effect of follicular size upon the status of steroid receptor mRNA expression in the luteinized granulosa cells when follicles were at least >1.5 mL.

Neuroradiological findings in atypical teratoid/rhabdoid tumor of the central nervous system

PURPOSE

To evaluate the computed tomography (CT) and magnetic resonance imaging (MRI) findings of atypical teratoid tumor/rhabdoid tumor (AT/RT) of the central nervous system (CNS).

MATERIAL AND METHODS

Twenty cases of CNS AT/RT have been found over the past 23 years in our hospital; these involving 11 boys and 9 girls whose mean age at diagnosis was 5.5 years. Their clinical data, the CT, and MRI findings were reviewed retrospectively.

RESULTS

AT/RT was located in the cerebellum in 15 cases. Four cases arose from the supratentorial region, while only one occurred primarily in the lumbar spinal cord. Almost all cases revealed heterogeneous intensity and heterogeneous enhancement. Peripheral cystic components were common. Survival time ranged from 2 months to 3 years, with a mean survival of 11.6 months.

CONCLUSION

Most cases of AT/RT are located in the cerebellum. The radiologic manifestations are non-specific. The diagnosis mainly depends on the pathologic findings. However, AT/RT should still remain in the differential diagnosis of brain tumors in young children, especially those located in the cerebellar hemisphere and with eccentric cysts.

Mineralization of polyethylene glycol in aqueous solution by hydrogen peroxide with basic oxygen furnace slag

This study evaluated the dissolution behavior of basic oxygen furnace slag (BOF slag) and the performance of H2O2 with BOF slag denoted as H2O2/BOF slag process to degrade polyethylene glycol (PEG) in the aqueous solution. The concentration of total organic carbon (TOC) was chosen as a mineralization index of the degradation of PEG by the H2O2/BOF slag process. A first-order kinetic model with respect to TOC was adopted to represent the mineralization of PEG by H2O2/BOF slag process. The experimental results in this study suggested that dosages with 3.98 x 10(-4) mole min(-1) l(-1) H2O2 and 15 g l(-1) BOF slag loading in the solution at pH 2 provided the optimal operation conditions for the mineralization of PEG yielding a 75.5% treatment efficiency at 100 min reaction time. The H2O2/Fe2+ ratio was then determined to be 13.5:1.

The homozygote AA genotype of the α1-antichymotrypsin gene may confer protection against early-onset Parkinson's disease in women

There has been increasing evidence suggesting that inflammatory response maybe involved in the pathogenesis of Parkinson's disease (PD). Alpha1-antichymotrypsin gene (ACT) has been regarded as a susceptibility factor for PD in the past, but the evidence remains controversial. This case-control study was designed to investigate the association of alpha1-antichymotrypsin gene (ACT) polymorphism between 210 Taiwanese patients with clinical definite sporadic PD and 260 controls, matched by age and sex. There were no differences of allelic frequency (A and T) and genotype polymorphism (AA, AT and TT) of the ACT in PD patients from the controls. However, there were significantly fewer early-onset PD (onset age younger than 60 years) or PD women carrying the homozygote AA genotype (ACT-AA) than in controls (p=0.046 and 0.044, respectively). Further analysis revealed that the reduced risk of ACT-AA was particularly significant among PD women with the onset age younger than 60 years (OR=0.796, 95% CI=0.749-0.847, p<0.0001). This study shows that ACT-AA may confer a modest protection against developing early-onset PD in women.