Perineural invasion is a poor prognostic factor for sinonasal squamous cell carcinoma

OBJECTIVES

In this study, our primary objective is to elucidate the correlation between sinonasal squamous cell carcinoma (SCC) and perineural invasion (PNI), a topic that has received limited attention in prior literature. Furthermore, we have undertaken an examination of various other clinicopathological factors.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of patients aged ≥ 20 years with newly diagnosed sinonasal cancer and received treatment and care at a tertiary medical center. We excluded patients who did not have an SCC diagnosis, those who underwent palliative surgery, and individuals with insufficient follow-up data at the study endpoint. Ultimately, a total of 49 eligible participants were included in our further analysis.

RESULTS

PNI and advanced T staging were associated with increased risk of local recurrence (LR). Furthermore, PNI was significantly associated with an adverse prognosis in terms of LR-free survival. Participants with PNI had significantly worse overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS). Patients with LR had significantly worse OS, DFS, and DSS.

CONCLUSION

PNI is associated with an elevated risk of LR and reduced OS, DFS, and DSS in patients with sinonasal SCC. These findings can facilitate the formulation of more targeted and effective treatment strategies for sinonasal SCC in clinical practice.

Erratum: ^{27}Al^{+} Quantum-Logic Clock with a Systematic Uncertainty below 10^{-18} [Phys. Rev. Lett. 123, 033201 (2019)]

This corrects the article DOI: 10.1103/PhysRevLett.123.033201.

Frequency-comb spectroscopy on pure quantum states of a single molecular ion

Spectroscopy is a powerful tool for studying molecules and is commonly performed on large thermal molecular ensembles that are perturbed by motional shifts and interactions with the environment and one another, resulting in convoluted spectra and limited resolution. Here, we use quantum-logic techniques to prepare a trapped molecular ion in a single quantum state, drive terahertz rotational transitions with an optical frequency comb, and read out the final state nondestructively, leaving the molecule ready for further manipulation. We can resolve rotational transitions to 11 significant digits and derive the rotational constant of 40CaH+ to be B R = 142 501 777.9(1.7) kilohertz. Our approach is suited for a wide range of molecular ions, including polyatomics and species relevant for tests of fundamental physics, chemistry, and astrophysics.

Urinary biomarkers of polycyclic aromatic hydrocarbons and the association with hearing threshold shifts in the United States adults

Polycyclic aromatic hydrocarbons (PAHs) are regarded as environmental pollutants that contribute to several adverse health outcomes. There is no research evidence to support a connection between PAH exposure and hearing loss. Our study aimed to determine the association between PAH exposure and hearing threshold shifts using the National Health and Nutrition Examination Survey (NHANES) dataset. A cross-sectional study was conducted among 1,071 US adults participating in the NHANES from 2001 to 2004. The association between PAH metabolites and the log-transformed hearing threshold was investigated using multivariate regression models, which included log-transformed, low-frequency and high-frequency thresholds. After additional pertinent adjustments, a positive correlation between PAH metabolite concentration and log-transformed hearing thresholds was observed. Individuals in the fourth quartile of PAH metabolite concentration had higher hearing thresholds compared with those in the first quartile of PAH metabolite concentration. Exposure to PAHs is related to hearing threshold shift at both low and high frequencies in the US adult population.

^{27}Al^{+} Quantum-Logic Clock with a Systematic Uncertainty below 10^{-18}

We describe an optical atomic clock based on quantum-logic spectroscopy of the ^{1}S_{0}↔^{3}P_{0} transition in ^{27}Al^{+} with a systematic uncertainty of 9.4×10^{-19} and a frequency stability of 1.2×10^{-15}/sqrt[τ]. A ^{25}Mg^{+} ion is simultaneously trapped with the ^{27}Al^{+} ion and used for sympathetic cooling and state readout. Improvements in a new trap have led to reduced secular motion heating, compared to previous ^{27}Al^{+} clocks, enabling clock operation with ion secular motion near the three-dimensional ground state. Operating the clock with a lower trap drive frequency has reduced excess micromotion compared to previous ^{27}Al^{+} clocks. Both of these improvements have led to a reduced time-dilation shift uncertainty. Other systematic uncertainties including those due to blackbody radiation and the second-order Zeeman effect have also been reduced.

Sympathetic Ground State Cooling and Time-Dilation Shifts in an ^{27}Al^{+} Optical Clock

We report on Raman sideband cooling of ^{25}Mg^{+} to sympathetically cool the secular modes of motion in a ^{25}Mg^{+}-^{27}Al^{+} two-ion pair to near the three-dimensional (3D) ground state. The evolution of the Fock-state distribution during the cooling process is studied using a rate-equation simulation, and various heating sources that limit the efficiency of 3D sideband cooling in our system are discussed. We characterize the residual energy and heating rates of all of the secular modes of motion and estimate a secular motion time-dilation shift of -(1.9±0.1)×10^{-18} for an ^{27}Al^{+} clock at a typical clock probe duration of 150 ms. This is a 50-fold reduction in the secular motion time-dilation shift uncertainty in comparison with previous ^{27}Al^{+} clocks.

Trapped-ion state detection through coherent motion

We demonstrate a general method for state detection of trapped ions that can be applied to a large class of atomic and molecular species. We couple a spectroscopy ion (27Al+) to a control ion (25Mg+) in the same trap and perform state detection through off-resonant laser excitation of the spectroscopy ion that induces coherent motion. The motional amplitude, dependent on the spectroscopy ion state, is measured either by time-resolved photon counting or by resolved sideband excitations on the control ion. The first method provides a simplified way to distinguish clock states in 27Al+, which avoids ground-state cooling and sideband transitions. The second method reduces spontaneous emission and optical pumping on the spectroscopy ion, which we demonstrate by nondestructively distinguishing Zeeman sublevels in the (1)S0 ground state of 27Al+.

Quantum coherence between two atoms beyond Q=10(15)

We place two atoms in quantum superposition states and observe coherent phase evolution for 3.4×10(15) cycles. Correlation signals from the two atoms yield information about their relative phase even after the probe radiation has decohered. This technique allowed a frequency comparison of two (27)Al(+) ions with fractional uncertainty 3.7(-0.8)(+1.0)×10(-16)/√[τ/s]. Two measures of the Q factor are reported: The Q factor derived from quantum coherence is 3.4(-1.1)(+2.4)×10(16), and the spectroscopic Q factor for a Ramsey time of 3 s is 6.7×10(15). We demonstrate a method to detect the individual quantum states of two Al(+) ions in a Mg(+)-Al(+)-Al(+) linear ion chain without spatially resolving the ions.

Association between sensorimotor function and forward reach in patients with diabetes

Deterioration in the function of the sensorimotor system is often seen in patients with diabetes and could be related to balance impairments. The purpose of this study was to determine the association between sensorimotor function and forward reach ability in patients with diabetes. Thirty-one patients with Type 2 diabetes went through a monofilament test of plantar touch-pressure threshold, an ankle joint reposition test for joint position sense, and a series of strength tests of the lower leg. These patients also performed the forward reach test in standing to measure the reach distance and displacement of the center of mass (COM), using a motion analysis system. Correlational and regressional analyses were conducted to determine the association between sensorimotor and balance parameters. It was found that greater reach distance and COM displacement were significantly correlated with lower plantar touch-pressure threshold and greater plantarflexion strength. Regression analysis showed that after controlling the variance in the subject characteristics, plantar touch-pressure threshold was a significant predictor for reach distance and COM displacement, while plantarflexion strength was also a significant predictor for COM displacement. These findings highlight the importance of the assessment of plantar sensitivity and the need for detailed balance or fall risk assessment for patients with impaired plantar insensitivity.

Frequency comparison of two high-accuracy Al+ optical clocks

We have constructed an optical clock with a fractional frequency inaccuracy of 8.6x10{-18}, based on quantum logic spectroscopy of an Al+ ion. A simultaneously trapped Mg+ ion serves to sympathetically laser cool the Al+ ion and detect its quantum state. The frequency of the {1}S{0}<-->{3}P{0} clock transition is compared to that of a previously constructed Al+ optical clock with a statistical measurement uncertainty of 7.0x10{-18}. The two clocks exhibit a relative stability of 2.8x10{-15}tau{-1/2}, and a fractional frequency difference of -1.8x10{-17}, consistent with the accuracy limit of the older clock.

Analysis of oligonucleotides by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

MALDI-MS is one of the most useful techniques available for determining biomolecule mass. It offers high mass accuracy, good sensitivity, simplicity, and speed. Because singly charged ions of oligonucleotides are typically observed, MALDI-MS spectra are easy to interpret. This unit presents protocols for sample preparation and purification, matrix preparation, and matrix/analyte sample preparation. It provides an introduction to the instrumentation and its calibration, and a discussion of some of the useful applications of MALDI-MS analysis in the study of oligonucleotides. This technique is typically used for 120-mer or smaller oligonucleotides.

Frequency ratio of Al+ and Hg+ single-ion optical clocks; metrology at the 17th decimal place

Time has always had a special status in physics because of its fundamental role in specifying the regularities of nature and because of the extraordinary precision with which it can be measured. This precision enables tests of fundamental physics and cosmology, as well as practical applications such as satellite navigation. Recently, a regime of operation for atomic clocks based on optical transitions has become possible, promising even higher performance. We report the frequency ratio of two optical atomic clocks with a fractional uncertainty of 5.2 x 10(-17). The ratio of aluminum and mercury single-ion optical clock frequencies nuAl+/nuHg+ is 1.052871833148990438(55), where the uncertainty comprises a statistical measurement uncertainty of 4.3 x 10(-17), and systematic uncertainties of 1.9 x 10(-17) and 2.3 x 10(-17) in the mercury and aluminum frequency standards, respectively. Repeated measurements during the past year yield a preliminary constraint on the temporal variation of the fine-structure constant alpha of alpha/alpha = (-1.6+/-2.3) x 10(-17)/year.

Heralded entanglement between atomic ensembles: preparation, decoherence, and scaling

Heralded entanglement between collective excitations in two atomic ensembles is probabilistically generated, stored, and converted to single-photon fields. By way of the concurrence, quantitative characterizations are reported for the scaling behavior of entanglement with excitation probability and for the temporal dynamics of various correlations resulting in the decay of entanglement. A lower bound of the concurrence for the collective atomic state of 0.9+/-0.3 is inferred. The decay of entanglement as a function of storage time is also observed, and related to the local dynamics.

Direct measurement of decoherence for entanglement between a photon and stored atomic excitation

Violations of a Bell inequality are reported for an experiment where one of two entangled qubits is stored in a collective atomic memory for a user-defined time delay. The atomic qubit is found to preserve the violation of a Bell inequality for storage times up to 21 micros, 700 times longer than the duration of the excitation pulse that creates the entanglement. To address the question of the security of entanglement-based cryptography implemented with this system, an investigation of the Bell violation as a function of the cross correlation between the generated nonclassical fields is reported, with saturation of the violation close to the maximum value allowed by quantum mechanics.

Three-dimensional analysis for radio-frequency ablation of liver tumor with blood perfusion effect

Increase of temperature above 50 approximately 60 degrees C for few minutes by the emitted radio-frequency (RF) energy has been shown to be able to denaturate the intracellular proteins and destruct membranes of tumor cells. To improve the efficacy of this thermal therapy, it is important to investigate factors that may affect the RF heating characteristics for the hepatocellular carcinoma and metastatic liver tumors. In order to make sure the applied RF energy is adequate to ablate the target tumor, a 3D thermoelectric analysis for the system consisting of liver, liver arteries and 4 mm diameter tumor is conducted. The effect of blood perfusion is addressed in this study.

Measurement-induced entanglement for excitation stored in remote atomic ensembles

A critical requirement for diverse applications in quantum information science is the capability to disseminate quantum resources over complex quantum networks. For example, the coherent distribution of entangled quantum states together with quantum memory (for storing the states) can enable scalable architectures for quantum computation, communication and metrology. Here we report observations of entanglement between two atomic ensembles located in distinct, spatially separated set-ups. Quantum interference in the detection of a photon emitted by one of the samples projects the otherwise independent ensembles into an entangled state with one joint excitation stored remotely in 10(5) atoms at each site. After a programmable delay, we confirm entanglement by mapping the state of the atoms to optical fields and measuring mutual coherences and photon statistics for these fields. We thereby determine a quantitative lower bound for the entanglement of the joint state of the ensembles. Our observations represent significant progress in the ability to distribute and store entangled quantum states.

Temporal dynamics of photon pairs generated by an atomic ensemble

The time dependence of nonclassical correlations is investigated for two fields (1,2) generated by an ensemble of cold cesium atoms via the protocol of Duan et al. [Nature (London) 414, 413 (2001)]]. The correlation function R(t1,t2) for the ratio of cross to autocorrelations for the (1,2) fields at times (t1,t2) is found to have a maximum value R(max=292+/-57, which significantly violates the Cauchy-Schwarz inequality R< or =1 for classical fields. Decoherence of quantum correlations is observed over taud approximately 175 ns, and is described by our model, as is a new scheme to mitigate this effect.

Single-photon generation from stored excitation in an atomic ensemble

Single photons are generated from an ensemble of cold Cs atoms via the protocol of Duan et al. [Nature (London), ()]]. Conditioned upon an initial detection from field 1 at 852 nm, a photon in field 2 at 894 nm is produced in a controlled fashion from excitation stored within the atomic ensemble. The single-quantum character of field 2 is demonstrated by the violation of a Cauchy-Schwarz inequality, namely w(1(2),1(2)|1(1))=0.24+/-0.05 not > or = 1, where w(1(2),1(2)|1(1)) describes the detection of two events (1(2),1(2)) conditioned upon an initial detection 1(1), with w-->0 for single photons.

Generation of nonclassical photon pairs for scalable quantum communication with atomic ensembles

Quantum information science attempts to exploit capabilities from the quantum realm to accomplish tasks that are otherwise impossible in the classical domain. Although sufficient conditions have been formulated for the physical resources required to achieve quantum computation and communication, there is a growing understanding of the power of quantum measurement combined with the conditional evolution of quantum states for accomplishing diverse tasks in quantum information science. For example, a protocol has recently been developed for the realization of scalable long-distance quantum communication and the distribution of entanglement over quantum networks. Here we report the first enabling step in the realization of this protocol, namely the observation of quantum correlations for photon pairs generated in the collective emission from an atomic ensemble. The nonclassical character of the fields is demonstrated by the violation of an inequality involving their normalized correlation functions. Compared to previous investigations of non-classical correlations for photon pairs produced in atomic cascades and in parametric down-conversion, our experiment is distinct in that the correlated photons are separated by a programmable time interval (of about 400 nanoseconds in our initial experiments).

Usefulness of the suspended microbubble sign in differentiating empyemic and nonempyemic hydropneumothorax

OBJECTIVE

The suspended microbubble sign is defined as the image seen on ultrasonography consisting of a pleural effusion strewn with numerous hyperechoic pinpoints and more or less linear shadows that move synchronously with respiration. In this study, we intended to evaluate the clinical usefulness of the suspended microbubble sign in differentiating empyemic and nonempyemic hydropneumothorax.

METHODS

This series consisted of 8 patients with empyemic hydropneumothorax and 23 patients with nonempyemic hydropneumothorax. The finding of the presence of the suspended microbubble signs on ultrasonography was recorded. To further elucidate the generation of the suspended microbubble sign, the interaction between air and pleural fluid of different types was investigated in vitro.

RESULTS

The suspended microbubble sign was shown on ultrasonography in all 8 patients with empyemic hydropneumothorax but was absent in the 23 patients with nonempyemic hydropneumothorax. These findings were supported by the observation that the pus seemed to mix with and trap the air more easily than did the nonpurulent pleural fluid, as shown in vitro. In this selected population, the sensitivity and specificity of the suspended microbubble sign in aiding a diagnosis of empyemic hydropneumothorax were both 100%.

CONCLUSION

The suspended microbubble sign shown on ultrasonography might be of considerable value in differentiating empyemic and nonempyemic hydropneumothorax.

A novel endo-beta-galactosidase from Clostridium perfringens that liberates the disaccharide GlcNAcalpha 1-->Gal from glycans specifically expressed in the gastric gland mucous cell-type mucin

We found that commercially available sialidases prepared from Clostridium perfringens ATCC10543 were contaminated with an endoglycosidase capable of releasing the disaccharide GlcNAcalpha1-->4Gal from glycans expressed in the gastric gland mucous cell-type mucin. We have isolated this enzyme in electrophoretically homogeneous form from the culture supernatant of this organism by ammonium sulfate precipitation followed by affinity chromatography using a Sephacryl S-200 HR column. The enzyme was specifically retained by and eluted from the column with methyl-alpha-Glc. By NMR spectroscopy, the structure of the disaccharide released from porcine gastric mucin by this enzyme was established to be GlcNAcalpha1-->4Gal. The specificity of this enzyme as an endo-beta-galactosidase was established by analyzing the liberation of GlcNAcalpha1-->4Gal from GlcNAcalpha1-->4Galbeta1-->4GlcNAcbeta1-->6(GlcNAcalpha1--> 4Galbeta1-->3)GalNAc-ol by mass spectrometry. Because this novel endo-beta-galactosidase specifically releases the GlcNAcalpha1-->4Gal moiety from porcine gastric mucin, we propose to call this enzyme a GlcNAcalpha1-->4Gal-releasing endo-beta-galactosidase (Endo-beta-Gal(GnGa)). Endo-beta-Gal(GnGa) was found to remove the GlcNAcalpha1-->4Gal epitope expressed in gastric adenocarcinoma AGS cells transfected with alpha1,4-N-acetylglucosaminyltransferase cDNA. Endo-beta-Gal(GnGa) should become useful for studying the structure and function of glycoconjugates containing the terminal GlcNAcalpha1-->4Gal epitope.

Anterior pituitary failure (panhypopituitarism) with balanced chromosome translocation 46,XY,t(11;22)(q24;q13)

Hypopituitarism is the clinical syndrome that results from failure of the anterior pituitary gland to produce its hormones. Hypopituitarism can result from: (1) intrinsic or primary pituitary disease; (2) intrinsic hypothalamic or secondary pituitary disease; or (3) extrinsic extrasellar or parasellar disease. The etiologies of primary hypopituitarism are miscellaneous. The dominant clinical picture of hypopituitarism in the adult is that of hypogonadism. Reports have associated hypopituitarism with anti-pituitary-antibodies, hereditary syndrome and chromosome defects, but hypopituitarism has rarely been associated with balanced chromosome translocation (11;22)(q24;q13). Here, we describe a case of anterior pituitary failure with balanced chromosome translocation. A 19-year-old Chinese teenager presented with failure of pubertal development and sexual infantilism. On examination, the patient had the classic appearance of hypogonadism. Endocrine studies and three combined pituitary function tests revealed panhypopituitarism. A chromosomal study revealed 46,XY,t(11;22)(q24;q13), a balanced translocation between 11q24 and 22q13. Chest films showed delayed fusion of bilateral humeral head epiphyses and bilateral acromions. Scrotal sonography revealed testes were small bilaterally. Magnetic resonance imaging (MRI) of the sella revealed pituitary dwarfism. The patient received 19 months replacement therapy, including steroids (prednisolone 5 mg each day), L-thyroxine (Eltroxin 100 ug each day), and testosterone enanthate 250 mg every two weeks. His height increased 4 cm with secondary sexual characteristics developed, and muscle power increased.

Diagnosis of pulmonary alveolar proteinosis: usefulness of papanicolaou-stained smears of bronchoalveolar lavage fluid

BACKGROUND

The globules (stained green, orange, or orange in the center coated with a green rim) seen in Papanicolaou-stained smears of bronchoalveolar lavage fluid are suggested to be characteristic of pulmonary alveolar proteinosis (PAP).

OBJECTIVE

To evaluate the usefulness of Papanicolaou-stained smears of bronchoalveolar lavage fluid in aiding a diagnosis of PAP.

METHODS

Papanicolaou-stained smears of bronchoalveolar lavage fluid obtained from 7 patients (5 idiopathic, 2 secondary) with PAP were evaluated. To serve as controls, the smears of 11 normal subjects and 128 patients with other pulmonary disorders were also examined. The findings on the presence and number of globules were recorded. To differentiate PAP from other pulmonary disorders, the highest globule value obtained from the control group was chosen as the cutoff point.

RESULTS

The characteristic globules were not found in normal subjects and only found in 6 of 128 patients with other pulmonary disorders. Their clinical diagnoses were Sjögren syndrome in 2 cases; polymyositis, idiopathic pulmonary fibrosis, asbestosis, and hypersensitivity pneumonitis in 1 case each. The numbers of globules in these 6 patients were 1, 3, 17, 7, 3, and 2. In contrast, more than 100 globules were found in all patients with PAP. The number of globules was highly sensitive and specific in aiding a diagnosis of PAP when the cutoff value was set at 18.

CONCLUSION

The globules seen in Papanicolaou-stained smears of bronchoalveolar lavage fluid may be valuable in aiding a diagnosis of PAP, especially when the number of globules is more than 18.

Down's syndrome with mucosa-associated lymphoid tissue, thyroid lymphoma and cerebral infarction

Primary lymphoma of the thyroid gland is rare. The histopathology of most low-grade thyroid lymphomas is of a mucosa-associated lymphoid tissue (MALT) type. A typical feature of this type of lymphoma is a close lymphocyte-epithelium interaction. It tends to appear in patients with a history of autoimmune disease or chronic inflammatory disorders. A clinical picture of hypothyroidism may be present. Hyperthyroidism associated with thyroid lymphoma is also rare. Thyroid lymphoma could be misdiagnosed as lymphocytic thyroiditis or small cell anaplastic carcinoma. It is rarely reported in patients with Down's syndrome. In this report, we describe a Down's syndrome patient with MALT thyroid lymphoma and cerebral infarction. The patient, a 42-year-old man, presented with chest discomfort and bilateral leg weakness of one week's duration. Physical examination of his neck showed a right-sided mass lesion. Neurologic examination revealed decreased muscle power and hyperreflexia in both lower legs. Babinski's sign was present bilaterally. Endocrinologic studies showed subclinical hypothyroidism. A thoracolumbar radiograph showed disc space narrowing. Thyroid sonography revealed a hypoechoic mass lesion in the right lobe of the thyroid gland. Fine needle aspiration cytology of the neck mass demonstrated a large amount of lymphocyte infiltration. An I131 thyroid scan and 24-hour uptake revealed the possibility of thyroid malignancy at the upper poles of both thyroid lobes. Computerized tomography of the brain revealed a lacunar infarct in the posterior aspect of the left putamen. Magnetic resonance imaging of the lumbar spine revealed a healed L4 compression fracture with L4-5 retrolithesis. The patient later underwent a right total thyroidectomy. The pathologic finding showed MALT lymphoma. The patient received steroid suppression therapy, and after nine months of treatment and follow-up, he developed clinical hypothyroidism. Neither local tumor recurrence nor distant metastasis was found.

Non-insulin-dependent diabetes mellitus with type I multiple symmetrical lipomatosis: a case report

Type I multiple symmetrical lipomatosis (MSL; Madelung's disease) is characterized by lipomas in the nape of the neck and the supraclavicular and deltoid regions, resulting in a bull-necked appearance (Madelung's collar). It is most common in alcoholic men between 35 and 50 years of age. Type I MSL has been reportedly associated with hyperinsulinemia, but its association with diabetes mellitus is rarely discussed. We describe a case of non-insulin-dependent diabetes mellitus (NIDDM) associated with type I MSL. A 47-year-old alcoholic man presented with a seven-year history of hyperglycemia and progressive neck swelling with dysphagia for one year. Physical examination showed diffuse and symmetrical swelling of the bilateral posterior aspects of the neck. Biochemistry profiles revealed elevated concentrations of fasting serum glucose (276 +/- 16 mg/dl), triglycerides (358 +/- 79 mg/dl) and total cholesterol (323 +/- 28 mg/dl). Endocrinologic studies showed normal thyroid function. Neck sonography revealed diffuse thickening and swelling of the fatty structures of both sides of the neck. Normal sonography showed no fatty deposition in the liver. Maxillary and neck computerized tomography revealed diffuse fat accumulation in the submental and posterior neck regions, with no extension to the superior mediastinum. Fine needle aspiration cytology of the neck masses showed only fat cells. The patient received an oral hypoglycemic agent (glibenclamide 5 mg bid) for blood glucose control and lovastatin (20 mg before bed-time) for hyperlipidemia, and ceased drinking alcohol. The neck swelling resolved markedly after 15 months of medical treatment. This suggests that, in addition to the cessation of alcohol consumption, the reduction of blood glucose and lipid concentrations by medication may also assist in resolving the accumulated fat of type I MSL in patients with NIDDM.

Primary hyperparathyroidism with cardiac abnormalities: a case report

Primary hyperparathyroidism, characterized by hypersecretion of parathyroid hormone (PTH) leading to hypercalcemia and relative hypophosphatemia, is quite common in the elderly. Most patients with primary hyperparathyroidism have only mild hypercalcemia and are symptomless. But others experience various other organ diseases. Primary hyperparathyroidism is also associated with cardiovascular abnormalities, including QT interval shortening, heart block, cardiac arrhythmias, hypertension, myocardial hypertrophy, myocardial calcification and, though rarely, with valvular heart disease. We described a case of primary hyperparathyroidism associated with cardiac abnormalities. An 82-year-old male presented with the complaints of chest discomfort, fatigue, general weakness, nausea and vomiting over a period of months and was admitted in July 1996. Physical examination with heart auscultation showed a pansystolic murmur over the right sternal border and apex region, and a blowing diastolic murmur over the left sternal border. Biochemistry profiles revealed elevations of serum calcium (14.3 mg/dl) and chloride/phosphate ratio (> 33). Endocrinological studies showed elevations of serum PTH-C (4.8 ng/ml) and PTH-intact (705 pg/ml) concentrations. Kidney ultrasonography revealed a left renal stone. A spine X-ray revealed spondylosis and a compression fracture of the lumbar-spine with osteoporotic change. Thyroid ultrasonography and Thallium (Tl201)-technetium (Tc99m) subtraction scan showed parathyroid adenoma in the low pole of the right thyroid bed. Parathyroid aspiration cytology revealed few and discrete cells. Echocardiogram revealed moderate to severe aortic valvular calcification as well as stenosis with moderate aortic regurgitation, mitral regurgitation and myocardial calcification. The patient received parathyroidectomy one month later. During his postoperative days, he suffered from muscle twitching with positive Trousseau's sign and Chvostek's sign. The patient received calcium carbonate and vitamin D for hypocalcemia, diltiazem and capoten for his heart problems. A repeated echocardiogram two months after surgery showed no improvement of valvular calcification.

Prolonged survival in a nasopharyngeal carcinoma patient with multiple metastases: a case report and review of the literature

Nasopharyngeal carcinoma is a common cancer in South East Asia. In the early stages, radiotherapy alone may achieve sustained control, but once metastasis occurs, it becomes an incurable disease with limited survival time. We report a case of nasopharyngeal carcinoma, initial stage T4N0M0, diagnosed in 1985 in a patient aged 36 years who received 70 Gy radiotherapy to the head and neck region. In 1988, relapse occurred with multiple lung metastases. The patient received many chemotherapy regimens with a very good response, including near complete remission with the first treatment regimen of cisplatin, 5-fluorouracil and leucovorin for lung metastases, and with the fifth chemotherapy regimen of ifosfamide as a single agent. After ifosfamide treatment, there was residual fibrotic change in the lung and complete disappearance, lasting for almost a year, of the liver and bone lesions. The patient eventually died in July 1995 due to progressive disease. Prolonged survival after mainly thoracic metastasis is possible in patients with nasopharyngeal carcinoma, especially if the tumor is chemo-responsive.

Adenocarcinoma in the middle third of the stomach--an evaluation for the prognostic significance of clinicopathological features

BACKGROUND/AIMS

The prognosis of patients with gastric adenocarcinoma varies with the location of the tumor. Adenocarcinoma in the middle third of the stomach has been claimed to have a better outcome than those in other locations. However, there is still very limited information specifically regarding the prognostic factors which influence the survival time of patients with adenocarcinoma in the middle third of the stomach. This retrospective study was designed with the aim to evaluate and uncover the possible significant clinicopathological parameters for adenocarcinoma in the middle third of the stomach.

METHODOLOGY

Between 1986 and 1992, 363 patients underwent gastric resection for primary gastric adenocarcinoma at this hospital. Fifty-two (14.3%) of these patients were included in this study and they all met the following criteria: 1) tumor primarily located in the middle third of the stomach without distant metastases or peritoneal seeding, 2) undergoing curative resection and 3) undergoing R2 nodal dissection, at least. The clinicopathological findings were obtained by detailed review of the medical records and the histologic slides. All surviving patients were also contacted and their current conditions were recorded.

RESULTS

The overall 5-year survival rate (Kaplan-Meier method) was 42.5%. In univariate survival analysis by Kaplan-Meier method and long-rank test, serosal invasion (p < 0.01), lymph node metastasis (p < 0.01) and lymphatic involvement (p < 0.01) had an individual prognostic significance. When a multivariate analysis using Cox proportional hazards regression was performed, serosal invasion (P < 0.01) and lymphatic involvement (p < 0.05) appeared as the only two independent prognostic factors regarding long-term survival. When these 52 patients were categorized into patients with early gastric cancer (n = 10) and patients with advanced gastric cancer (n = 42), there was a significant difference (p < 0.01) between the survival rates (90.0% vs. 29.1%). When these tumors were further categorized into early gastric cancer (n = 10), early simulating advanced gastric cancer (n = 14) and Borrmann type advanced gastric cancer (n = 28), there were significant differences (P < 0.01 and P < 0.01, respectively) in 5-year overall survival rates between early gastric cancer (90.0%) and Borrmann type advanced gastric cancer (18.9%), also between early simulating advanced gastric cancer (52.5%) and Borrmann type advanced gastric cancer (18.9%). UICC stage also had significant influence (P < 0.01) on the survival rates.

CONCLUSIONS

Serosal invasion and lymphatic involvement are the significant, independent prognostic factors in predicting the survival rate of patients with adenocarcinoma in the middle third of the stomach. Since more advanced stage tumors usually carry a poorer prognosis, early detection is of extreme importance for improving the survival rate.

Affinity methods for purification of DNA sequencing reaction products for mass spectrometric analysis

Time-of-flight mass spectrometry has the potential to replace gel electrophoresis for rapid and accurate analysis of DNA sequencing mixtures. However, impurities in the Sanger sequencing reaction solutions can complicate and degrade the mass spectrometric performance. Therefore, a fast purification procedure is necessary for mass spectrometric analysis. Two affinity methods were tested for the capture of the target fragments: a probe strand, complementary to the primer used to initiate synthesis of the Sanger fragments, is immobilized to a solid support either before or after hybridization so that the impurities are readily separated by filtering and washing the support material. The approaches were tested using mock sequencing mixtures assembled from synthetic DNA strands, to which representative impurities could be added. The results showed that the latter method has better overall yield. The recovered fragments were analyzed by matrix-assisted laser desorption/ionization.

Pathological studies on calcification of the intervertebral discs

Calcified deposits in the intervertebral discs of 35 cadavers microradiographically appeared as linear of flake-like densities composed of calcium pyrophosphate dihydrate (CPPD) crystals and as multiple punctates possibly composed of dicalcium phosphate dihydrate (DCPD) crystals. Calcium deposits were found in 57% of the cadavers by microradiography and 63% by light microscopy, without known metabolic or familial history related to articular chondrocalcinosis. By scanning electron microscopy, CPPD crystals were mainly rod-like, rectangular and cuboid and were about 4 to 10 mu in length while DCPD crystals were prismatic and about 20 to 60 microns in length.