Nomograms and prognosis for superficial esophageal squamous cell carcinoma

In recent years, endoscopic resection, particularly endoscopic submucosal dissection, has become increasingly popular in treating non-metastatic superficial esophageal squamous cell carcinoma (ESCC). In this evolving paradigm, it is crucial to identify factors that predict higher rates of lymphatic invasion and poorer outcomes. Larger tumor size, deeper invasion, poorer differentiation, more infiltrative growth patterns (INF-c), higher-grade tumor budding, positive lymphovascular invasion, and certain biomarkers have been associated with lymph node metastasis and increased morbidity through retrospective reviews, leading to the construction of comprehensive nomograms for outcome prediction. If validated by future prospective studies, these nomograms would prove highly applicable in guiding the selection of treatment for superficial ESCC.

[Attention should be paid to glaucoma following pediatric cataract surgery]

Glaucoma following cataract surgery is one of the common complications after pediatric cataract surgery, and it is the main cause of "second blindness" in children. Since this atypical disease is difficult to diagnose and evaluate, it has been gradually paid more attention by clinicians. There are still some controversies and challenges related to the characteristics of the disease, diagnostic criteria, and treatment options. This article discusses the definition, diagnostic criteria, related risk factors, treatment strategies, follow-up, and prognoses of glaucoma following cataract surgery. Establishment of a diagnosis and treatment system can better improve the visual rehabilitation of pediatric cataract children.

[Clinical characteristics and surgical effect observation of congenital aniridia combined with cataract]

Objective: To analyze the clinical manifestations, surgical approaches and postoperative prognosis for the cases of congenital aniridia combined with cataract. Methods: In this retrospective case series, 26 patients diagnosed with congenital aniridia combined with cataract were collected from Zhongshan Ophthalmic Center from February 2002 to August 2016. The Clinical data were collected to analyze the clinical features, surgical approaches and postoperative prognosis. T-test was used for statistical analysis. Results: Twenty-six bilateral congenital aniridia patients were included in the case series, with 50% male cases. The average age for the first visit was (8.72±8.06) years old. Hereditary patients constitutes 30.8% (8/26) of the total number. The proportions for bilateral and unilateral cataracts were 88.5% (23/26) and 11.5% (3/26) respectively, and 49 eyes suffering from both congenital aniridia and cataract were therefore included in the final analysis. The most common morphology cataract subtypes were lamellar cataract (24.5%, 12/49), posterior subcapsular cataract (22.4%, 11/49), and total cataract (18.4%,9/49). The observed ocular comorbidities included nystagmus (36.7%, 18/49), vitreous opacity (28.6%, 14/49), foveal hypoplasia (20.4%, 10/49), ametropia (12.2%, 6/49), exotropia (12.2%, 6/49), congenital glaucoma (12.2%, 6/49), esotropia (4.1%, 2/49), congenital ptosis (4.1%, 2/49), lens ectopia (4.1%, 2/49), scleral staphyloma (2.0%, 1/49) and pigmentary degeneration of retina (2.0%, 1/49). 30.6% (15/49) eyes were performed the cataract extraction surgery. The percentage of postoperative best corrected visual acuity (BCVA) for ≥0.1 and ≥0.3 were 93.3% (14/15) and 20.0% (3/15) respectively. Evaluated ocular pressure (33.3%, 5/15), severe posterior capsular opacification (PCO) (13.3%, 2/15) and choroidal hemorrhage combined with choroidal detachment (6.7%, 1/15) were detected as the postoperative complications. Followed by cataract extraction, 80.0% (12/15) eyes were sequentially performed the intraocular lens implantation, while, 20.0% (3/12) eyes remained aphakia due to ocular comorbidities. Conclusions: Congenital aniridia combined with cataract are rare diseases, calling for the precious retrospective researches. This disorder tended to affect both eyes and occurred hereditary. The clinical courses of the cases presented progressive features. Ocular comorbidities were the crucial factors to influence the surgical approaches and postoperative prognosis. (Chin J Ophthalmol, 2017, 53: 821-827).

Solid-state, ambient-operation thermally activated delayed fluorescence from flexible, non-toxic gold-nanocluster thin films: towards the development of biocompatible light-emitting devices

Luminescent gold nanoclusters (AuNCs) with good biocompatibility have gained much attention in bio-photonics. In addition, they also exhibit a unique photo-physical property, namely thermally activated delayed fluorescence (TADF), by which both singlet and triplet excitons can be harvested. The combination of their non-toxic material property and unique TADF behavior makes AuNCs biocompatible nano-emitters for bio-related light-emitting devices. Unfortunately, the TADF emission is quenched when colloidal AuNCs are transferred to solid states under ambient environment. Here, a facile, low-cost and effective method was used to generate efficient and stable TADF emissions from solid AuNCs under ambient environment using polyvinyl alcohol as a solid matrix. To unravel the underlying mechanism, temperature-dependent static and transient photoluminescence measurements were performed and we found that two factors are crucial for solid TADF emission: small energy splitting between singlet and triplet states and the stabilization of the triplet states. Solid TADF films were also deposited on the flexible plastic substrate with patterned structures, thus mitigating the waveguide-mode losses. In addition, we also demonstrated that warm white light can be generated based on a co-doped single emissive layer, consisting of non-toxic, solution-processed TADF AuNCs and fluorescent carbon dots under UV excitation.

A Facile and Low-Cost Method to Enhance the Internal Quantum Yield and External Light-Extraction Efficiency for Flexible Light-Emitting Carbon-Dot Films

Solution-processed, non-toxic carbon dots (CDs) have attracted much attention due to their unique photoluminescence (PL) properties. They are promising emissive layers for flexible light-emitting devices. To this end, the CDs in pristine aqueous solutions need to be transferred to form solid-state thin films without sacrificing their original PL characteristics. Unfortunately, solid-state PL quenching induced by extra non-radiative (NR) energy transfer among CDs would significantly hinder their practical applications in optoelectronics. Here, a facile, low-cost and effective method has been utilized to fabricate high-performance CD/polymer light-emitting flexible films with submicron-structured patterns. The patterned polymers can serve as a solid matrix to disperse and passivate CDs, thus achieving high internal quantum yields of 61%. In addition, they can act as an out-coupler to mitigate the waveguide-mode losses, approximately doubling the external light-extraction efficiency. Such CD/polymer composites also exhibit good photo-stability, and thus can be used as eco-friendly, low-cost phosphors for solid-state lighting.

Influenza A plasma and serum virus antibody detection comparison in dogs using blocking enzyme-linked immunosorbent assay

Background and Aim:

The influenza A virus (IAV) is an important zoonotic pathogen with infections also reported in dogs. IAV infections can be detected through the presence of antibodies using the enzyme-linked immunosorbent assay (ELISA). Serum is the only standard sample source; however, there is no information on the availability of other sample sources for IAV antibody detection in dogs. Compared with serum, plasma is more widely employed in most animal hospitals. The object of this study is to investigate whether plasma collected in ethylenediaminetetraacetic acid (EDTA) tubes (EDTA plasma) or heparin tubes (heparin plasma) could be used in the ELISA protocol instead of serum for IAV antibody detection in dogs.

Materials and Methods:

Totally, 82 matched EDTA plasma and serum sample pairs and 79 matched heparin plasma and serum sample pairs were employed using blocking enzyme-linked immunosorbent assay (bELISA). The agreement and correlation between the plasma (EDTA or heparin plasma) and serum were assessed using the agreement index kappa (kD) calculation and Pearson correlation coefficient, respectively.

Results:

The agreement index kD of EDTA plasma and serum was 1.0, and that of heparin plasma and serum was 0.85. The Pearson correlation coefficient of EDTA plasma and serum was 0.87 (p<0.01), and that of heparin plasma and serum was 0.82 (p<0.01).

Conclusion:

The results proved that plasma, especially EDTA plasma, could be substituted for serum in the bELISA test. This might greatly expand the clinical applicability of IAV antibody detection in dogs.

Pitfalls of CT for deep neck abscess imaging assessment: a retrospective review of 162 cases

OBJECTIVES

To investigate the diagnostic value of contrast-enhanced computed tomography (CT) for the prediction of deep neck abscesses in different deep neck spaces and to evaluate the false-positive results.

METHOD

We retrospectively analysed the clinical charts, CT examinations, surgical findings, bacteriology, pathological examinations and complications of hospitalised patients with a diagnosis of deep neck abscess from 2004 to 2010. The positive predictive values (PPV) for the prediction of abscesses by CT scan in different deep neck spaces were calculated individually on the basis of surgical findings.

RESULTS

A total of 162 patients were included in this study. All patients received both intravenous antibiotics and surgical drainage. The parapharyngeal space was the most commonly involved space. The overall PPV for the prediction of deep neck abscess with contrast-enhanced CT was 79.6%. The PPV was 91.3% when more than one deep neck space was involved but only 50.0% in patients with isolated retropharyngeal abscesses. In the false-positive group, cellulitis was the most common final result, followed by cystic degeneration of cervical metastases. Five specimens taken intra-operatively revealed malignancy and four of these were not infected.

CONCLUSIONS

There are some limitations affecting the differentiation of abscesses and cellulitis, particularly in the retropharyngeal space. A central necrotic cervical metastatic lymph node may sometimes also mimic a simple pyogenic deep neck abscess on both clinical pictures and CT images. Routine biopsy of the tissue must be performed during surgical drainage.

Energy transfer from InGaN quantum wells to Au nanoclusters via optical waveguiding

We present the first observation of resonance energy transfer from InGaN quantum wells to Au nanoclusters via optical waveguiding. Steady-state and time-resolved photoluminescence measurements provide conclusive evidence of resonance energy transfer and obtain an optimum transfer efficiency of ~72%. A set of rate equations is successfully used to model the kinetics of resonance energy transfer.

Artificial neural network analysis for reliability prediction of regional runoff utilization

Many factors in the reliability analysis of planning the regional rainwater utilization tank capacity need to be considered. Based on the historical daily rainfall data, the following four analyzing procedures will be conducted: the regional daily rainfall frequency, the amount of runoff, the water continuity, and the reliability. Thereafter, the suggested designed storage capacity can be obtained according to the conditions with the demand and supply reliability. By using the output data, two different types of artificial neural network models are used to build up small area rainfall-runoff supply systems for the simulation of reliability and the prediction model. They are also used for the testing of stability and learning speed assessment. Based on the result of this research, the radial basis function neural network (RBFNN) model, using the Gaussian function that has a similar trend as the nature as basic function, has better stability than using the back-propagation neural network (BPNN) model. Despite the fact that RBFNN was more reliable than BPNN, it still made a conservative estimate for the actual monitoring data. The error rate of RBFNN was still higher than the correction of BPNN 4-3-1-1. This should have significant benefit in the future application of the instantaneous prediction or the development of related intelligent instantaneous control equipment.

Thermal modeling and performance analysis of a thermoacoustic refrigerator

A heat-driven thermoacoustic refrigerator has been designed and tested. A detailed thermal model of the device is presented. Energy balances within the system are discussed using external, heat exchanger, and stack control volumes in order to clarify the relationships of work and heat fluxes below and above onset. Thermal modeling is discussed as a tool for performance analysis as well as for determining system heat losses and finding input heat flows required by a thermoacoustic code. A method of using the control volume balance equations to find stack work and device efficiencies is presented. Experimental measurements are compared to DELTAE thermoacoustic modeling predictions. Modeling results show that viscous losses within the system have a significant impact on the device performance as well as on the ability of DELTAE to accurately predict performance. Modeling has led to an understanding of system performance and highlighted loss sources that are areas for improvement in a redesign.

Dissipation of epoxiconazole in the paddy field under subtropical conditions of Taiwan

The environmental fate and distribution of fungicide epoxiconazole were studied by a rice paddy field model ecosystem. One week before the head-sprouting stage, rice plant was treated separately once with OPUS (tradename of epoxiconazole) 12% SC 2.1 kg ha(-1) and 1.4 kg ha(-1), respectively. Soil, water and rice plant were sampled seven days intervals nine times after application. The bioconcentration factor of epoxiconazole on mosquito fish in the ecosystem was also determined, based on the amounts of epoxiconazole content both in fish and water. This was initiated one day after the fungicide treatment, and continued for four days. In addition, the residue of epoxiconazole in rice grains was analyzed after harvest. After harvest, both planted water spinach (Ipomoea aquatica Forsk) and edible amaranth (Amaranthus mangostanüs L.) were analyzed. The results showed that epoxiconazole degraded in the local environment under the experimental conditions described. The degradation equations were in accordance with the first order kinetics. The DT50 of soil, field water and rice plant were 20-69 days, 11-20 days and 14-39 days, respectively. The bioconcentration factors of epoxiconazole on mosquito fish were 12.9 and 10.6 from 2.1 kg ha(-1) and 1.4 kg ha(-1) treatment, respectively. Residues of epoxiconazole in both rice and harvest vegetables were non-detectable. This indicates that epoxiconazole applied to rice at the recommended rates and application frequencies will not accumulate on rice grain and successive cropping vegetables.

Hantavirus infection in Taiwan: the experience of a geographically unique area

Hantaviruses are rodent-borne viruses, and they, mainly the Hantaan (HTN) serotype, are the causative agents of a group of febrile nephropathies known as "hemorrhagic fever with renal syndrome (HFRS). " Despite the fact that HFRS is frequently reported in China, with an annual incidence of 50,000-100,000 cases, one puzzling observation that no local case of HFRS has been confirmed in Taiwan has yet to be explained. We hypothesized that the hantavirus strain prevailing in Taiwan mainly belongs to the mild strain, the Seoul (SEO) strain, and the absence of severe disease was related to the absence of HTN. To test these hypotheses, this epidemiologic study was performed, including a seroprevalence survey and phylogenetic analysis on hantavirus isolated from the rodent population trapped in major seaports, rural, and mountainous areas of Taiwan. This study also included rodents and viruses from two isolated islands, Kinmen and Matzu, which are geographically adjacent to the east coast of mainland China. There were a total of 5,461 rodents of 16 species captured, and R. norvegicus was the most common species, with an antibody prevalence much higher in international seaports (20%) than in rural regions (approximately 5%) and intermediate in some domestic seaports. By reverse transcriptase polymerase chain reaction (RT-PCR), 33.9% of the seropositive R. norvegicus were found to have amplifiable hantavirus sequences in their lung tissues, and subsequent phylogenetic analyses indicated that almost all hantavirus in Taiwan was most closely related to the prototype SEO strain, and no HTN strain was recovered from any rodent species indigenous to Taiwan. The seroprevalence of SEO infection in R. norvegicus on Kinmen and Matzu was also different from that in southern provinces of China but closely resembled that in seaports in Taiwan, and the SEO identified was genetically linked to Taiwanese SEO strains. These results substantiate our hypotheses, and suggest that the epidemiology of hantavirus infection in Taiwan are different from that in China, where the HTN and SEO strains and HFRS concurrently prevail.

Changes in volatile flavor components of guava juice with high-pressure treatment and heat processing and during storage

The changes in volatile flavor components of guava juice during pressure processing (25 degrees C, 600 MPa, 15 min), heat processing (95 degrees C, 5 min), and storage at 4 and 25 degrees C were evaluated by purge and trap/gas chromatography/mass spectrometry. Esters were the major volatile fraction in guava juice, and alcohols were the second. Pressure processing could maintain the original flavor distribution of the juice. Heat processing (95 degrees C, 5 min) caused decreases in the majority of flavor components in the juice when compared with freshly extracted juice. High-pressure treatment at 600 MPa for 15 min can effectively sterilize microbes but partially inactivate enzymes of guava juice; therefore, volatile components in pressure-treated juice gradually changed during storage periods. Pressure-treated guava juice showed increases in methanol, ethanol, and 2-ethylfuran with decreases in the other components during storage period. Nevertheless, the volatile distribution of 600 MPa treated guava juice was similar to that of freshly extracted juice when stored at 4 degrees C for 30 days.

High pressure and heat treatments effects on pectic substances in guava juice

Effects of high pressure treatment on changes in pectic substances in guava juice were investigated and compared with those of heat treated samples. The viscosity and turbidity of guava juice pressurized at 6000 atm and 25 degrees C for 10 min increased slightly, whereas the viscosity of juice heated at 95 degrees C for 5 min decreased from 362 to 285 cps while turbidity increased from 0.87 to 1.15 (OD 600 nm). There were no apparent changes in water soluble, oxalate soluble and alkali soluble pectins in the pressurized juice. However, heat treated juice exhibited a decrease in its water and alkali soluble pectins and a slight increase in oxalate soluble pectin. The DEAE-cellulose profiles of pectic substances in guava juice were apparently unchanged after high pressure treatment while they were markedly changed by heat treatment, due to coagulation or degradation. During thermal processing, the degradation of pectin in guava juice caused a decrease in viscosity while the coagulation of pectin resulted in an increase in turbidity and cloud content. High pressure treatment showed no marked changes in pectic substances and cloud content in guava juice and maintained its natural viscous properties.

Quantitative analysis of mRNA encoding MUC1, MUC2, and MUC5AC genes: a correlation between specific mucin gene expression and sialomucin expression in non-small cell lung cancer

The expression of mucins is important for tumor invasiveness and metastasis. In our previous report (Am. J. Respir. Crit. Care Med. 1997; 155:1419-1427), non-small cell lung cancers bearing sialomucin expression tended to relapse earlier than those without sialomucin. However, it remained unclear whether the expression of sialomucin in lung cancer is caused by an abnormal glycosylation process or by the expression of a specific mucin gene product. To address this problem, we established a modified quantitative competitive polymerase chain reaction (QC-PCR) analysis. RNA internal standards of MUC1, MUC2, and MUC5AC non-tandem repeat sequences were constructed, and known copy numbers of mucin RNA internal standards were introduced into reverse transcription-polymerase chain reactions (RT-PCR) for each mucin gene in order to compete with native mucin gene RNA during the reaction. The RNA of Gbeta-like gene (a housekeeping gene) was used as internal control for the RNA analysis. Twenty-five lung cancer tissues (13 adenocarcinomas and 12 squamous cell carcinomas) were used for analysis. Mann-Whitney rank sum test was applied to compare the expression amounts of different mucin genes in tissues. The results revealed that adenocarcinoma expressed higher amounts of MUC5AC gene than did squamous cell carcinoma (P = 0.03). The expression amount of MUC5AC correlated positively with the expression status of sialomucin (P = 0.012). Further studies are anticipated to elucidate the underlying mechanism contributing to this phenomenon.

99Tcm-HMPAO-labelled white blood cell scans to detect acute appendicitis in older patients with an atypical clinical presentation

Forty-nine patients (age > 50 years) with an acute abdomen and suspected appendicitis, but with atypical findings, were included in the study. After the intravenous injection of 99Tcm-hexamethylpropylene amine oxime (99Tcm-HMPAO) labelled white blood cells (WBCs), serial anterior images of the abdomen and pelvis were obtained after 30, 60, 120 and 240 min. Any abnormal localization of WBC accumulation in the right lower quadrant of the abdomen equal to or greater than bone marrow activity was considered positive. Twenty-five patients had positive WBC scans, all of whom underwent laparotomy. Twenty-three of these patients were shown to have appendicitis; the other 2 did not. The other 24 patients had a negative WBC scan, 2 of whom underwent laparotomy and were shown to have appendicitis; the other 22 patients did not undergo surgery and showed no evidence of appendicitis during follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values of WBC scans for diagnosing appendicitis were as follows: 92.0%, 91.7%, 91.8%, 92.0% and 91.7% respectively. In conclusion, 99Tcm-HMPAO-labelled WBC scans provide a rapid and highly accurate method for diagnosing appendicitis in older patients with equivocal clinical findings.

Tc-99m HMPAO-labeled WBC scans to detect appendicitis in women

Fifty female patients with acute abdomen and suspected appendicitis but atypical findings were included in this study. After intravenous injection of Tc-99m HMPAO-labeled WBCs, serial anterior abdominal/pelvic images at 30, 60, 120, and 240 minutes were obtained by a gamma camera. Any abnormal localization of WBC accumulation in the right lower quadrant of the abdomen with equal to or greater than bone marrow activity was considered as a positive scan. Thirty patients had positive WBC scans and underwent laparotomy, 28 had proven appendicitis, and 2 were not related to appendicitis. Twenty patients had negative WBC scans, 2 patients underwent laparotomy and were proved to have appendicitis. The remaining 18 patients did not undergo surgery and revealed no evidence of appendicitis after follow-up. The overall sensitivity, specificity, accuracy, and positive and negative predictive values for WBC scans to diagnose appendicitis is 93.3%, 90.0%, 92.0%, 93.3%, and 90.0%, respectively. In conclusion, Tc-99m HMPAO-labeled WBC imaging provides a rapid and highly accurate method for diagnosis of appendicitis in female patients with equivocal clinical examinations.

Supine lung clearance of Tc-99m DTPA and HMPAO aerosols

The speed of Tc-99m DTPA/HMPAO radioaerosol clearance from the lungs that is represented as a slope from lungs to blood was measured in 23 male normal controls using commercial lung radioaerosol delivery units in the supine position in order to avoid the influences of gravity. The right lung was selected and three regions of interest were created for equal subdivisions of the upper, middle, and lower third. The results show that the clearance of Tc-99m DTPA/HMPAO aerosols in the upper lung is slowest. The differences between upper and lower lungs for Tc-99m DTPA/HMPAO aerosol clearances are significant. The clearance of Tc-99m DTPA aerosols was significantly faster than those of Tc-99m HMPAO in any region. The authors conclude that, although the effect of gravity disappears in the supine position in our study, the differences of aerosol clearance in different regions are still significant. Lipophilic Tc-99m HMPAO aerosols were slower than those of hydrophilic Tc-99m DTPA, which suggests there are at least two different mechanisms.

Effects of corticosteroid inhalation therapy on the deposition pattern of Tc-99m human serum albumin radioaerosols in asthma

This study evaluated the effects of steroid inhalation on the deposition pattern of Tc-99m human serum albumin (Tc-99m HSA) radioaerosols in 25 asthma patients. A total of 12 normal controls also underwent the same examination. The pattern of radioaerosol deposition was quantitatively evaluated as the percentage of total deposition (PTD) in the central, intermediate, and peripheral regions of the right lung. The baseline PTD was calculated before and after the administration of a 1-week course of inhalation therapy of 0.05 mg beclomethasone dipropionate four times daily. There were significant differences in PTD between normal controls and asthma patients. Significant differences were also found before and after corticosteroid inhalation therapy in asthma patients. In conclusion, a week-long course of beclomethasone dipropionate inhalation therapy does influence the deposition patterns of aerosols in asthma patients, based on the findings of Tc-99m HSA radioaerosol inhalation lung scintigraphy.

Alveolar integrity in pulmonary emphysema using technetium-99m-DTPA and technetium-99m-HMPAO radioaerosol inhalation lung scintigraphy

The alveolar integrity (AI) in 17 male patients with pulmonary emphysema (EMPH) diagnosed by chest x-ray was measured by 99mTc-DTPA and 99mTc-HMPAO radioaerosol inhalation lung scintigraphy.

METHODS

The patients were divided into two groups: (A) nine patients with pulmonary emphysema and normal carbon monoxide diffusion capacity (DLCO) and (B) eight patients with pulmonary emphysema and abnormal DLCO. The degree of AI damage in EMPH was presented as the slope of the time-activity curves from the dynamic left lung imagings in DTPA and HMPAO. The AI of EMPH patients were compared with the AI of 16 normal controls.

RESULTS

The results show that: (1) the slope of DTPA is larger than that of HMPAO in each of the portions of the left lung for any of the study groups; (2) statistical differences were found between the normal controls and EMPH patients in HMPAO but not in DTPA; and (3) the correlation was not good between DLCO and DTPA/HMPAO in EMPH patients.

CONCLUSION

Our results suggest that: (1) at least two different mechanisms in the lungs were at work; (2) the AI damage in EMPH developed mainly in the lipophilic part of the alveoli; and (3) the AI damage presented as slopes of DTPA/HMPAO in our study was different from the traditional pulmonary function such as DLCO.

Lung inflammation in patients with systemic lupus erythematosus detected by quantitative 67Ga-citrate lung scanning

The severity of lung inflammation in 34 patients with systemic lupus erythematosus (SLE) was measured by quantitative 67Ga-citrate lung scanning. The severity of lung inflammation in SLE was represented by the 67Ga uptake index (GUI). Quantitative 67Ga lung scanning was also performed on 20 normal controls for comparison with the SLE patients. The patients were divided into two subgroups according to the following two criteria: (a) stable or flare stage according to clinical features; or (b) positive or negative results of chest X-ray. The GUI values of the subgroups were also compared. The results revealed a trend towards higher values of GUI in SLE patients than in the normal controls. The GUI values were also higher for SLE cases with a flare stage or a negative chest X-ray than in SLE cases with a stable stage or a positive chest X-ray. The statistical results reveal that the differences in the GUI values are not significant. However, we found that (1) positive chest X-ray findings may be a later manifestation of a lung inflammation and (2) the values of GUI parallel clinical features in SLE patients.

Relationship of alveolar permeability and lung inflammation in patients with active diffuse infiltrative lung disease detected by 99Tcm-DTPA radioaerosol inhalation lung scintigraphy and quantitative 67Ga lung scans

The alveolar permeability (AP) in 21 patients with active diffuse infiltrative lung disease (ILD) was measured by 99Tcm-diethylenetriaminapentaacetate (DTPA) radioaerosol inhalation lung scintigraphy. The degree of AP damage in ILD was presented as the slope (% min-1) of the time-activity curve from the dynamic lung image. Meanwhile, the quantitative Ga lung scan (GA) was performed as a Ga uptake index (GUI) to evaluate the severity of lung inflammation in active ILD. The results show that no good correlation between the degree of AP damage and lung inflammation was found. When the patients were divided into two groups of (A) eight active ILD with normal chest X-ray (X-ray) and (B) 13 active ILD with abnormal X-ray, there was no significant difference between groups A and B for the DTPA and Ga results. In conclusion, the relationship between the degree of AP damage and lung inflammation in active ILD is not significant. This was not consistent with X-ray findings. There was, however, a significant difference between those with ILD and normal controls.

Influences of noise on the occurrence of period doubling in distributed-feedback laser diodes under direct-current modulation

The influences of Langevin noise on period doubling (PD) of a strongly modulated distributed-feedback laser have been investigated. The onset of PD was confirmed to be reduced through the use of the rate equations as a model. The threshold values of PD were examined in terms of driving frequency and rf power and have been compared with the measurements of PD.

[The management of sinus tracts of dental origin]

The purpose of this study was to evaluate the results of conservative endodontic therapy of 86 fistulous cases of dental origin at the Department of Conservative Dentistry, Kaohsiung Medical College Hospital. Approximately 60% (52/86) endodontically treated teeth, with a minimum recall period of 6 months, were evaluated for success or failure. The results are as follows: (1) The overall success rate was 82.7% (43/52) fistulous cases. There was no significant statistical difference between male and female patients. (2) There was a better success rate with cases over a 2-year recall period than with cases under a 2-year recall period, but there was no significant statistical difference between these two groups. (3) Cases with periapical pathosis less than 5 mm in diameter, had a better success rate than those with periapical pathosis larger than 5 mm in diameter, but there was no significant statistical difference between these two groups. (4) There was a 79.1% (34/43) success rate in non-surgically treated cases, and a 66.7% success rate (6/9, excluding three successfully retreated cases which had been originally treated with a non-surgical technique) in surgically treated cases.

[Sinus tracts of dental origin. A clinical study. Part I]

Chronic draining sinus tracts on the oral mucosa or the skin of the face frequently have dental pathosis. The purpose of this study was to investigate the incidence and the distribution of age, sex, opening, and tooth position of sinus tract cases with dental origin. A total of 678 teeth requiring endodontic treatment and having periapical pathosis at the Department of Conservative Dentistry, Kaohsiung Medical College Hospital, were studied. There were 86 (12.7%) teeth associated with sinus tracts, among these 47 (16.3%, 47/288) were from males and 39 (10.0%, 39/390) were from females. Of the openings of the sinus tracts, 70 were on the facial, 2 were on the palatal, 1 was on the distal, 4 were on the lingual, 2 were on both facial and lingual surfaces of teeth, and 7 were extraorally. The sinus tracts occurred more frequently in the mandibular than maxillary teeth. The maximum number of 34 cases (39.5%, 34/86) were from the 21-30 years of age group. In addition, we also found that the teeth with periapical lesions of larger than 5 mm in diameter are more frequently associated with sinus tracts than those teeth with lesions of smaller than 5 mm in diameter.

Significant variability in the mode of ventricular tachycardia induction and its implications for interpretation of acute drug testing

Fifty-four patients with previous myocardial infarction and sustained ventricular tachycardia on fibrillation underwent two electrophysiologic studies in the drug-free state within 72 hours. Although the concordance of overall ventricular tachycardia induction over the 2 days was good (87% of patients), there was variability in the number of extrastimuli needed to induce sustained ventricular tachycardia on each day in 60% of patients. Of those in whom ventricular tachycardia was inducible on both days, 40% required additional extrastimuli and 20% required fewer extrastimuli. A change by two or more extrastimuli was found in 12% of patients. There was no correlation between the variability observed and multiple clinical and laboratory parameters (including the aggressiveness of the stimulation protocol); however, the direction of the variability (easier or harder to induce) correlated with changes in ventricular refractoriness. Inherent day-to-day variability may affect the reproducibility of electrophysiologic studies and influence the results of serial drug testing.

Amiodarone pulmonary toxicity: prospective evaluation of serial pulmonary function tests

Pulmonary toxicity developed in 15 (17%) of 89 patients treated with amiodarone during a follow-up period of 2 weeks to 54 (mean 20 +/- 15) months. Prospective evaluation of serial pulmonary function tests in 67 patients demonstrated both a significant decrease from baseline in three of six variables in patients with toxicity at the time of diagnosis and a significant difference compared with the same variables in patients without toxicity. The most significant of these was the diffusing capacity for carbon monoxide (DLCO). An individual decrease in DLCO greater than or equal to 15% gave an optimal sensitivity of 100% and a specificity of 89% for the diagnosis of pulmonary toxicity. However, a decrease in DLCO greater than or equal to 15% did not alone warrant a change in therapy in asymptomatic patients. Although higher maintenance doses of amiodarone appeared to be related to the development of this complication, an abnormal baseline DLCO (less than 60% of predicted) with or without an initial abnormal chest roentgenogram did not predispose to pulmonary toxicity.

Surgical treatment of right atrial focal tachycardia in adults

Although successful operative treatment of atrial focal tachycardia has been reported in children, there are only isolated reports of surgical treatment of this arrhythmia in adults. In this case series of eight patients (aged 10 to 53 years) with drug-resistant right atrial focal tachycardia, results of electrophysiologic studies, surgical techniques and long-term follow-up are described. Atrial focal tachycardia was reproduced during electrophysiologic study, and endocardial mapping localized the earliest onset of atrial activation in the right atrium in all patients. Epicardial mapping confirmed the location of atrial tachycardia foci in seven of eight patients whose tachycardia was inducible intraoperatively. Of four patients treated with epicardial cryoablation alone, two had recurrent tachycardia and required a second procedure. None have had arrhythmia recurrence. In all four patients after right atrial excision (two of whom had intraoperative recurrence of atrial focal tachycardia after epicardial cryoablation alone), there has been no recurrence during a clinical follow-up period of 11 to 67 months (mean 30). It is concluded that in adult patients 1) electrophysiologic study with endocardial and epicardial mapping permits successful surgical treatment of atrial focal tachycardia; 2) epicardial cryoablation alone may be associated with recurrence of atrial focal tachycardia either intraoperatively or postoperatively; and 3) subtotal right atrial resection appears to be a well tolerated procedure with no long-term recurrence of atrial focal tachycardia.

Cumulative effects of amiodarone on inducibility of ventricular tachycardia: implications for electrophysiological testing

To determine whether the slow onset of action of amiodarone might result in a delayed effect on the inducibility of sustained ventricular arrhythmias, 45 patients with ischemic heart disease and inducible sustained monomorphic ventricular tachycardia were prospectively studied. Each patient had at least one initial repeat study on amiodarone and those with persistently inducible arrhythmias were rescheduled for further studies over the following 24 weeks. After 2-3 weeks of amiodarone therapy, nine patients no longer had inducible tachycardias, and tachycardia in another eight patients (18%) later became noninducible. Using life-table methods, analysis based on the results of the first re-study showed 18-month recurrence rates of 43% in the inducible vs 17% in the noninducible groups (p = 0.056). When the results of additional testing were then used to reclassify patients, the recurrence rates for these two groups were 50% and 17%, respectively (p = 0.004). Observation of blood pressure and level of consciousness during induced arrhythmias was also predictive of clinical tolerance in patients having recurrences; 16 of 19 patients experienced symptoms of similar severity to those produced during testing. We conclude: (1) early testing of amiodarone may result in misclassification of some patients as remaining inducible; (2) re-testing at a later time more accurately predicts tachycardia recurrence; (3) observation of hemodynamic response also provides important prognostic information.

Surgical treatment of supraventricular arrhythmias. Results in 67 patients

Over 6 years, recurrent drug-refractory supraventricular arrhythmias were treated by electrophysiologically guided surgical procedures in 67 patients. There were 57 patients, age 10-72 years, with accessory pathways who had 61 operations. The perioperative mortality rate was 3.5%, with deaths occurring in two patients with complex problems. Four patients with multiple but one or more silent accessory pathways had successful reoperation, and modified surgical technique has eliminated this problem. All patients are free of arrhythmias 2-70 months after operation. The survival and primary cure rates were 100% for 36 patients with solitary accessory pathways. Eight patients, age 10-53 years, were operated on for atrial focal tachycardia. Right atrial cryothermic lesions without excision or cardiopulmonary bypass were used in four patients: local excision was used in two patients and combined procedures were used in two patients. Because of recurrence in two of four patients treated by isolated cryoablation, a new technique was applied subsequently to one of these patients and two other patients: wide atrial excision and PTFE patch replacement during cardiopulmonary bypass. All patients are free of arrhythmias at a follow-up of 9-72 months. Intractable atrial flutter or fibrillation occurred in 11 patients who had 15 attempts at transvenous A-V node electroshock ablation. In three patients in whom this failed, subsequent open cryoablation of the A-V node during cardiopulmonary bypass and epicardial pacemaker implantation were performed successfully. Two patients had A-V nodal modification for control of A-V nodal re-entry tachycardia: one patient with cryothermia at the time of ablation of atrial focal tachycardia and the other patient with sharp dissection at the time of accessory pathway division. Of the initial 67 patients, 65 (97%) survived operation and all were cured of their presenting arrhythmia. Surgery for drug-refractory supraventricular arrhythmias is safe and effective in selected cases.

Prospective comparison of right and left ventricular stimulation for induction of sustained ventricular tachycardia

Thirty-eight patients who had sustained monomorphic ventricular tachycardia (VT) or sudden cardiac death underwent programmed ventricular stimulation. To assess the relative efficacy of right and left ventricular (RV and LV) stimulation, a tandem protocol with 1 to 4 extrastimuli and burst pacing was used. Each step of the protocol was performed in a rotating sequence at the RV apex, basal RV septum and LV apex. Sustained VT was induced from the RV apex in 26 patients, right ventricle (either site) in 27, and LV apex in 24, and spontaneous VT was reproduced from those sites in 11, 14 and 12 patients, respectively. In the 23 patients who had sustained VT induced from both ventricles, RV stimulation always required fewer or the same number of extrastimuli for induction. At every stage of the protocol, the cumulative yield of sustained VT was consistently greater from the right ventricle than from the left ventricle. After delivering 4 extrastimuli and burst pacing, LV stimulation only increased the yield of sustained VT by 1 patient, and spontaneous VT by 3 patients. Inducibility or noninducibility in the right ventricle generally predicted the same outcome in the left ventricle. Previously undocumented VT or ventricular fibrillation was induced from the right ventricle in 19 patients and from the left ventricle in 13. Thus, LV stimulation was less efficacious than RV stimulation. LV stimulation increased the yield over RV stimulation only minimally and did not reduce the number of extrastimuli required to induce sustained VT.

125I-triiodothyronine plasma binding ratio test in assessment of thyroid function

Twenty patients with vertebral arteriovenous fistulas (eight spontaneous, six traumatic without vertebral artery transection, and six traumatic with vertebral artery transection) were treated by transvascular embolization techniques, resulting in complete fistula closure in all patients. The fistulas were located at C1–C2 in 45%, C2–C3 in 25%, C4–C5 in 15%, C5–C6 in 10%, and C6–C7 in 5%. Trauma was the most common cause: 30% followed knife wounds, 20% followed gunshot injuries, and 10% followed blunt trauma. Eight patients had spontaneous fistulas, two associated with fibromuscular dysplasia. Three patients—all with large, long-standing fistulas—developed neurologic deficits coincident with the abrupt closure of the fistula, which resolved with reestablishment of fistula flow. Two of these patients were treated by staged closure; the other one by gradual closure. In all three cases the result was complete fistula closure without neurologic sequelae. The remaining spontaneous fistulas were all closed by balloon embolization with preservation of the vertebral artery and without deficits. The six patients with traumatic fistulas without transection were cured by balloon embolization, without deficits; in four there was also preservation of vertebral flow. The other six patients had traumatic fistulas with transection and were all cured by balloon embolization with preservation of flow in two. Four patients required bilateral approaches to the fistula to achieve complete fistula closure. The only complication was a mild residual Wallenberg syndrome after occlusion of the posterior inferior cerebellar artery in the treatment of a transection located at C1.

In our opinion, transvascular techniques are the treatment of choice for vertebral arteriovenous fistulas.

Two different patterns of entrainment of ventricular tachycardia

In a patient with two morphologic forms of ventricular tachycardia, rapid pacing from different ventricular sites produced two distinctively different patterns of entrainment. Pacing from sites contralateral to the site of emergence of ventricular tachycardia caused progressive fusion. Following pacing, the interval (return interval) between the first tachycardia beat (return beat) and the preceding beat was equal to the pacing cycle length. Near the site of emergence, the local electrogram of the return beat was morphologically identical to that of the preceding paced beats. In contrast, pacing from sites ipsilateral to the site of emergence did not cause fusion. The return intervals increased with decreasing pacing cycle lengths. The local electrogram of the return beat was morphologically different from that of the preceding paced beats. Using a model of ventricular reentrance, both patterns of responses can be explained. Pacing impulses arising from sites contralateral to the site of emergence activate the latter orthodromically. Fusion occurs between the emerging tachycardia wavefront and the next pacing wavefront. In contrast, pacing impulses arising from sites ipsilateral to the site of emergence activate the latter antidromically. Fusion is not observed because collision within the area of slow conduction prevents the emergence of the tachycardia during pacing.

Immunological diagnosis of IgD paraprotein

IgD monoclonal peaks are relatively small, with broad bases, and are preferentially of gamma-1 or beta mobility. Often IgDgamma paraproteins can only be detected after proper dilution or reduction of the patient's serum. Assay for Bence Jones protein should not be neglected, and if it is present, the co-existence of IgD monoclonal gammopathy should be suspected.

A study of the effect of simultaneous vaccination with BCG and smallpox vaccine in newborn infants

In order to determine whether the BCG and smallpox vaccinations of newborn infants could be combined, thus saving staff, time and money, particularly in the developing countries, 696 newborn infants in Taiwan were divided into three groups and vaccinated by one of the following three methods: simultaneous vaccination with BCG and smallpox vaccine, vaccination with BCG only, and vaccination with smallpox vaccine only. On follow-up, no difference was observed between the "simultaneous" group and the "smallpox only" group in respect of either no-take rate and frequency distribution by size of vaccination lesions or reactions to smallpox revaccination at 12 weeks. Tuberculin tests at 12 weeks revealed a normal distribution in the size of tuberculin reactions with a mean of 11.94 mm and 12.19 mm respectively in the "simultaneous" group and the "BCG only" group; in the "smallpox only" group all the reactions were below 9 mm, the great majority being 0-3 mm. The author concludes that there is no interaction between primary BCG and smallpox vaccination when both vaccines are administered simultaneously, and that, despite the reported complications, simultaneous administration of BCG and smallpox vaccine in newborn infants is a safe procedure.