QTLs and Candidate Genes for Seed Protein Content in Two Recombinant Inbred Line Populations of Soybean

This study aimed to discover the quantitative trait loci (QTL) associated with a high seed protein content in soybean and unravel the potential candidate genes. We developed two recombinant inbred line populations: YS and SI, by crossing Saedanbaek (high protein) with YS2035-B-91-1-B-1 (low protein) and Saedanbaek with Ilmi (low protein), respectively, and evaluated the protein content for three consecutive years. Using single-nucleotide polymorphism (SNP)-marker-based linkage maps, four QTLs were located on chromosomes 15, 18, and 20 with high logarithm of odds values (5.9-55.0), contributing 5.5-66.0% phenotypic variance. In all three experimental years, qPSD20-1 and qPSD20-2 were stable and identified in overlapping positions in the YS and SI populations, respectively. Additionally, novel QTLs were identified on chromosomes 15 and 18. Considering the allelic sequence variation between parental lines, 28 annotated genes related to soybean seed protein-including starch, lipid, and fatty acid biosynthesis-related genes-were identified within the QTL regions. These genes could potentially affect protein accumulation during seed development, as well as sucrose and oil metabolism. Overall, this study offers insights into the genetic mechanisms underlying a high soybean protein content. The identified potential candidate genes can aid marker-assisted selection for developing soybean lines with an increased protein content.

Mask-induced dermatoses during the COVID-19 pandemic: a questionnaire-based study in 12 Korean hospitals

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, various adverse skin reactions to long-term mask wearing have been reported.

AIM

To assess the clinical features of mask-induced dermatoses and to recommend prevention and treatment options.

METHODS

From April to August 2020, questionnaires including topics such as demographic information, pre-existing skin disorders, reported mask-related symptoms, daily mask-wearing duration and frequency, types of masks used and whether the participant was a healthcare worker, were distributed to patients in 12 hospitals. Dermatologists assessed skin lesions, confirmed diagnosis and recorded treatments.

RESULTS

Itchiness was the most frequent symptom, mostly affecting the cheeks. The most common skin disease was new-onset contact dermatitis (33.94%), followed by new-onset acne (16.97%) and worsening of pre-existing acne (16.97%). Daily wearing of masks was significantly (P = 0.02) associated with new-onset contact dermatitis. More than half of patients with pre-existing skin problems experienced disease worsening while wearing masks. Longer duration of wearing (> 6 h/day, P = 0.04) and use of cotton masks (P < 0.001) significantly increased acne flare-up. Healthcare workers had a higher incidence of skin disease. Skin lesions were generally mild and well tolerated with topical treatment. The study had some limitations: the effect of seasonal characteristics and other risk factors were not assessed, and the patients were visiting dermatological clinics and had interest in their skin status, thus, there may have been selection bias.

CONCLUSION

Mask-induced/-triggered dermatoses contribute to increase the dermatological burden during the pandemic.

Cooking Characteristics and Antioxidant Activity of Rice-Barley Mix at Different Cooking Method and Mixing Ratio

This study aimed to compare the phenolic compounds and antioxidant activity of barley at different proportion (0, 5, 10, 15, and 20%), and using different cooking methods. The grains used in this experiment are barley (Hordeum vulgare L. cv. Huinchalssal) and Samkwang rice. The rice-barley mixture was cooked using general and high pressure cooking methods with and without fermented alcohol. The quality characteristics such as water binding capacity, pasting characteristic, water solubility, and swelling power of different proportions of barley were evaluated. The antioxidant characteristics evaluated are total polyphenol, flavonoid contents, 2,2-diphenyl-1-picrylhydrazyl (DPPH), and 2,2-azinobis(3-ethylbenothiazoline-6-sulphonic acid) (ABTS) diammonium salt radical scavenging activities. Results showed that peak [195.0~184.0 rapid visco units (RVU)], trough (130.0~116.2 RVU), final (252.0~221.8 RVU), and setback viscosity (57.0~37.5 RVU) decreased correspondingly with the increase in the amount of barley. Water binding capacity (187.31~136.01%) and swelling power (162.37~127.58%) decreased as amounts of barley increases, however the water solubility (5.35~6.89%) increased. Moreover, the total polyphenol and flavonoid, and the DPPH and ABTS radical scavenging activities contents increased as the amounts of barley in the mixture increases. This study generally aims to provide useful information for the manufacturing of processed products.

Once-daily dosing of amikacin for treatment of Mycobacterium abscessus lung disease

SETTING

Tertiary referral centre, Samsung Medical Center, South Korea.

OBJECTIVE

To evaluate the pharmacokinetic parameters and toxicities of once-daily amikacin (AMK) dosing for lung disease due to Mycobacterium abscessus.

DESIGN

A retrospective review of 48 patients with M. abscessus lung disease who received once-daily AMK for 4 weeks between January 2012 and June 2015.

RESULTS

With a starting dose of 15 mg/kg/day and adjustment of AMK dose according to the peak serum level (Cmax), the Cmax target of 55-65 μg/ml was achieved in 31.3% (15/48) of patients in the first week, 68.8% (33/48) in week 2, 91.7% (44/48) in week 3 and 95.8% (46/48) in week 4. Transient nephrotoxicity developed in 6.3% (3/48) of patients and ototoxicity in 25.0% (6/24), which was determined by audiogram as hearing loss, asymptomatic in five patients and tinnitus in one. Multivariate analysis revealed that the highest drug concentration 12 h after administration was significantly associated with the development of toxicities (adjusted odds ratio 1.862, P = 0.047).

CONCLUSION

Our results suggest that once-daily AMK for 4 weeks with a target Cmax of 55-65 μg/ml can be used in patients with M. abscessus lung disease, with careful monitoring of toxicity.

Malvidin Protects WI-38 Human Fibroblast Cells Against Stress-induced Premature Senescence

Background:

Malvidin is one of the most abundant components in red wines and black rice. The effects of malvidin on aging and lifespan under oxidative stress have not been fully understood. This study focused on the anti-aging effect of malvidin on stress-induced premature senescence (SIPS) in WI-38 human lung-derived diploid fibroblasts.

Methods:

In order to determine the viability of WI-38 cells, MTT assay was conducted, and malondialdehyde level was determined using thiobarbituric acid-reactive substance assay. Protein expression of inflammation-related factors was also evaluated by Western blot analysis.

Results:

Acute and chronic oxidative stress via hydrogen peroxide (H₂O₂) treatment led to SIPS in WI-38 cells, which showed decreased cell viability, increased lipid peroxidation, and a shortened lifespan in comparison with non-H₂O₂-treated WI-38 cells. However, malvidin treatment significantly attenuated H₂O₂-induced oxidative stress by inhibiting lipid peroxidation and increasing cell viability. Furthermore, the lifespan of WI-38 cells was prolonged by malvidin treatment. In addition, malvidin downregulated the expression of oxidative stress-related proteins, including NF-κB, COX-2, and inducible nitric oxide synthase. Furthermore, protein expression levels of p53, p21, and Bax were also regulated by malvidin treatment in WI-38 cells undergoing SIPS.

Conclusions:

Malvidin may potentially inhibit the aging process by controlling oxidative stress.

Development and evaluation of a novel taekwondo chest protector to improve mobility when performing axe kicks

The axe kick, in Olympic style taekwondo, has been identified as the most popular scoring technique aimed to the head during full contact competition. The first purpose of this study was to identify and investigate design issues with the current World Taekwondo Federation approved chest protector. A secondary purpose was to develop a novel chest protector addressing the identified design issues and to conduct a biomechanical analysis. Fifteen male elite Taekwondo players were selected to perform three different styles of the axe kick, i.e., front, in-out, and out-in axe kick five times each for a total of 45 kicks. Two-way repeated measures ANOVA showed significant differences between the novel and existing chest protector conditions for vertical height of the toe, downward kicking foot speed, hip flexion angle and ipsilateral shoulder flexion extension range of motion (ROM) (p < 0.05). There were no significant differences between the control condition (no chest protector) and the novel chest protector condition for these variables (p > 0.05). These results indicate that the novel chest protector interferes less with both the lower and upper limbs during the performance of the axe kick and provides a more natural, free-moving alternative to the current equipment used.

Extracorporeal shockwave for hip necrosis in systemic lupus erythematosus

Patients with systemic lupus erythematosus (SLE) frequently received corticosteroid therapy, resulting in osteonecrosis of the femoral head (ONFH). Prior studies demonstrated the effectiveness of extracorporeal shockwave treatment (ESWT) for ONFH.. This study evaluated the effectiveness of ESWT for ONFH in patients with SLE. We studied 39 patients, including 15 patients with SLE (26 hips) and 24 controls (29 hips). To each affected hip we applied ESWT (6000 impulses at 28 kV in a single session). Patients were ambulated with partial weight bearing for 4-6 weeks. The primary endpoint was the need for hip replacement. The secondary endpoints were improvement in hip pain and function and image changes on X-ray and MRI. Patients received total hip replacement in 12% of patients with SLE and in 14% of controls (P = 0.802). There was no statistically significant difference in pain scores (0.86 vs. 0.89; P = 0.467) and function scores (89% vs. 91%; P = 0.194) between patients with SLE and controls. SLE response to ESWT for ONFH is comparable with ONFH in patients without SLE.

Comparison of echocardiography and electron beam tomography in differentiating the etiology of heart failure

BACKGROUND

The clinical manifestations in patients with ischemic cardiomyopathy are often indistinguishable from those in patients with primary dilated cardiomyopathy (DCM). Clinicians often base work-up of patients with heart failure on echocardiographic wall motion abnormalities; however misclassification can lead to unnecessary coronary angiography.

HYPOTHESIS

The study was undertaken to evaluate the diagnostic ability of echocardiography and electron beam tomography (EBT) to differentiate between ischemic and nonischemic cardiomyopathy.

METHODS

The accuracy of EBT and echocardiography was compared in 111 patients undergoing coronary angiography for the evaluation of heart failure. The presence of coronary calcification (CC) by EBT or segmental wall motion abnormalities by echocardiography was used as evidence of coronary-induced cardiomyopathy.

RESULTS

Of 63 patients, 61 (97%) with obstructive coronary artery disease had CC by EBT. This sensitivity was significantly higher compared with 43 of 63 patients (68%) with segmental wall motion abnormalities by echocardiography (p < 0.001). Of 48 patients without obstructive coronary artery disease by angiography, 39 (81%) had no CC by EBT and 35 (73%) had no segmental wall motion (global hypokinesis) by echocardiography (p = 0.33). The overall accuracy of EBT to differentiate ischemic from nonischemic cardiomyopathy was 90%, significantly higher than echocardiography (70%, p < 0.001).

CONCLUSION

This double-blind study demonstrates that the presence of CC by EBT is superior to that of segmental wall motion abnormalities by echocardiography to distinguish ischemic from nonischemic cardiomyopathy. This modality may prove to be an important diagnostic tool when the etiology of the cardiomyopathy is not clinically evident.

Induction chemotherapy with mitomycin, epirubicin, cisplatin, fluorouracil, and leucovorin followed by radiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma

PURPOSE

Survival in advanced nasopharyngeal carcinoma (NPC) is compromised by distant metastasis. Because mitomycin is active against hypoxic and G0 cells, which may help to eradicate micrometastasis, we investigated the effect of mitomycin-containing cisplatin-based induction chemotherapy.

PATIENTS AND METHODS

Recruited for this study were American Joint Committee on Cancer (AJCC) 1992 staging system stage IV NPC patients with the following adverse features: obvious intracranial invasion, supraclavicular or bilateral neck lymph node metastasis, large neck node (> 6 cm), or elevated serum lactate dehydrogenase (LDH) level. Patients were given three cycles of chemotherapy before radiotherapy. The chemotherapy comprised a 3-week cycle of mitomycin, epirubicin, and cisplatin on day 1 and fluorouracil and leucovorin on day 8 (MEPFL).

RESULTS

From January 1994 to December 1997, 111 patients were recruited. The median follow-up period was 43 months. The actuarial 5-year overall survival rate was 70% (95% confidence interval [CI], 60% to 80%; n = 111). For patients having completed radiotherapy (n = 100), the 5-year locoregional control rate was 70% (95% CI, 55% to 84%) and the distant metastasis-free rate was 81% (95% CI, 73% to 89%). The 5-year distant metastasis-free rate of N3a and N3b disease of AJCC 1997 staging system were 79% (95% CI, 62% to 95%) and 74% (95% CI, 60% to 89%), respectively. By Cox multivariate analysis, high pretreatment serum LDH level (P = .04) and neck nodal enlargement before radiotherapy (P = .001) were adverse prognostic factors of survival.

CONCLUSION

The good 5-year survival of N3 disease supports the effectiveness of induction MEPFL in the primary treatment of advanced NPC. Further investigation to incorporate concurrent chemoradiotherapy is warranted.

Topiramate treatment of bipolar spectrum disorders: a retrospective chart review

The objective of this paper was to determine if topiramate is effective as treatment for bipolar spectrum disorders in a naturalistic setting. All charts of outpatients treated with topiramate (n = 76) were reviewed, and clinical response was assessed retrospectively using the Clinical Global Impressions Scale for Improvement. Mild improvement was seen in 47% (n = 36) and moderate-to-marked improvement in 13% (n = 10). Responders received a higher mean dose (180 mg/day) than did nonresponders (83.2 mg/day, p = 0.002). Topiramate dose was also higher in those who lost weight (138.3 mg/day) than in those who did not (70 mg/day, p = 0.007). Weight loss was experienced by 50% of the sample, with a mean loss of 14.2 lbs. Side effects were reported by 82% (n = 62) of the population, including cognitive effects, sedation, parasthesias, nausea, insomnia, headache, and dizziness. Adverse effects led 36% (n = 27) of the total sample to discontinue treatment with topiramate. Topiramate led to significant weight loss in about half of this bipolar population, while also improving mood symptoms at least mildly in most patients. Topiramate response and weight loss were both dose-related, with efficacy, in particular, associated with higher doses (mean = 180 mg/day) than frequently used in current clinical practice.

Information circulation in a two-mode solid-state laser with optical feedback

A two-mode solid-state laser subjected to a delayed optical feedback is studied. Simultaneous random switchings between stable and chaotic antiphase spiking oscillations featuring the establishment of causal (drive response) relationships among modes have been demonstrated by a proposed information circulation analysis of an experimental time series. The observed phenomenon has been well reproduced by numerical simulations of two-mode laser equations with uncorrelated modal phase fluctuations.

Acute septic arthritis of the hip in children

Thirty-three cases of acute septic arthritis of the hip in children were treated at our hospital from 1986 to 1997. The average follow-up period was 6 years (range 2-11 years). In 17 cases the right hip was affected, and in 16 the left hip. The average duration of symptoms was 5 days (range 1-14 days). Microorganisms were isolated from the blood, joint aspirate, or surgical specimens in 25 cases (76%). Staphylococcus aureus was the most common bacteria found (44%). Those patients with S. aureus infection were older than 1 year of age. There was no significant difference in the final outcome between the younger and the older age groups. Twenty-six out of 33 patients (89%) had a satisfactory outcome. Satisfactory results can also be expected with arthrocentesis and medical treatment if the diagnosis is made early, and antibiotic treatment affords a good clinical response. Four out of 7 cases with an unsatisfactory result were associated with osteomyelitis of the proximal femur. The two most important factors associated with poor results included a delay of definite treatment lasting longer than 5 days and the presence of osteomyelitis of the proximal femur.

The bipolar spectrum and the antidepressant view of the world

Whereas much progress has been made in the diagnosis and treatment of schizophrenia and depression in recent years, bipolar disorder continues to be frequently misunderstood, leading to its inconsistent diagnosis and treatment. In this article, we seek to identify the causes of this problem and suggest possible solutions, based on a critical review of studies concerning the nosology of bipolar disorder and the effects of antidepressant agents. Bipolar disorder appears to be underdiagnosed as well as frequently misdiagnosed as unipolar major depressive disorder. Underdiagnosis can stem from patients' impaired insight into mania and failure to involve family members in the diagnostic process and also from clinicians' inadequate understanding of manic symptoms. Underdiagnosis may also reflect disagreement about the breadth of the bipolar spectrum. We therefore propose a heuristic definition of "bipolar spectrum disorder," a diagnosis that gives greater weight to family history and antidepressant-induced manic symptoms. This diagnosis would include all forms of bipolar illness that are not type I or II . The evidence also suggests that antidepressants are probably overused and mood stabilizers underused. We consequently recommend aggressive use of mood stabilizers and less emphasis on antidepressants. In summary, the state of diagnosis and treatment in bipolar disorder is suboptimal. More diagnostic attention to the criteria for mania is necessary. In addition, the current pattern of antidepressant use in bipolar disorder does not appear to be evidence-based.

Instability in a laser-diode-pumped microchip Nd:YAG laser in a n-ary product scheme

Dynamical instability, chaotic pulsations, and generalized bistability have been observed in a laser-diode-pumped microchip Nd:YAG laser operating in a double transition scheme in which lasing occurs on two transitions with overlapping gain profiles, F(3/2)(4)(2)? I(11/2)(4)(3) and F(3/2)(4)(1)? I(11/2)(4)(2), and simultaneously involves excited Nd atoms from different sublevels of the upper manifold. The modeling of the experimental results requires rate equations that include cross-gain coupling among oscillating modes that belong to different transitions whose population inversion densities are determined by the Boltzmann distribution.

Phase I clinical trial of curcumin, a chemopreventive agent, in patients with high-risk or pre-malignant lesions

Curcumin (diferuloylmethane), a yellow substance from the root of the plant Curcuma longa Linn., has been demonstrated to inhibit carcinogenesis of murine skin, stomach, intestine and liver. However, the toxicology, pharmacokinetics and biologically effective dose of curcumin in humans have not been reported. This prospective phase-I study evaluated these issues of curcumin in patients with one of the following five high-risk conditions: 1) recently resected urinary bladder cancer; 2) arsenic Bowen's disease of the skin; 3) uterine cervical intraepithelial neoplasm (CIN); 4) oral leucoplakia; and 5) intestinal metaplasia of the stomach. Curcumin was taken orally for 3 months. Biopsy of the lesion sites was done immediately before and 3 months after starting curcumin treament. The starting dose was 500 mg/day. If no toxicity > or = grade II was noted in at least 3 successive patients, the dose was then escalated to another level in the order of 1,000, 2,000, 4,000, 8,000, and 12,000 mg/day. The concentration of curcumin in serum and urine was determined by high pressure liquid chromatography (HPLC). A total of 25 patients were enrolled in this study. There was no treatment-related toxicity up to 8,000 mg/day. Beyond 8,000 mg/day, the bulky volume of the drug was unacceptable to the patients. The serum concentration of curcumin usually peaked at 1 to 2 hours after oral intake of crucumin and gradually declined within 12 hours. The average peak serum concentrations after taking 4,000 mg, 6,000 mg and 8,000 mg of curcumin were 0.51 +/- 0.11 microM, 0.63 +/- 0.06 microM and 1.77 +/- 1.87 microM, respectively. Urinary excretion of curcumin was undetectable. One of 4 patients with CIN and 1 of 7 patients with oral leucoplakia proceeded to develop frank malignancies in spite of curcumin treatment. In contrast, histologic improvement of precancerous lesions was seen in 1 out of 2 patients with recently resected bladder cancer, 2 out of 7 patients of oral leucoplakia, 1 out of 6 patients of intestinal metaplasia of the stomach, I out of 4 patients with CIN and 2 out of 6 patients with Bowen's disease. In conclusion, this study demonstrated that curcumin is not toxic to humans up to 8,000 mg/day when taken by mouth for 3 months. Our results also suggest a biologic effect of curcumin in the chemoprevention of cancer.

Factors affecting the overall survival after salvage surgery in patients with recurrent nasopharyngeal carcinoma at the primary site: experience with 60 cases

OBJECTIVE

To analyze the factors affecting overall survival after salvage surgery in patients with recurrent nasopharyngeal carcinoma at the primary site after a full course of radiotherapy.

DESIGN

Retrospective analysis of 60 consecutive patients treated by surgical resection of the recurrent tumors, with a mean follow-up of 43.1 months (range, 19-96 months).

SETTING

Academic tertiary referral center.

RESULTS

The overall survival and locoregional relapse-free survival were 56% and 60% at 2 years, respectively, and 30% and 40% at 5 years. Twenty-nine (81%) of 36 patients died with uncontrolled local disease. The T stage of the recurrent tumors appeared to be an important prognostic factor. Age, sex, pathologic findings, and disease-free interval (time between previous radiotherapy and local recurrence) were not significant prognosis-affecting factors by the log-rank test. Multivariate analysis showed that patients with recurrent tumors of undifferentiated carcinoma, sarcoma, or small cell carcinoma had unfavorable prognoses. Uncontrolled local disease and the emergence of distant metastasis predicted grave results as well. Postoperative irradiation showed some benefit to patients, but the difference was not statistically significant.

CONCLUSIONS

The T stage of the recurrence was the prominent prognosis-affecting factor in patients with recurrent nasopharyngeal carcinoma who received salvage surgery. Patients with local recurrence should be carefully selected for the salvage surgery. We recommend this surgery for patients with rT1, rT2, or limited rT3 lesions. The results of surgical resection in terms of local control and overall survival were slightly better than those of high-dose reirradiation, with fewer late complications.

Treatment of lateral epicondylitis of the elbow with shock waves

In a prospective clinical study, the effectiveness of shock wave treatment for lateral epicondylitis in 56 elbows in 53 patients (27 men and 26 women) with an average age of 46 years was investigated. Three patients received treatment for both elbows. Each elbow was treated with 1,000 impulses of shock waves at 14 kV. A 100-point scoring system was used for evaluation including 40 points for pain, 30 points for function, 20 points for strength, and 10 points for elbow motion. The intensity of pain was measured using a visual analogue scale from 0 to 10. The overall results were 13.2% excellent, 44.7% good, 36.8% acceptable, and 5.3 unchanged in 35 patients with 12 weeks followup; 30.8% excellent, 42.3% good, and 26.9% acceptable in 25 patients with 24 weeks followup. Considerable improvement was observed from 6 weeks to 6 months after the treatment. None of the patients' symptoms became worse. The results of nine patients who also received a second treatment were good in three patients, acceptable in five patients, and unchanged in one patient. There was no device-related problems, systemic, or local complications. Shock wave therapy may offer a new and safer nonoperative treatment for patients with lateral epidoncylitis of the elbow.

Treatment of calcifying tendinitis of the shoulder with shock wave therapy

In a prospective clinical study, the effectiveness of shock wave treatment for calcifying tendinitis in 31 shoulders in 29 patients (14 women and 15 men) with an average age of 52 years was assessed. Each shoulder was treated with 1,000 impulses of shock waves at 14 kV. A 100-point Constant score system was used for evaluation. The overall results of 20 patients (21 shoulders) with 12 weeks followup were no complaints in 23.8%, significantly improved in 38.1%, some improvement in 14.3%, and unchanged in 23.8%. Considerable improvement was observed between 6 and 12 weeks. The results of seven patients with 24 weeks followup were no complaints in two patients, significantly improved in three, and unchanged in two patients. Radiographs showed complete elimination of the calcium deposits in six patients (28.6%), incomplete elimination in two patients (9.5%), and three patients (14.3%) had fragmentation of the calcium deposits. There was no recurrence of calcium deposits observed at 24 weeks. There was a correlation between the functional improvement and the elimination of calcium deposits. There were no device-related problems, systemic or local complications. Low-energy shock wave therapy may offer a new and safer additional nonoperative treatment for patients with calcifying tendinitis of the shoulder.

Nonstationary chaotic oscillations in lasers with frequency-shifted feedback

The nonlinear dynamics of lasers with frequency-shifted delayed feedback are investigated. Resonant excitation of sustained relaxation oscillations by harmonic resonance is demonstrated. Self-induced switching between sustained relaxation oscillation and spiking oscillation is observed as the feedback coefficient is increased. Observed instabilities are well reproduced by numerical simulations of proposed model equations. A statistical analysis of this switching phenomenon is carried out numerically, and the results indicate that an inverse-power relation with the feedback coefficient determines the periods over which the system dwells in its relaxation-oscillation state.

Quantum-noise-induced order in lasers placed in chaotic oscillation by frequency-shifted feedback

A kind of chaotic oscillations featuring random switching between sustained relaxation oscillations (RO) and spiking oscillations (SO) has been demonstrated in lasers with frequency-shifted feedback. The presence of stochastic frequency locking between two periodicities of RO and SO motions and selective quantum-noise-induced ordering of chaotic spiking oscillations is demonstrated theoretically and experimentally.

Pulsations induced by quantum interference in a microchip solid-state laser operating on a ? transiton

Self-induced pulsations that are associated with atomic interference have been found in a laser-diode-pumped LiNdP(4)O(12) microchip laser with an intracavity KTP frequency-doubling crystal operating in a ? scheme. The instability and peculiar pulsations that were observed have been verified by a linear stability analysis and numerical simulation of two-mode laser equations, including nonlinear absorptions of a purely quantum nature and spontaneous-emission noise.

Diabetes and the associated incidence of subclinical atherosclerosis and coronary artery disease: Implications for management

BACKGROUND

We sought to examine the prevalence, sensitivity, and specificity of coronary calcium (CC), a marker of atherosclerosis, in a population of symptomatic and asymptomatic diabetic persons.

METHODS

We used electron beam tomography (EBT) to quantitate CC in 168 symptomatic (chest pain or anginal equivalent) persons with diabetes who underwent coronary angiography and then compared this with a cohort of 155 asymptomatic persons with diabetes.

RESULTS

In the 168 symptomatic diabetic persons, 124 (74%) had obstructive coronary artery disease (CAD) by angiography. Receiver-operator characteristic curve analysis was used to maximize sensitivity and specificity for obstructive CAD (>50% stenosis), which established a CC score of 102 as optimal. With use of this cut point, EBT has a sensitivity of 77% and a specificity of 77% for detecting obstructive CAD. Of the 155 asymptomatic diabetic persons, 72% had CC and 48% had a CC score >102. The presumed prevalence of obstructive disease (on the basis of EBT scores and prevalence of CC) among asymptomatic diabetic persons is quite high (as high as symptomatic persons without diabetes). Analyzing the 323 diabetic patients demonstrated no significant age difference in CC scores between women and men.

CONCLUSIONS

This study confirms that higher CC scores should be used in diabetic patients to improve the specificity of CC to determine obstructive disease. EBT can allow a noninvasive diagnosis of CAD before clinical presentation, allowing for more therapy for those in which CC is detected. These results suggest that asymptomatic diabetic persons have the same atherogenic burden of those patients with CAD without diabetes. The high prevalence of CC in asymptomatic persons with diabetes supports the need for aggressive management of diabetes and associated risk factors.

DNA content of nasopharyngeal carcinoma: an independent prognostic indicator

The purpose of this study was to examine whether tumor DNA content correlated with prognosis in nasopharyngeal carcinoma (NPC). DNA flow-cytometric analysis in fresh specimens of nasopharyngeal biopsy from 123 patients with clinical suspicion of NPC was collected initially. Histopathologic study and successful flow-cytometric analysis had 28 lymphoid hyperplasias and 87 NPCs. Seventeen NPC patients were treated elsewhere and were excluded. A total of 98 patients, including 28 lymphoid hyperplasias and 70 NPCs, formed the materials of this study. There were 34 (49%) diploid and 36 (51%) aneuploid in NPC patients. No lymphoid hyperplasias were aneuploid. The mean of S-phase fraction was higher in NPC than in lymphoid hyperplasia (P < .001), indicating higher cellular activity in NPC. DNA content failed to associate with age, gender, pathology, distant metastasis, and stage, indicating that DNA content was an independent prognostic indicator and possibly a clinical parameter. The log-rank test of overall survival curves was significant for stage (P = .002) and DNA ploidy (P = .042); it was almost significant for S-phase fraction (P = .057). Because the follow-up duration was not long enough, univariate and multivariate analysis were not significant for stage, ploidy, and S-phase fraction, except for distant metastasis. It is also most likely colinearity of clinical stage and distant metastasis that explained why clinical stage could not show significance in prognosis. Interestingly, the DNA content appeared to be a potential prognostic parameter in overall survival, although it was not statistically significant (P = .052). Our data suggested that NPC patients with aneuploid DNA and high S-phase fraction tend to have poor prognosis and should be treated more aggressively, even in the early stage of the disease.

Guidewire-induced coronary artery perforation treated with transcatheter injection of polyvinyl alcohol form

We describe a first case of successful transcatheter management of guidewire-induced distal coronary artery perforation and impending cardiac tamponade, which developed during percutaneous coronary angioplasty, with transcatheter injection of polyvinyl alcohol form. This method may be an effective alternative in the management of distal coronary artery perforation requiring surgical repair.

Intravascular ultrasound findings of negative arterial remodeling at sites of focal coronary spasm in patients with vasospastic angina

BACKGROUND

There are few data about the intravascular ultrasound (IVUS) findings in patients with vasospastic angina, especially regarding patterns of vascular remodeling.

METHODS AND RESULTS

Coronary spasm was documented by angiography and electrocardiographic evidence of ischemia in 36 patients after administration of ergonovine (cumulative doses up to 350 microg). After relief of spasm with 1000 microg of intracoronary nitroglycerin, quantitative angiography and IVUS imaging were performed and analyzed by standard methods. The 36 focal spasm sites were compared with the proximal and distal reference segments. The angiographic baseline minimum lumen diameter measured 1.78 +/- 0.66 mm, which decreased to 0.66 +/- 0.38 mm with ergonovine provocation (P <.0001), increased to 2.66 +/- 0.64 mm after intracoronary nitroglycerin (P <.0001 compared with baseline and after ergonovine), and did not change after IVUS imaging (2.66 +/- 0.63, P =.9). By IVUS, atherosclerotic lesions were observed at all coronary spasm sites; the mean plaque burden measured 56% at the spasm site and 35% at the reference. Spasm site plaque composition was hypoechoic in 31 and hyperechoic, noncalcific in 5; there was no calcium. The mean eccentricity index (maximum divided by minimum plaque thickness) was 6.7. Positive remodeling (spasm site arterial area greater than proximal reference) was present in 5; intermediate remodeling (proximal reference greater than spasm site greater than distal reference arterial area) was present in 7; and negative remodeling (spasm site arterial area less than distal reference) was present in 24.

CONCLUSIONS

Sites of vasospasm in patients with variant angina showed characteristics of early atherosclerosis, except for an unusually high incidence of negative arterial remodeling.

A probability prediction rule for malignant cervical lymphadenopathy using sonography

BACKGROUND

Our purpose was to weigh various sonographic parameters as predicting malignant cervical lymphadenopathy and build a reliable prediction rule.

METHODS

One hundred and eighty-nine cervical lymph node lesions from 125 consecutive patients were used for building the prediction model. Sonographic variables, including 15 morphologic features of B-mode, 5 vascular parameters of color Doppler mode, along with age and sex, were analyzed with multivariate logistic regression to evaluate the joint effect of a set of independent variables. A prediction rule for malignant lymphadenopathy was established, and prospective validation was assessed on a new group consisting of 100 lymph nodes from another 60 consecutive patients.

RESULTS

The association of heterogeneous content, long transverse diameter, pathologic vascular pattern, high vascular density, and older age provided the most robust prediction value. Scoring scale was designed as 1x (age) + 2x (vascularity index) + 3x (short axis) + 4x (vascular pattern) + 4x (internal echo) according to the parameter estimates of multivariate logistic regression analysis. Cut-off value of score >==10 as malignancy resulted in 89.2% sensitivity and 85.2% specificity. Prospective validation also showed satisfactory results (sensitivity, 82.9%; specificity, 86.2%).

CONCLUSIONS

By measuring only 4 sonographic parameters and age, this prediction rule could provide the physician a nonconfusing and reliable probability reference for managing cervical lymphadenopathy.

Surgical treatment of muscular torticollis for patients above 6 years of age

Eighteen patients with congenital muscular torticollis, aged 6-22 (average 11) years, underwent surgical releases of the contractive bands. There were 8 boys and 10 girls. Preoperative open mouth radiograph of the odontoid process in 16 patients showed asymmetry of articular facets of the axis and tilt of the odontoid process to the side of the torticollis. Sixteen patients received bipolar releases, the others received distal releases. After the operation, a neck collar was applied and an exercise program was started. At an average follow-up of 5 years and 7 months, there were excellent or good results in 10 patients. All of the patients except 2 showed improvement of the facial asymmetry and all except 1 had a satisfactory range of motion of the neck. One patient underwent a second operation due to recurrence. The follow-up radiographs showed improvement of the tilt of the odontoid process, but the asymmetry of the articular facets of the axis persisted. We suggest that bipolar release is the treatment of choice for congenital muscular torticollis in patients of more than 6 years of age. To determine the influence of a bipolar release on the functions of the cervical spine, longer follow-up intervals are needed.

Synchronization of mutually coupled self-mixing modulated lasers

Synchronization of mutually coupled chaotic lasers has been demonstrated in a microchip LiNdP4O12 laser array with self-mixing feedback modulation. An abrupt transition to synchronized chaos by way of "phase squeezing" was observed when coupling between the two lasers was increased. This phenomenon is well reproduced by numerical calculations using model equations. It is also shown that low energy variation as well as high disorder are concurrently established in synchronized chaos.

Herpes zoster oticus treated with acyclovir and prednisolone: clinical manifestations and analysis of prognostic factors

Herpes zoster oticus is a cranial polyneuropathy with facial nerve involvement as its main feature. The prognosis of the facial palsy is usually poor. Thirty patients with herpes zoster oticus suffering from facial palsy were admitted for parenteral acyclovir and oral prednisolone. Multiple regression analysis of improvement of facial palsy showed three significant covariates: age, multiple nerve palsies, and the initial grading of the palsy. The recovery of the facial palsy treated with acyclovir and prednisolone was good, and possibility of a good outcome was greater when the initial grade of the palsy was higher. Multiple nerve palsies and age had negative effects on the improvement.

Dysphagia after radiotherapy: endoscopic examination of swallowing in patients with nasopharyngeal carcinoma

Dysphagia is a late sequela compromising the lives of more than one fourth of patients with nasopharyngeal carcinoma (NPC) who survive long after radiotherapy. By using fiberoptic endoscopic examination of swallowing as a modality for dysphagia evaluation, we were able to easily recognize the functional and anatomic changes in 31 dysphagic NPC patients. The majority of patients were found to aspirate after the act of swallowing (77.4%). Seventeen (54.8%) had tongue atrophy, and 9 (29%) had vocal cord palsy. Dysfunctions such as dry mouth (45.2%), velopharyngeal incompetence (58%), premature leakage (41.9%), delay or absence of swallow reflex (87.1%), poor pharyngeal constriction (80.6%), pharyngeal residue retention (83.9%), penetration or aspiration (93.5%), and silent aspiration (41.9%) were noted in these patients. Multiple dysfunctions were demonstrated in each patient. Abnormality of pharyngeal constriction and/or aberrant upper esophageal sphincter function played the major role in the postswallow aspiration of these irradiated NPC patients. Clinically compromised patients (weight loss of > or =5 kg in 1 year or pneumonia) had more of the above anatomic and functional impairments. The radiation dosage and volume bore no correlation to the time of symptom onset, or to the occurrence of functional changes.

Usefulness of the C1 transverse process as a reference guide in the dissection of the upper lateral neck

In this investigation we dissected 3 cadavers with the lateral cervical approach to assess the usefulness of the transverse process of the atlas (TPA) as a reference guide in the upper lateral neck. Our results indicate that all the important structures in this space can be identified systematically. Lateral to the TPA sits the posterior belly of the digastric muscle, the stylohyoid muscle, and the occipital artery. Anterior to the TPA, the styloid process can be exposed. The internal jugular vein and cranial nerves X, XI, and XII sit between the styloid process and the TPA. Superior to the TPA, tracing the carotid sheath upward, the carotid canal and jugular foramen can be reached. Anteroinferior to the jugular foramen, the hypoglossal nerve emerges from the cranial cavity through the hypoglossal canal. Posterior to the TPA, the suboccipital triangle can be recognized. Within the triangle, the vertebral artery and its accompanying venous complex can be identified.

Epstein-Barr virus-encoded latent membrane protein 1 co-expresses with epidermal growth factor receptor in nasopharyngeal carcinoma

Latent membrane protein 1 (LMP-1) is the only Epstein-Barr virus (EBV)-encoded oncogenic protein that has been detected in nasopharyngeal carcinoma (NPC), a cancer that is closely associated with EBV. Previous in-vitro studies have demonstrated that LMP-1 can upregulate epidermal growth factor receptor (EGFR) in epithelial cells. It was not established whether this cellular effect exists in NPC. To assess the association between LMP-1 and EGFR in NPC tissues, 60 NPC specimens were examined by immunohistochemistry using anti-LMP-1 antibody (CS 1-4) and anti-EGFR antibodies (EGFR 1, EGFR 1005). The results revealed that 41 (68.3%) specimens were immunopositive for LMP-1 and 44 (73.3%) specimens over-expressed EGFR. Morphologically, the expressions of LMP-1 and EGFR were homogeneously distributed in the tumor nests. In addition, the correlation between LMP-1 and EGFR was statistically significant (P<0.001, chi2 test, d.f. = 1). To elucidate further the correlation between LMP-1 and EGFR in vivo and in situ, an indirect dual immunofluorescence assay was conducted, using secondary antibodies conjugated with fluorescein isothiocyanate (FITC) or indocarbocyanine (Cy3). The results disclosed an intimate co-expression of LMP-1 and EGFR. In summary, the data indicate that over-expression of EGFR is a common phenomenon in NPC, and that EGFR is co-expressed with LMP-1 in NPC. Thus, EBV may play a role in the tumorigenesis of NPC through the effects of LMP-1 and EGFR.

Intravascular ultrasound comparison of chronic recoil among different stent designs

Intravascular ultrasound studies were acquired in 70 native coronary artery lesions after implantation and at follow-up of Palmaz-Schatz, GFX, NIR, and CrossFlex stents. Chronic stent recoil was minimal in the Palmaz-Schatz, GFX, and NIR stents; however, there was small, but significant chronic recoil of the CrossFlex stent.

Induction with mitomycin C, doxorubicin, cisplatin and maintenance with weekly 5-fluorouracil, leucovorin for treatment of metastatic nasopharyngeal carcinoma: a phase II study

The combination of cisplatin and 5-fluorouracil (5-FU) (PF) is the most popular regimen for treating metastatic nasopharyngeal carcinoma (NPC) but it is limited by severe stomatitis and chronic cisplatin-related toxicity. A novel approach including induction with mitomycin C, doxorubicin and cisplatin (MAP) and subsequent maintenance with weekly 5-FU and leucovorin (FL) were designed with an aim to reduce acute and chronic toxicity of PF. Thirty-two patients of NPC with measurable metastatic lesions in the liver or lung were entered into this phase II trial. Mitomycin C 8 mg m(-2), doxorubicin 40 mg m(-2) and cisplatin 60 mg m(-2) were given on day 1 every 3 weeks as initial induction. After either four courses or remission was achieved, patients received weekly dose of 5-FU 450 mg m(-2) and leucovorin 30 mg m(-2) for maintenance until disease progression. With 105 courses of MAP given, 5% were accompanied by grade 3 and 0% were accompanied by grade 4 stomatitis. The dose-limiting toxicity of MAP was myelosuppression. Forty per cent of courses had grade 3 and 13% of courses had grade 4 leukopenia. No grade 3 or 4 cisplatin-related toxicity was observed. The overall response rate was 94% (95% confidence interval (CI) 84.9-100%) with a complete response rate (CR) of 6% (95% CI: 0-15.2%) and a good partial response (PR) rate of 28% (95% CI 11.7-44.6%), which was optionally defined as observance of only equivocal lesion identifiable under imaging study. Twenty-seven cases entered weekly FL maintenance phase. The median duration of maintenance with weekly FL was 38 weeks (8-91 weeks). There was no grade 3 or 4 toxicity noted during weekly FL. The median progression-free survival and overall survival were 11.6+/-0.4 and 18.1+/-3.6 months respectively. Six patients with a median follow-up of 19.8 months (9.6-41.0 months) were still alive and five of them had disease under control with FL. Good responders (CR and good PR) had better survival than less satisfactory responders (PR and stable disease) (P = 0.05). From Cox's multivariate regression analysis, the only significant prognostic factor for survival was good response to MAP (P = 0.042). Liver metastasis was the only significant variable in the best subset regression model that predicted good response to MAP (CR and good PR) (P = 0.027). MAP was an effective combination for metastatic NPC with minimal stomatitis and cisplatin-related toxicity but had significant myelosuppression. Weekly FL was a maintenance therapy with minimal side-effects. The response rate and overall survival of MAP-FL were better than series previously reported even when a subset of patients with poor prognosis was selected. MAP-FL's role as neoadjuvant or adjuvant therapy is worthy of further study.

Chromosomal aberrations in nasopharyngeal carcinoma analyzed by comparative genomic hybridization

To investigate the genomic imbalances associated with nasopharyngeal carcinoma (NPC), we have performed chromosome analysis by comparative genomic hybridization (CGH) on 51 tumors, including 25 primary and 26 recurrent tumors. The most common copy number increases occurred on chromosome arms 12p (59%), 1q (47%), 17q (47%), 11q (41%), and 12q (35%). The minimal overlapping regions were at 12p12-13, 1q21-22, 17q21, 17q25, 11q13, and 12q13. The most frequent losses were from chromosome arms 3p (53%), 9p (41%), 13q (41%), 14q (35%), and 11q (29%). The minimal overlapping regions were at 3p12-14, 3p25-26, 9p21-23, 13q21-32, 14q12-21, and 11q14-23. Compared with the primary cancers, no additional chromosomal change was found in the recurrent tumors; however, the most frequent gain in the recurrent NPCs was at 11q13 (53%) instead of 12p in the primary tumors. An increase of gene alterations correlated with clinical stage. Our results provide a first comprehensive view of the genomic changes associated with NPC and reveal several new sites of genomic imbalance, indicating the possible involvement of novel oncogenes/tumor suppressor genes in the carcinogenesis of NPC.

Congenital dislocation of the knee

Between February 1988 and June 1995, 24 congenital dislocations of the knee joints (17 patients) were reduced with closed methods including immediate reduction, serial casting, or traction in patients from 10 min to 26 days old. At an average follow-up of 4 years and 10 months, an excellent or good result was achieved if there were no associated anomalies. Fair or poor results were the result of delayed treatment or associated musculoskeletal anomalies including arthrogryposis multiplex congenita or Larsen's syndrome. Routine check of the hip dislocation is suggested. Diagnosis with manual testing was difficult, and other methods such as radiography or sonography were suggested in combination to detect hip dysplasia. The dislocated knee should be reduced before treating the hip dislocation. Concomitant treatment of the congenital dislocation of the knee and the hip with Pavlik harness provided satisfactory results. When late, progressive, genu valgus deformity occurred because of global instability of the knee and asymmetric physeal growth, reconstruction of the medial structures of the knee and prolonged bracing provided good results.

Circulating intercellular adhesion molecule 1 (ICAM-1), E-selectin and vascular cell adhesion molecule 1 (VCAM-1) in head and neck cancer

The sera from patients with nasopharyngeal carcinoma (n = 30), oral carcinoma (n = 22) and laryngeal carcinoma (n = 22) was extracted before treatment. The concentration of circulating intercellular adhesion molecule 1 (ICAM-1), E-selectin and vascular cell adhesion molecule 1 (VCAM-1) was measured by enzyme-linked immunoassay and compared with those from normal subjects (n = 20). The concentration of circulating ICAM-1, E-selectin and VCAM-1 was significantly increased in nasopharyngeal carcinoma. Correspondingly, VCAM-1 and E-selectin were significantly increased in laryngeal carcinoma, whereas only E-selectin was elevated in oral carcinoma. The concentrations of these adhesion molecules did not significantly differ with respect to the early and late stages of these carcinomas. Elevated levels of soluble adhesion molecules in the sera of cancer patients at three different head and neck regions, although appearing to be implicated in these tumour formations, may be unrelated to tumour progression.

Nasopharyngeal angiofibroma: a reappraisal of clinical features and treatment at National Taiwan University Hospital

Nasopharyngeal angiofibroma (NAF), occurring mostly in young men, is a histologically benign tumor with aggressive clinical behavior that includes repeated epistaxis and intractable nasal obstruction. This paper reviews our recent experience at National Taiwan University Hospital (NTUH), and compares the results with those of a previous study (1955-1980) at NTUH to highlight the developments in the treatment of NAF. Fifteen patients with a diagnosis of NAF from 1984 to 1997 were included, and their clinical presentations, radiographic studies, treatments, and outcomes were retrospectively analyzed. The results showed that the clinical and demographic features were similar in the two studies. The average number of patients decreased from 2.1 patients in the previous study to 1.1 patients in this study. The duration of symptoms in the current study (8 months) was shorter than that of the previous study (16 months). Previously, the treatment consisted of radiation followed by surgery if there was residual tumor. The current treatment modality is preoperative transarterial embolization followed by surgery. The estimated intraoperative blood loss was reduced from 750 mL in the first study to 400 mL in this study. The recurrence rate decreased from 11% to 7% and the absolute relapse-free rate rose from 56% to 73%. Owing to the development of modern imaging techniques, the advent of preoperative arterial embolization, and advances in surgical techniques, successful removal of highly vascular tumors has become more feasible. Preoperative selective embolization followed by excision is an effective treatment modality. This strategy, an alternative to radiotherapy, not only avoids the long-term complications induced by radiation, but also reduces the tumor recurrence rate.

Nasopharyngeal swab and PCR for the screening of nasopharyngeal carcinoma in the endemic area: a good supplement to the serologic screening

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in Taiwan. Early detection is the best way to improve survival for this disease. A prospective study was designed to assess the feasibility of a new screening method for NPC by use of polymerase chain reaction (PCR) based on the close association of NPC and Epstein-Barr virus (EBV).

METHODS

One hundred thirty-three different tissues from nasopharynx, nose, and sinus were investigated by use of PCR to check for the presence of EBV genome. Subsequently, from April 1996 to March 1997, 55 patients were enrolled in a prospective screening study. All patients underwent nasopharyngeal swabs before biopsy. Polymerase chain reaction detection of EBV genome was conducted on swab samples. Anti-EBV viral capsid antigen (VCA) in IgA and IgG class were checked at the same visit.

RESULTS

The EBV genome was present in 91.4% (85/93) of NPC tissues and in 25.0% (10/40) of non-NPC tissues (p < .001, chi2 test). Of the 55 swabs, 49 (89.1%) specimens obtained enough cells for PCR examination. Thirty of these 49 patients were pathologically proved NPC. The presence of EBV were 86.7% (26/30) in NPC group and 42.1% (8/19) in non-NPC group. The sensitivity and specificity were 86.7% and 57.9%, respectively, which were similar to those of serologic method (87.5% and 43.5%) when the cut-off point was set at anti-VCA IgG > or = 160 and IgA > or = 10. Combining both methods elevates the specificity to 84.2%.

CONCLUSIONS

The sensitivity of this PCR screening method is similar to that of the serologic method. Combining both methods can greatly increase the specificity, indicating this new method is a good supplement to the serologic screening of this endemic disease.

Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervical lymphadenopathies

OBJECTIVE

Our purpose was to depict the characteristics of the global vasculature of cervical lymphadenopathies and to clarify the efficiency of Doppler spectral analysis and power Doppler sonography in the differential diagnosis.

SUBJECTS AND METHODS

Prospectively, 289 lymph node lesions underwent Doppler flow studies and were grouped as metastasis, lymphoma, tuberculosis, and benign lymphadenopathies. Sonographic assessments included vascular pattern and vascular density (presented as vascularity index) as revealed by power Doppler sonography. Vascular resistive index and pulsatility index were assessed by at least three flow samplings. Values of both the highest and the lowest resistance were analyzed. Vascularity index, resistive index, pulsatility index, nodal size, and age were correlated.

RESULTS

Most benign lymphadenopathies (87%), tuberculous lymphadenopathies (72%), and lymphomas (71%) revealed an avascular or hilar vascular pattern. Vascular patterns of most metastatic lymphadenopathies (90%) were of spotted (26%), peripheral (11%), or mixed (53%) type. The vascularity indexes of metastatic lymphadenopathy (mean, 0.176) and lymphoma (mean, 0.122) were significantly higher than those of tuberculous and benign lymphadenopathy (mean, 0.054 and 0.042, respectively). In vascular resistance studies, the highest pulsatility index and resistive index in metastatic lymphadenopathy statistically exceeded those of benign lymphadenopathy, whereas no difference was found in the lowest values. Negative correlation was found between the vascularity index of metastatic lesions and their lowest vascular resistance, and positive correlation was found between vascularity index and nodal size in benign lymphadenopathies.

CONCLUSION

In addition to vascular resistance assessed traditionally with Doppler spectral analysis, vascular pattern and vascular density assessed with power Doppler sonography can better differentiate the nature of lymphadenopathies.