Generation of an induced pluripotent stem cell line (KNIHi001-A) by reprogramming peripheral blood mononuclear cells isolated from a patient with Parkinson's disease

Parkinson's disease is a degenerative brain disorder characterized by dopamine neuronal degeneration and dopamine transporter loss. In this study, we generated an induced pluripotent stem cell (iPSC) line, KNIHi001-A, from the peripheral blood mononuclear cells (PBMCs) of a 76-year-old man with Parkinson's disease. The non-integrating Sendai virus was used to reprogram iPSCs. iPSCs exhibit pluripotent markers, a normal karyotype, viral clearance, and the ability to differentiate into the three germ layers.

Off-the-Shelf, Immune-Compatible Human Embryonic Stem Cells Generated Via CRISPR-Mediated Genome Editing

Human embryonic stem cells (hESCs) hold promise in regenerative medicine but allogeneic immune rejections caused by highly polymorphic human leukocyte antigens (HLAs) remain a barrier to their clinical applications. Here, we used a CRISPR/Cas9-mediated HLA-editing strategy to generate a variety of HLA homozygous-like hESC lines from pre-established hESC lines. We edited four pre-established HLA-heterozygous hESC lines and created a mini library of 14 HLA-edited hESC lines in which single HLA-A and HLA-B alleles and both HLA-DR alleles are disrupted. The HLA-edited hESC derivatives elicited both low T cell- and low NK cell-mediated immune responses. Our library would cover about 40% of the Asian-Pacific population. We estimate that HLA-editing of only 19 pre-established hESC lines would give rise to 46 different hESC lines to cover 90% of the Asian-Pacific population. This study offers an opportunity to generate an off-the-shelf HLA-compatible hESC bank, available for immune-compatible cell transplantation, without embryo destruction. Graphical Abstract.

Frank's sign - A dermatological link to coronary artery disease?

Frank's sign, also known as diagonal earlobe crease (DELC), was observed to be an aural sign of coronary artery disease (CAD). Since then, there has been much interest in examining this unique and controversial association. This report describes a patient who has bilateral complete and deep diagonal ear lobe creases, presented with angina and diagnosed to have coronary artery disease on angiography. The characteristics of the sign and its association with atherosclerotic disease were discussed.

Enhancing the radiative emission rate of single molecules by a plasmonic nanoantenna weakly coupled with a dielectric substrate

Enhancing the spontaneous emission of single emitters has been an important subject in nano optics in the past decades. For this purpose, plasmonic nanoantennas have been proposed with enhancement factors typically larger than those achievable with optical cavities. However, the intrinsic ohmic losses of plasmonic structures also introduce an additional nonradiative decay channel, reducing the quantum yield. Here we report on experimental studies of a weakly coupled dielectric substrate and a plasmonic nanoantenna for enhancing the radiative decay rate of single terrylene molecules embedded in an ultrathin organic film. We systematically investigate how the refractive index of the dielectric substrate affects the lifetime and the quantum efficiency and show that the coupled structure could moderately enhance the radiative decay rate while maintaining a high quantum efficiency.

Dysphagia lusoria - a rare cause of prolonged Dysphagia

A 64-year-old man presented with prolonged history of intermittent dysphagia with sensation of food sticking at his upper chest. Physical examination was unremarkable, and an upper endoscopy did not reveal the underlying cause. On computed tomography scan of thorax, an aberrant right subclavian artery was seen coursing posterior to the esophagus resulting in external compression, which is a typical radiological feature of Dysphagia Lusoria. The pathophysiology, clinical features, imaging features and updated treatment modalities of this rare disease are discussed.

Varicella-zoster infection with secondary bacteremia and extensive facial abscesses

Varicella-zoster (chickenpox) infection is a common infectious disease and generally considered to be selflimiting. However, severe bacterial complications associated with the disease have been reported. We describe a case of varicella-zoster infection with secondary Staphylococcus aureus bacteremia, preseptal orbital cellulitis and extensive facial abscesses. She was aggressively treated with intravenous antibiotics and repeated surgical drainage, and eventually made good recovery.

A Study of Weekend and Off-hour Effect on Mortality in a Public Hospital in Malaysia

INTRODUCTION

Several studies have found higher in-hospital mortality for admissions during weekend or off hours, known as "weekend or off-hour effect". However, data for this on Malaysian populations is limited. This study was conducted to analyze the 3-year mortality trend in a secondary hospital and its relation to time and date of admission.

METHODS

The clinical data of 126,627 patients admitted to Taiping Hospital from 1st January 2008 to 31st December 2010 obtained via patient registry database of hospital was analyzed. This study compared mortality during weekdays with weekends, office hours (0800-1700) with off hours (1701-0759), and subanalysis of office hours with evening (1701-2259) or night hours (2300-0759), adjusted for age and gender.

RESULTS

Although the overall staff-to-patient ratio is improving, analyses showed a statistically significant increased risk of mortality for those patients admitted during weekends (OR = 1.22; 95% confidence interval [CI] = 1.14-1.31) or off hours in a weekday (OR = 1.67; 95% CI = 1.57-1.78). In the comparison between time of admission, there was statistically significant increased risk of mortality for admissions during evening hours (OR = 1.44; 95% CI = 1.28-1.62) and night hours (OR = 1.92; 95% CI = 1.71-2.16). Diseases of cardiovascular and respiratory system remained the top two causes of death over the three years.

CONCLUSION

The risk of mortality is significantly higher as a result of "weekend or off-hour effect". Recognition and intervention addressing these issues will have important implications for the healthcare system setting, hospital staffing and training, quality and timeliness of medical care delivery.

Gender-specific association of androgenetic alopecia with metabolic syndrome in a middle-aged Korean population

BACKGROUND

Although several previous studies have investigated the association between metabolic syndrome (MetS) and androgenetic alopecia (AGA), the study results have been inconsistent.

OBJECTIVES

The aim of this study was to investigate the relationship between the presence of MetS and AGA according to gender in a middle-aged Korean population.

METHODS

A population-based cross-sectional study was conducted on a sample from the Korean Genome Epidemiology Study. In total, 3408 subjects (1707 men and 1701 women) were enrolled between January 2008 and February 2010. The Norwood classification for men and Ludwig classification for women were used for assessment of the degree of hair loss. Information on components of MetS together with other possible risk factors was collected.

RESULTS

In men, the risk of having Norwood type IV or greater was not increased for subjects with MetS compared with those without MetS. In women, the risk of having Ludwig type I or greater was significantly increased for subjects with MetS compared with those without MetS after controlling for age and smoking status (OR 1.68, 95% CI 1.14-2.48; P=0.01). Similar results were also observed for the number of fulfilled components of MetS [odds ratio (OR) 1.38, 95% confidence interval (CI) 1.00-1.91; P<0.05]. When each component of MetS was considered individually, associations between AGA and all five components of MetS (waist circumference, triglycerides, high-density lipoprotein-C, blood glucose, and blood pressure) were not statistically significant. When multiple regression was used to adjust for age, family history and smoking, there was no significant association between the prevalence of MetS and moderate to severe AGA in the male group. On the contrary, a statistically significant positive association was noted between the prevalence of MetS and AGA in the female group.

CONCLUSIONS

Our analysis of AGA and the prevalence of MetS in a large population-based cohort demonstrated quite different findings compared with previous reports. The different results according to gender suggest that there may be different mechanisms that are yet to be defined between male and female AGA.

The effect of the respiratory cycle on liver stiffness values as measured by transient elastography

The findings of several studies suggest that liver stiffness values can be affected by the degree of intrahepatic congestion respiration influence intrahepatic blood volume and may affect liver stiffness. We evaluated the influence of respiration on liver stiffness. Transient elastography (TE) was performed at the end of inspiration and at the end of expiration in patients with chronic liver disease. The median values obtained during the inspiration set and during the expiration set were defined as inspiratory and expiratory liver stiffness, respectively. A total of 123 patients with chronic liver disease were enrolled (mean age 49years; 64.2% men). Liver cirrhosis coexisted in 29 patients (23.6%). Expiratory liver stiffness was significantly higher than inspiratory liver stiffness (8.7 vs 7.9kPa, P=0.001), while the expiratory interquartile range/median ratio (IQR ratio) did not differ from the inspiratory IQR ratio. Expiratory liver stiffness was significantly higher than inspiratory liver stiffness in 49 (39.8%) patients (HE group), expiratory liver stiffness was significantly lower than inspiratory stiffness in 15 (12.2%) patients, and there was no difference in 59 (48.0%) patients. Liver cirrhosis was more frequent in those who had a lower liver stiffness reading in expiration, and only the absence of liver cirrhosis was significantly associated with a higher reading in expiration in multivariate analysis. In conclusion, liver stiffness was significantly elevated during expiration especially in patients without liver cirrhosis. The effect of respiration should be kept in mind during TE readings.

3-dimensional local field polarization vector mapping of a focused radially polarized beam using gold nanoparticle functionalized tips

We have measured local electric field polarization vectors in 3-dimensional space on the nanoscale. A radial polarized light is generated by using a radial polarization converter and focused by an objective lens. Gold nanoparticle functionalized tips are used to scatter the focused field into the far-field region. Two different methods, rotational analyzer ellipsometry and Stokes parameters, are used in determining the polarization state of the scattered light. Two methods give consistent results with each other. Three dimensional local polarization vectors could be reconstructed by applying back transformation of the fully characterized polarizability tensor of the tip.

Surface plasmon polariton detection discriminating the polarization reversal image dipole effects

Image dipole effects are highly dependent on the polarization direction, constructive (destructive) interference between real and image dipoles for the vertically (horizontally) aligned one in the vicinity of metal surfaces, respectively. This polarization-reversal of the image dipole effects is quantitatively investigated by using a gold nanoparticle functionalized tip as a local dipolar scatterer and a propagating surface plasmon polariton as an excitation source of dipoles. The polarization-resolved detection technique is applied to separate the radiations of the vertical and the horizontal dipoles from each other. In our study, the image dipole effects on the far-field detected signals are fully explained by the Fabry-Perot like interference between the radiations from the real and the image dipoles, and by considering the finite size effects of the gold nanoparticle.

Vector field mapping of local polarization using gold nanoparticle functionalized tips: independence of the tip shape

We have measured local electric field vectors of local polarizaton on the nanoscale using gold nanoparticle functionalized tips as local field scatterers. In our experiments, the local field induces a dipole-moment in the gold nanoparticle functionalized tip, which then radiates into the far-field, transferring the full information about the local electric field from the near into the far field. The polarization characteristics of the scattered fields are analyzed using a conventional ellipsometry method. The tip dependent scattering function- the polarizability tensor- is fully determined by far field scattering measurements. Once the polarizability tensor for each tip is correctly accounted for in the data analysis, our results show that the finally determined local field polarization vectors are essentially independent of the tip shape.

Coupling of surface plasmon polaritons and light in metallic nanoslits

We clarify the nature of coupling between surface plasmon polaritons (SPP) and transmitted light in metallic nanoslit structures. The coupling strength is found to be the product of the geometric opening ratio, the aperture momentum, and the Fabry-Perot factor. We determine the effective coupling, which includes corrections due to other SPPs, and show that this effective coupling causes enhanced transmission with redshifted or blueshifted transmission peaks. Without coupling, SPP is proven to suppress transmission due to the equipartition of diffraction orders. These results show good agreement with experiment.

In vitro morphogenesis of amphibian erythroblasts

Non-mammalian vertebrate erythrocytes are flattened nucleated ellipsoids containing marginal bands (MBs) of microtubules that assemble during cellular morphogenesis. Earlier work suggested that pointed erythroid cells containing pointed MBs were intermediate stages in terminal differentiation, rather than aberrant forms, but direct evidence was lacking. Here we report on morphogenesis in individual post-cytokinetic amphibian erythroblasts in culture. Daughter cells remained adjacent in pairs, and developed pointed morphology over 1-2 h in the following sequence: (a) ends opposite the cytokinetic furrow became pointed, producing a spheroidal singly-pointed stage; (b) furrow ends usually became pointed, yielding doubly-pointed cells; (c) furrow-end points disappeared, producing a second singly-pointed stage that was flattening. Over a longer term, the single points sometimes disappeared, yielding a flattened discoid. These observations support the hypothesis that pointed cells are normal intermediates in a biogenetic program in which post-mitotic centrosomes organize MBs while occupying the singly-pointed ends of differentiating erythroblasts.

Coherent optical phonon oscillations in bulk GaN excited by far below the band gap photons

We report on generation of coherent optical phonon oscillations in 150 microm thick bulk GaN. With photon energy far below the band gap, the generation mechanisms of coherent phonon modes of A1(LO), high- and low-frequency E2 are revealed to be the impulsive stimulated Raman scattering. We find that one among the two degenerate E2 modes is selectively detected with a proper choice of probe polarization. Dephasing times range from 1.5 to 70 ps for different modes, and phonon-three-photon absorbed carrier interactions are compared between the A1(LO) and the E2 mode.

Studies of the central neural pathways to the stomach and Zusanli (ST36)

The purpose of this morphological study was to investigate the relation between the meridian, meridian points and viscera using neuroanatomical tracers. The common locations of the spinal cord and brain projecting to the stomach and Zusanli were observed following injection of CTB (cholera toxin B subunit) and pseudorabies viruses (PRV-Ba, Bartha strain and PRV-Ba-Gal, galactosidase insertion) into the stomach and Zusanli (ST36). After 4-5 days of survival following injection into twelve rats, they were perfused, and their spinal cords and brains were frozen sectioned (30 microm). These sections were stained by X-gal histochemical, CTB and PRV-Ba immunohistochemical staining methods, and examined with the light microscope. The results were as follows: Commonly labeled medulla oblongata regions were dorsal motor nucleus of vagus nerve (DMV), nucleus tractus solitarius (NTS) and area postrema (AP) following injection of CTB and PRV-Ba-Gal into stomach and Zusanli, respectively. In the spinal cord, commonly labeled neurons were found in thoracic, lumbar and sacral spinal segments. Densely labeled areas were found in lamina IV, V, VII (intermediolateral nucleus) and X of the spinal cord. In the brain, commonly labeled neurons were found in the Al noradrenalin cells/Cl adrenalin cells/caudoventrolateral reticular nucleus, dorsal motor nucleus of vagus nerve, nucleus tractus solitarius, area postrema, raphe obscurus nucleus, raphe pallidus nucleus, raphe magnus nucleus, gigantocellular nucleus, locus coeruleus, parabrachial nucleus, Kolliker-Fuse nucleus, A5 cell group, central gray matter, paraventricular hypothalamic nucleus, lateral hypothalamic nucleus, retrochiasmatic hypothalamic nucleus, bed nucleus of stria terminalis and amygdaloid nucleus. Thus central autonomic center project both to the stomach and Zusanli. These morphological results suggest that there is a commonality of CNS cell groups in brain controlling stomach (viscera) and Zusanli (limb).

Inhibition of malonaldehyde formation from blood plasma oxidation by aroma extracts and aroma components isolated from clove and eucalyptus

The inhibitory effect of aroma extracts isolated from clove buds [Syzygium aromaticum (L.) Merr. et Perry] and eucalyptus leaves (Eucalyptus polyanthemos Schauer) on malonaldehyde (MA) formation from horse blood plasma oxidized with Fenton's reagent was determined by gas chromatography. Aroma chemicals such as eugenol, thymol and benzyl alcohol, identified in the aroma extracts, were examined for their inhibitory effect on the same system. Between the two aroma extracts tested, clove exhibited the most potent antioxidant activities. Extracts of eucalyptus and clove inhibited MA formation by 23 and 48%, respectively, at the level of 400 microg/ml, whereas, alpha-tocopherol and BHT inhibited MA formation by 52 and 70%, respectively, at the same level. Eugenol, thymol and benzyl alcohol inhibited MA formation by 57, 43 and 32%, respectively, at the level of 400 microg/ml.

Mucinous cystadenoma coexisting with stromal tumor with minor sex-cord elements of the ovary: a case report

Mucinous neoplasms occur rarely in association with cystic teratoma, Sertoli-Leydig cell tumor, granulosa cell tumor or carcinoid tumor. Several cases of an ovarian stromal tumor with minor sex-cord elements have been reported in the literatures. However, there has been no report about an ovarian mucinous neoplasm coexisting with a stromal tumor with sex-cord elements yet. We report a case of an ovarian neoplasm composed of both mucinous cystadenoma and stromal tumor with minor sex-cord elements in a 58-yr-old female. The ovary including the mass measured 5 cm in size. On section, it revealed an unilocular cyst (4.5 cm in diameter) filled with mucinous fluid. There was a round, yellow, solid nodule, 1.5 cm in diameter within the wall. Microscopically, the cyst was lined by a single layer of endocervical mucinous epithelium and the nodule was composed of spindle cells showing an intersecting and whorled arrangement. There were cell nests showing polygonal shape with abundant cytoplasm among the spindle cells. They showed immunoreactivity for inhibin and did not have any connection with the adjacent mucinous epithelium. Therefore, we interpret the mucinous cystadenoma as having arisen de novo.

Determination of antioxidant properties of aroma extracts from various beans

Aroma extracts from fresh soybeans, mung beans, kidney beans, and azuki beans were prepared using simultaneous steam distillation and solvent extraction (SDE) under mild conditions (55 degrees C and 95 mmHg). Extracts were examined for antioxidative activities in two different assays. The aroma extracts isolated from all beans inhibited the oxidation of hexanal for nearly one month at a level of 250 microL/mL. Mung bean and soybean extracts inhibited malonaldehyde (MA) formation from cod-liver oil by 86% and 88%, respectively, at the 250 microL/mL level. Azuki and kidney bean extracts inhibited MA formation from cod-liver oil by 76% and 53%, respectively, at the 250 microL/mL level. The antioxidative activities of mung bean and soybean extracts were comparable with that of the natural antioxidant, alpha-tocopherol (vitamin E).

The effects of Pva/chitosan/fibroin (PCF)-blended spongy sheets on wound healing in rats

The effects of poly vinyl alcohol (PVA)/Chitosan/Fibroin (PCF)-blended sponge on wound healing in rats were investigated. We excised the skin of a rat, including the dermis, approximately 2 x 2 cm in size. The wound was covered with PCF-blended spongy sheets. The spongy sheets absorbed the exudate, and gained flexibility and softness. Histopathological inspection of the wound 12 d later showed an increase of vascular ingrowth and the absence of inflammatory cells. Regeneration of the skin around the wound was faster than that of the control. We also tested wound healing effects of PVA, Chitosan and Fibroin, alone or in various combinations. Wound healing was accelerated in the order of PCF-blended sponge>Chitosan/Fibroin (CF)-blended sponge>Fibroin (F) sponge > PVA/Chitosan-blended sponge (PC) > Chitosan (C) sponge.

Antioxidant properties of aroma compounds isolated from soybeans and mung beans

Aroma compounds contained in the extracts of soybean and mung bean that possess antioxidant activity were identified by gas chromatography (GC) and gas chromatography/mass spectrometry (GC/MS). The major aroma constituents of soybeans were 1-octen-3-ol (13.699 ppm), maltol (1.662 ppm), phenylethyl alcohol (1.474 ppm), hexanol (1.430 ppm), and gamma-butyrolactone (1.370 ppm). The major aroma constituents of mung beans were hexanol (3.234 ppm), benzyl alcohol (2.060 ppm), gamma-butyrolactone (1.857 ppm), 2-methyl-2-propenal (1. 633 ppm), and pentanol (1.363 ppm). The major aroma chemicals of soybeans and mung beans were examined for antioxidative activities in two different assays. Eugenol, maltol, benzyl alcohol, and 1-octen-3-ol showed potent antioxidative activities in two different assays. Eugenol, maltol, benzyl alcohol, and 1-octen-3-ol inhibited the oxidation of hexanal by 100%, 93%, 84%, and 32%, respectively, for a period of 40 days at the 500 microg/mL level. Eugenol, maltol, benzyl alcohol, and 1-octen-3-ol inhibited malonaldehyde (MA) formation from cod liver oil by 91%, 78%, 78%, and 78%, respectively, at the 160 microg/mL level. The antioxidative activity of eugenol was comparable to that of the natural antioxidant alpha-tocopherol (vitamin E).

The biomechanics of rapid maxillary sutural expansion

Micro-displacements (fringe patterns) in the bones of the craniofacial complex as seen through laser holography during midpalatal sutural expansion with the Hyrax appliance are used to define the centers of rotation of the maxillary halves in both the frontal and occlusal views. Biomechanical analyses of the maxillary expansion force system are concomitant with the holographic findings and strongly suggest that the stainless steel wires joining the teeth to any expansion device be of the largest diameter possible. In addition, in the case of the Hyrax expansion device, it is recommended that the manufacturer increase the diameter of the activating screw as well as those of the 2 adjacent wire guides. And, importantly, the use of acrylic as a structural member to join the teeth to a sutural expansion device should be avoided if tipping of the maxillary halves is to be minimized, as the acrylic lacks sufficient rigidity.

Antioxidative activities of aroma extracts isolated from natural plants

Natural leaves and flowers containing numerous aroma chemicals are widely used in aromatherapy since ancient times. In addition to their pleasant smells, aroma chemicals might have some beneficial health effects. Aroma extracts, isolated from coffee beans, soybeans, and mung beans by steam distillation under mild conditions (55 degrees C and 85 mm Hg) were examined for their antioxidative activities. The inhibitory effect of these extracts toward hexanal/hexanoic acid conversion was measured in the testing solution over prolonged time periods. The inhibitory effects of these extracts toward malonaldehyde formation from lipids oxidized by Fenton's reagent were also measured. The antioxidative activity of these extracts, in particular coffee bean extract, was consistent with that of BHT or alpha-tocopherol (vitamin E). Soybeans and mung beans extract contained maltol, which inhibits hexanal oxidation significantly. Eugenol, which is one of the major constituents of mung bean extract, exhibited potent antioxidative activity in an aldehyde/carboxylic acid assay. Antioxidants such as eugenol and maltol may play an important role in the pharmaceutical activities of natural plant extracts used for aromatherapy.

Reversible alteration of morphology in an invertebrate erythrocyte: properties of the natural inducer and the cellular response

The normal shape of the erythrocytes of the bivalves known as blood clams is maintained by a marginal band (MB) of microtubules. When hemolymph (or "blood") is withdrawn from the animal, its erythrocytes change, within minutes, from the normal smooth-surfaced, flattened ellipsoids (N-cells) to spheroids with folded surfaces (X-cells). This alteration can be prevented by rapidly diluting the hemolymph with physiological medium, yielding N-cells for use in studying the transformation to X-cells. Bioassays showed that shape transformation was induced by a hemolymph activity (Hx) and was a function, in part, of cell responsiveness to this activity. Eventually the shape of the cells spontaneously returned to normal, at a rate dependent upon the concentration of the cells and of Hx; recovery was correlated with loss of Hx. The X-cells contained an intact but highly deformed MB, but this was not the effector of the transformation. Erythrocytes made to lack MBs still changed shape, although they did not recover as completely as did the MB-containing controls. When clams were cooled before hemolymph was withdrawn, the concentration of Hx was reduced. Hx was retained after dialysis of hemolymph, and initial filtration and chromatography indicated that its Mr was greater than 500,000. Shape transformation was blocked by EGTA, by serine protease inhibitors, and by sodium azide; the last indicates ATP-dependence. Although the mechanism responsible for shape transformation remains to be determined, the data suggest that the change is triggered by a coagulation-related activity in response to the removal of hemolymph from the animal.

A reexamination of various extraoral appliances in light of recent research findings

The location of the center of resistance of the dentomaxillary complex has recently been identified more accurately than before. Based on this new finding, various modifications of the common facebow are presented for use in protraction therapy. Clinical applications for specific treatment objectives are also reviewed. Orthopedic and biomechanical implications of various standard retraction type extraoral appliances are also analyzed.

Detection of human papillomavirus in warty carcinoma of the uterine cervix: comparison of immunohistochemistry, in situ hybridization and in situ polymerase chain reaction methods

Warty carcinoma of the uterine cervix is a very rare specific variant of invasive squamous cell carcinoma, usually described as a hybrid feature of condyloma with invasive squamous cell carcinoma. Besides having the koilocytes and maturation of squamous epithelium, there is unequivocal stromal invasion. The feathery surface seems to be characteristic of warty carcinoma, differentiating it from condylomata acuminata or verrucous carcinoma. Using in situ polymerase chain reaction (IS-PCR) and in situ hybridization (ISH) as well as an immunohistochemical technique (IHC), we determined the amplification and expression of several human papilloma virus (HPV) types (6, 11, 33, 16 and 18) in nine warty carcinomas of the uterine cervix. We found amplified HPV predominantly in the nuclei of the feathery surface in all cases only when IS-PCR was applied, while it was detected only in five (55.6%) or six cases (66.7%) by conventional IHC or ISH, respectively. We found multiple types in the same lesion in six cases (66.7%) by IS-PCR, in comparison with ISH which detected a lower incidence (22.2%). This finding of coinfection is more consistent with that seen in low-grade squamous intraepithelial lesions (LSILs) of the uterine cervix than in high SIL. It is important to be aware of these distinct lesions in postmenopausal women with their characteristic feathery and thin surface, as well as a hybrid form of exophytic condyloma and stromal invasion, and frequent coinfection of multiple different HPVs as a type of LSILs.

Malignant eccrine spiradenoma with florid squamous differentiation

Malignant eccrine spiradenoma (MES) is an exceedingly rare neoplasm of cutaneous adnexal origin. To date, 31 cases have been documented in the literature. We herein report an additional case of MES that arose in longstanding eccrine spiradenoma (ES). A 54-year-old woman was seen for a bluish nodular mass on the right flank that previously had been stable for 7 to 8 years and had recently increased in size and become tender. The excised mass (2.8 x 2.5 x 2.5 cm) had no attachment to the overlying epidermis. Microscopically, 2 to 3 sharply demarcated lobules were surrounded by a markedly thickened and hyalinized fibrous capsule. Of the lesion removed, approximately 20% of the tumor showed typical histologic features of benign ES. In the remaining malignant areas, the typical configuration of benign counterpart, consisting of peripheral rows of small dark basaloid cells and central layers of large pale cells partially forming lumina, was replaced with a massive solid proliferation of large pale cells showing nuclear pleomorphism, prominent nucleoli, increased mitotic activity (reaching 12/10 HPF) and loss of PAS-positive basement membrane. There were multiple foci of florid squamous differentiation in the malignant portion. Cytokeratin, focally S-100 and EMA were expressed in large pale cells, whereas alpha smooth muscle actin and S-100 were positive in small dark basaloid cells. Focal reactivity of CEA and EMA was found in the central lumina. P53 was not expressed in benign areas, whilst in malignant areas an occasional nuclear reaction was disclosed.

Allergic and immunologic profile of symptomatic Persian Gulf War veterans

BACKGROUND

Persian Gulf War veterans have been enrolled in the Veterans Administration Persian Gulf Health Registry for evaluation of unexplained symptoms and illnesses. The allergy and immunology division at the West Los Angeles Veterans Administration Medical Center evaluated 20 consecutive symptomatic Persian Gulf War veterans.

OBJECTIVE

The purpose of this study was to examine the immunologic profiles of symptomatic Persian Gulf War Veterans.

METHODS

A detailed history was obtained that included duties/responsibilities, length of time in the Persian Gulf, location, and exposures during the Gulf War. A complete physical examination was performed, with extensive laboratory testing and immediate and delayed hypersensitivity skin testing. Data from these Persian Gulf War Veterans were compared with a control population consisting of 44 non-Persian Gulf War veterans enrolled in our allergy and immunology clinic. Presenting allergic symptoms, presence of atopy, and total serum IgE levels were compared.

RESULTS

Persian Gulf study patients and registry patients had a broad spectrum of nonspecific symptoms as compared with allergy clinic control patients who had dermatologic and respiratory symptoms. Persian Gulf study patients with allergy symptoms had a higher mean IgE level (88.7 IU/mL) than Persian Gulf study patients without allergy symptoms (47.5 IU/mL). Persian Gulf study patients with positive skin tests had a higher mean IgE level (161.5 IU/mL) than Persian Gulf study patients with negative skin tests (22.3 IU/mL). Laboratory data showed no significant immune abnormalities.

CONCLUSION

Our study showed that 20 Persian Gulf veterans with a multitude of nonspecific symptoms had no immune abnormality. Mean IgE levels and eosinophil counts correlated with atopic state and reported allergy symptoms.

Cytologic evaluation of primary malignant vascular tumors of the liver. One case each of angiosarcoma and epithelioid hemangioendothelioma

OBJECTIVE

To describe and compare the cytologic features of angiosarcoma (AS) and epithelioid hemangioendothelioma (EH) of the liver.

STUDY DESIGN

Fine needle aspirates and succeeding tissue biopsies from one case each of hepatic AS and EH were obtained. Both aspirates were compared for differences in cytologic features.

RESULTS

In the case of EH, the tumor cells were dispersed almost singly but occasionally assumed an acinuslike shape. They were polymorphic and had a folded nuclear outline with lacy and hematoxyphilic cytoplasm. Occasional intranuclear cytoplasmic inclusions and frequent binucleated or multinucleated giant cells were also characteristic. The tumor cells of AS showed tightly cohesive clusters forming syncytium in the bloody background with heavy aggregates of polymorphonuclear cells. The tumor cells were larger and more atypical but less polymorphic than those of EH. Each tumor cell of AS had a very distinct, huge, eosinophilic nucleolus and abundant cytoplasm of honeycombing micro/macrovesicular features. Frequently, huge intracytoplasmic vacuoles similar to those in signet-ring cells were present.

CONCLUSION

Preoperative diagnosis of malignant hepatic vascular tumor is possible by aspiration cytology provided that one is aware of these entities and some distinctive cytologic findings.

A study of holographic interferometry on the initial reaction of maxillofacial complex during protraction

Most extraoral appliances used for protracting small or retropositioned maxilla do not allow for variations in the point of force application or in its direction. This variation may be necessary to control vertical, anteroposterior, as well as transverse effects. The purpose of this study was to investigate the initial reaction of the maxillofacial complex according to force magnitude, force direction, and point of force application. For this purpose, an antenna-type modified protraction headgear was tested with double exposure holographic interferometry on a dry human skull with well-aligned upper teeth. Fringe patterns of each protraction condition were compared and analyzed. In most cases, upward rotation of the anterior portion of the maxilla changed to translation, or to downward rotation, as force direction was changed from parallel to the occlusal plane to 20 degrees downward to the occlusal plane. Furthermore, a 500 gm force applied 15 mm above and directed 20 degrees below the occlusal plane produced a translation of the maxillary complex, indicated by a typical circular fringe pattern on the holographic plate, which represents the center of resistance of the maxilla. In most cases, with all force variables tested, a protraction of the maxilla with palatal expansion was more effective in producing translation of the maxilla than was protraction without palatal expansion. By varying force magnitude, force direction and point of force application with maxillary protraction, the amount of maxillary rotation and translation might be controlled.

Diagnosis of cervical tuberculous lymphadenitis with fine needle aspiration biopsy and cytologic examination under ultrasonographic guides

The efficacy of the fine needle aspiration biopsy and cytological examination (FNABC) under ultrasonographic (US) guides for the diagnosis of cervical tuberculous lymphadenitis was assessed. In one hundred and one patients with a neck mass or masses, tuberculous lymphadenitis has been proved by FNABC. US disclosed the physical characteristics of the masses: All the cases that involved two or more lymph nodes were multiple lesions. Eighty lesions (79.1%) were multiregional, and in 19 cases (18.8%), bilateral neck was involved. The posterior triangle of the neck was the most prevalent site (N = 69, 68.3%). Ninety two cases (90.9%) were hypoechoic lesions and 9 (9.1%) showed mixed echo patterns. There was no hyperechoic lesion (p < 0.001). The sensitivity of FNABC was 77.2% and the specificity was 99.0%. The diagnostic accuracy was 85.0%. There was no complication during the procedure. FNABC for the diagnosis of cervical tuberculous lymphadenitis is a safe, convenient procedure and has a relatively high specificity. The limitation of FNABC, the low sensitivity, seemed to be compensated by US examinations.

Acquired tufted angioma associated with pregnancy

Acquired tufted angioma is a distinctive condition that is different from other types of acquired vascular proliferation. Despite the progressive spread of these angiomas, they appear to be benign, and malignant change has not been encountered. We describe a case of recurrent acquired tufted angioma associated with pregnancy, an association which has not been previously recorded.

Epidermal changes in active vitiligo

Light and electron-microscopic studies were performed on the vitiligo and adjacent, normal appearing skin from 97 patients with actively spreading vitiligo and 19 patients with stable vitiligo. The vitiliginous skin revealed complete loss of pigment and melanocytes. In addition to degenerative changes in melanocytes, vacuolar changes of basal cells, epidermal infiltration of lymphocytes, dermal infiltration of lymphocytes, and melanophages in the upper dermis were also seen in the normal appearing skin adjacent to vitiliginous skin. These epidermal and dermal changes are more prominent in the skin of actively spreading vitiligo than in stable vitiligo. These findings suggest that the adjacent, normal appearing skin of actively spreading vitiligo shows some characteristic histopathologic findings, especially in the epidermis, indicating that cellular immunity could be involved in the pathogenesis of vitiligo.

Fine-needle aspiration cytology of pulmonary adenocarcinoma of fetal type: report of a case with immunohistochemical and ultrastructural studies

This report describes the fine-needle aspiration (FNA) cytology of a case of adenocarcinoma resembling fetal lung in a 53-yr-old male, a very uncommon malignant tumor of the lung that is similar to an early stage of lung differentiation. FNA smears revealed relatively small, fairly uniform tumor cells appearing as cohesive cell groups and scattered, isolated cells, some of them showing a rosette or acinus pattern. In addition, clusters of larger cells with eosinophilic cytoplasm and prominent nucleoli existed contiguously with the small cells or separately. The possibilities of an unusual type of adenocarcinoma, carcinoid tumor, and pulmonary blastoma were suggested by the cytologic findings. Immunohistochemical studies performed on a resected tumor tissue showed immunoreactivity for alpha-fetoprotein, neuron-specific enolase, and somatostatin, and endocrine-type granules were found ultrastructurally. This type of adenocarcinoma is considered to have a histogenesis similar to that of pulmonary blastoma. To our knowledge this is the first reported case in the cytologic literature.

A clinicopathological study of Kimura's disease and epithelioid hemangioma

The clinicopathological features of 9 cases of Kimura's disease and 5 cases of epithelioid hemangioma(EH) were reviewed. Patients with Kimura's disease presented with multiple or solitary large tumors occurring in the thigh, arms as well as parotid gland. Histologically, the lesions were characterized by numerous lymphoid follicles with proliferation of post-capillary venules lined by plump endothelium and a marked eosinophilic infiltration. Patients with EH were older than those with Kimura's disease and presented papular nodular lesions, less than 1 cm in size. Microscopically, there was proliferation of blood vessels lined by epithelioid endothelium with infiltration by lymphocytes and eosinophils. Although there may occasionally be clinicopathological overlap between Kimura's disease and EH, we consider that these two disorders can be recognized as separate entities.

Histopathological and immunohistochemical studies of polymorphic reticulosis

This study reviewed 65 cases of polymorphic reticulosis (PR) with respect to clinical and histopathologic bases, and immunohistochemical studies were done using MT1 and UCHL as T-cell markers, MB2 as a B-cell marker and alpha-1-antichymotrypsin as a histiocytic marker. The results obtained were as follows: 1. The male to female ratio was 2.4:1 and the mean age of patients was 44.5 years. The sites involved primarily were the nasal cavity, tonsil and pharynx and about one-fourth of the total cases showed extensive involvement of two anatomical sites at initial presentation. 2. Almost all cases showed characteristic histologic features similar to those of peripheral T-cell lymphoma and showed positive reaction to the T-cell marker. The above immunohistochemical findings suggest strongly that quite a significant portion of PR is in fact T-cell lymphoma.

Infantile myofibromatosis

We report a case of infantile myofibromatosis in a male infant with involvement of the lungs and subcutaneous tissue. We studied our case by light microscopy, immunohistochemistry and electron microscopy. The results reveal that this entity is of a myofibroblastic nature. We reviewed 165 cases including our case. We believe this is the first report in Korea of infantile myofibromatosis with pulmonary involvement.

AIDS and anaesthesia

The Acquired Immune Deficiency Syndrome (AIDS) is a group of conditions which is reaching epidemic proportions. It is caused by a virus new to man, with an as yet poorly understood natural history, ominous prognosis and no known cure. Anaesthetists should be aware of the implications of dealing with increasing numbers of both diagnosed and undiagnosed AIDS patients and asymptomatic carriers in the fields of resuscitation, intensive therapy and theatre anaesthesia. The misunderstanding of AIDS is as extensive as the literature on the subject and a review of the current knowledge of the disease relevant to the anaesthetist is pertinent.