Altered microbiome of serum exosomes in patients with acute and chronic cholecystitis

BACKGROUND

This study aimed to investigate the differences in the microbiota composition of serum exosomes from patients with acute and chronic cholecystitis.

METHOD

Exosomes were isolated from the serum of cholecystitis patients through centrifugation and identified and characterized using transmission electron microscopy and nano-flow cytometry. Microbiota analysis was performed using 16S rRNA sequencing.

RESULTS

Compared to patients with chronic cholecystitis, those with acute cholecystitis exhibited lower richness and diversity. Beta diversity analysis revealed significant differences in the microbiota composition between patients with acute and chronic cholecystitis. The relative abundance of Proteobacteria was significantly higher in exosomes from patients with acute cholecystitis, whereas Actinobacteria, Bacteroidetes, and Firmicutes were significantly more abundant in exosomes from patients with chronic cholecystitis. Furthermore, functional predictions of microbial communities using Tax4Fun analysis revealed significant differences in metabolic pathways such as amino acid metabolism, carbohydrate metabolism, and membrane transport between the two patient groups.

CONCLUSIONS

This study confirmed the differences in the microbiota composition within serum exosomes of patients with acute and chronic cholecystitis. Serum exosomes could serve as diagnostic indicators for distinguishing acute and chronic cholecystitis.

[A case of acute poisoning of typhonium giganteum engler]

Unicorn lotus is a plant tuber in the araceae family, which has therapeutic effects such as dispelling cold and dampness, dispelling wind and phlegm, and treating stroke. However, acute poisoning of fresh Unicorn lotus has been rarely reported domestically and internationally. This article reports a case of poisoning caused by chewing unicorn lotus. The patient experienced numbness in the lips, swelling and rupture of the oral cavity, continuous salivation, difficulty swallowing and obvious burning sensation in the throat, accompanied by shortness of breath and mild hypoxemia. After receiving comprehensive treatments such as oxygen therapy, electrocardiographic monitoring, cleaning of necrotic oral mucosa, anti infection, inhibition of oral salivary secretion, and nutritional support, the patient finally recovered and was discharged.

Association between inflammatory bowel disease and risk of stroke: a systematic review and meta-analysis of cohort studies

Background/objectives

Recently, four meta-analyses have explored the association between inflammatory bowel disease (IBD) and the risk of stroke. These studies have demonstrated that people with IBD may be at an increased risk of stroke. However, some limitations such as high heterogeneity and the lack of uniformity in the types of research, especially the reuse of some sample sizes, cannot be neglected. These factors reduce the credibility of their research conclusions. Therefore, we conducted a meta-analysis to explore this possible association.

Methods

PubMed, Embase, and Web of Science were searched from inception to 30 June 2023. A random effects model with the generic inverse variance method was used in this meta-analysis. The Review Manager software was used to obtain all relative risks (RRs) and their 95% confidence intervals (CIs). Publication bias was tested, and sensitivity and subgroup analyses were conducted to explore possible heterogeneities.

Results

This meta-analysis included 12 cohort studies (involving 4,495,055 individuals). Meta-analysis of these data has shown that IBD was associated with an increased risk of stroke (RR = 1.19, 95%CI:1.14-1.24, p < 0.00001). Our results were stable and robust in subgroup and sensitivity analyses.

Conclusions

Our results suggest that IBD is associated with an increased risk of stroke. To reduce the incidence of stroke, patients with IBD are encouraged to undergo stroke risk assessments, especially for young female patients; assessing the risk of ischemic stroke is of particular importance. Prospective studies considering stroke subtypes, IBD severity and treatments, regions, and other confounding factors are needed to further explore the nature of each association.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022373656.

Association between glaucoma and risk of stroke: A systematic review and meta-analysis

Background/objectives

Recently, several studies explored the association between glaucoma and the risk of stroke, but these results were inconsistent. Therefore, we conducted a meta-analysis to examine this possible association.

Methods

We conducted a systematic literature search of PubMed, Embase, and Web of Science from inception until February 28, 2022. Random-effects meta-analysis was conducted by generic inverse variance method. Sensitivity and subgroup analyses were performed. The review protocol has been registered with PROSPERO (CRD42022312797).

Results

Seven studies (involving 362,267 participants) have been published from 2004 to 2017 and included in the meta-analysis. These studies included four retrospective cohort studies, two cross-sectional studies, and one case-control study. Meta-analysis of these data has shown that glaucoma was associated with an increased risk of stroke (OR = 1.94, 95% CI = 1.45-2.59). Most of the subgroup analyses demonstrated similar results. These findings were stable in sensitivity analyses.

Conclusions

We found that glaucoma was associated with an increased risk of stroke. The result suggests that patients with glaucoma need to be assessed the risk of stroke to reduce the incidence of stroke. To better explore the nature of any association, prospective studies that consider the stroke subtypes, sample size, district, and other confounding factors are needed.

[Lung transplantation for pulmonary alveolar proteinosis: a case report and literature review]

Objective: To observe the efficacy of lung transplantation for pulmonary alveolar proteinosis (PAP) patients and to improve the understanding of the therapy. Methods: The clinical data of a patient with autoimmune PAP treated with sequential homogenous bilateral lung transplantation were described and the literatures were reviewed. Results: This 55-year-old female patient was diagnosed with autoimmune PAP and had been treated with whole lung lavage for 19 times, but only achieved short-term symptomatic relief after each operation. Inhalation of granulocyte macrophage colony stimulating factor occurred allergic reactions. Lung transplantation was performed on February 15, 2022, and a significant improvement in oxygenation and clinical symptoms were observed. The patient remained stable during follow-up. Conclusion: Treatment with lung transplantation is safe and effective for end-stage patients with PAP in the early phase, but the long-term effect remains to be observed.

Simvastatin inhibits the inflammation and oxidative stress of human neutrophils in sepsis via autophagy induction

Simvastatin exerts a protective effect during sepsis (SP) in animal models; however, the underlying mechanism is not completely understood, particularly in human SP. Neutrophils are a critical effector in the host inflammatory response to SP. Therefore, the present study aimed to investigate the effect of simvastatin on neutrophils in human SP. Neutrophils were isolated from the peripheral venous blood of adult patients with SP and healthy volunteers (HP). Cell viability was analyzed using the MTT assay. Intracellular reactive oxygen species (ROS) generation and the concentrations of inflammatory mediators were also assessed using flow cytometry and ELISA. The results demonstrated that the cell viability of neutrophils from the SP group was significantly decreased compared with that in the HP group, and that treatment with simvastatin partly reversed the reduced cell viability. Furthermore, simvastatin administration significantly decreased ROS production and the concentrations of TNF‑α and IL‑6, which were significantly increased in neutrophils isolated from the SP group. Simvastatin also enhanced autophagy induction, as indicated by the promotion of the conversion of LC3I to LC3II and the increased expression levels of Beclin 1 in SP neutrophils. Treatment with 3‑methyladenine, an autophagy inhibitor, completely blocked the protective effects of simvastatin on neutrophils from SP, including the effects of simvastatin on the inhibition of inflammation, oxidative stress and improving cell viability. Collectively, the present study provided evidence for the simvastatin‑induced autophagic process of neutrophils involved in human SP, which protects neutrophils and partially attenuates the inflammatory response and oxidative stress. Therefore, the augmentation of neutrophil autophagy may serve as a potential therapeutic target for patients with SP.

[The molecular mechanism of oxaliplatin-induced peripheral neuropathic pain]

Objective: To investigate the molecular mechanism of oxaliplatin-induced chemotherapy-induced peripheral neuropathic pain (CIPNP). Methods: A total of 16 male Sprague-Dawley rats of specific pathogen-free grade were randomly divided into two groups: oxaliplatin experimental group (2.4 mg/kg oxaliplatin dissolved in 5.0% glucose solution, n=8) and control group (equal volume 5% glucose solution, n=8). The rat model of CIPNP was established by continuous administration with oxaliplatin. In addition, mechanical allodynia, thermal hyperalgesia and cold hyperalgesia were measured and compared between the two groups. To explore the molecular mechanism of oxaliplatin-induced CIPNP, the gene expression of dorsal root ganglia (DRG) from the rat model of CIPNP was analyzed using RNA sequencing (RNA-Seq). Results: Mechanical and thermal hypersensitivity was exhibited on day 7 and a stronger hypersensitivity was observed on day 14. A total of 20 152 genes were quantified by RNA-Seq, and 379 differentially expressed genes (DEGs) were obtained with absolute fold change cut-offs ≥ 2 and P value<0.05. There were 7 genes (Npy, Car3, Cdkn1a, Nts, Prc1, Ms4a7 and Ecel1) that were involved in peripheral nerve injury-related neuropathic pain. Gene ontology (GO) functional enrichment analyses indicated that the DEGs induced by oxaliplatin were involved in oxygen transport, cell division, intermediate, centromere, oxygen transporter activity, oxygen binding. Moreover, the result of Kyoto Encyclopedia of genes and genomes (KEGG) analyses highlighted that the DEGs induced by oxaliplatin were involved in malaria, African trypanosomiasis, primary immunodeficiency, peroxisome proliferator activated receptor (PPAR) signaling pathway. Conclusion: Oxaliplatin induces CIPNP via pain-related genes and signaling pathways.

Discovery of new tranylcypromine derivatives as highly potent LSD1 inhibitors

Tranylcypromine (TCP)-based structural modifications lead to the discovery of new LSD1 inhibitors, of which compounds 26b and 29b effectively inhibit LSD1 with the IC₅₀ values of 17 and 11 nM, respectively and also show good selectivity over MAO-B. Mechanistic studies showed that compound 29b concentration-dependently induced H3K4me1/2 accumulation in LSD1 overexpressed MGC-803 cells and also inhibited metastasis of MGC-803 cells. Collectively, both compounds could be promising lead compounds for further investigation.

[Analysis of direct economic burden of occupational asthma]

Objective: To analyze the direct economic burden of occupational asthma patients and provide economic basis for the government to rationally allocate health resources. Methods: In September 2019, colleted the case data of 53 patients diagnosed with occupational asthma who were hospitalized in our hospital from December 2008 to December 2018, and analyze the impact of gender, age, diagnosis time, ducation level, allergen type to the length of stay, hospitalization cost, medical technology diagnosis and treatment costs, western medicine costs, average daily hospitalization costs and other indicators. Results: The average length of hospitalization for occupational asthma patients was (38.7±8.1) days, and the average hospitalization cost was 14743 yuan, of which medical technology diagnosis and treatment costs, western medicine costs, and comprehensive medical service costs accounted for the top three, 42.5% (331977/781369) , 32.0% (249942/781369) , 19.6% (153268/781369) respectively. Hospitalization days for occupational asthma patients has decreased significantly in 2014-2018 (P<0.05) . There were no significant differences in hospitalization costs, medical technology diagnosis and treatment costs, western medicine costs, and average daily hospitalization costs for occupational asthma patients caused by different allergens (isocyanates, persulfates and phthalic anhydrides) (P>0.05) . Hospitalization days, hospitalization costs, medical technology diagnosis and treatment costs, western medicine costs, and average daily hospitalization costs of patients with moderate occupational asthma were significantly higher than those of mild patients (P<0.05) . Conclusion: Early detection of occupational asthma patients and early intervention can reduce the economic burden on patients and society.

Targeting histone demethylase KDM5B for cancer treatment

KDM5B (Lysine-Specific Demethylase 5B) erases the methyl group from H3K4me2/3, which performs wide regulatory effects on chromatin structure, and represses the transcriptional function of genes. KDM5B functions as an oncogene and associates with human cancers closely. Targeting KDM5B has been a promising direction for curing cancer since the emergence of potent KDM5B inhibitor CPI-455. In this area, most reported KDM5B inhibitors are Fe (Ⅱ) chelators, which also compete with the cofactor 2-OG in the active pockets. Besides, Some KDM5B inhibitors have been identified through high throughput screening or biochemical screening. In this reviewing article, we summarized the pioneering progress in KDM5B to provide a comprehensive realization, including crystal structure, transcriptional regulation function, cancer-related functions, development of inhibitors, and SAR studies. We hope to provide a comprehensive overview of KDM5B and the development of KDM5B inhibitors.

[Simultaneous determination for metabolites of benzene compounds in urine by high performance liquid chromatography]

Objective: To describe for the determination of contents of metabolites of benzene compounds in urine sample by high performance liquid chromatography. Methods: After acidification with hydrochloric acid, metabolites in urine were first extracted by acetonitrile and isopropanol (V∶V, 9∶1) with excessive sodium chloride, then gradient separated on a C18 column and then determined by DAD detector. Results: There were good linear relationship between peak areas and injection quality in range of 2.00-100 mg/L (r>0.999). The detection limit and quantitative limit of this method were 4.15-70.7 μg/L and 13.8-235 μg/L respectively. The precision for the analysis of urine was1.78%-8.23% (n =6). The average recovery of metabolites was 85.4%-105.5% at thee spiked levels in the range of 2.00-100 mg/L. Conclusion: The accuracy and reproducibility obtained make this method useful for the biological monitoring of occupational exposure to toluene, xylene, styrene and ethylbenzene.

[Treatment of postprandial discomfort syndrome in the elderly: a multi-centered prospective randomized controlled clinical study]

Objective: To evaluate the efficacy and safety of Oryz-Aspergillus enzyme and pancreatin tablets (Combizym(®)) in the treatment of postprandial distress syndrome (PDS) in the elderly, compared with gastrointestinal motility drugs. Methods: A prospective randomized controlled trial was designed and registered in the China Clinical Trials Registry (ChiCTR-IPR-16008185). The elderly patients with PDS were randomly divided into three groups, including Mosapride group with Mosapride citrate tablets 5 mg 3 times per day for 2 weeks; Combizym(®) group with Combizym tablets 244 mg 3 times per day for 2 weeks; combined treatment group with both drugs and same doses for 2 weeks. The modified Nepean dyspepsia index (NDSI) score, discomfort intensity score and PDS score were calculated on patients before treatment, at the end of first and second week of treatment, as well as 4 weeks after treatment finished, respectively. Adverse effects were evaluated. Results: A total of 323 patients from 16 tertiary hospitals in China were enrolled in this study. Among them, 105 patients were in Mosapride group, 109 in Combizym(®) group and 109 in combined treatment group. There were 148 males (45.8%) and 175 females (54.2%) with median age 71.4±9.0 years (60-100 years). Baseline characteristics of three groups were comparable. After treatment, the NDSI scores in three groups all decreased significantly (P<0.001), while they were similar between groups (P>0.05). The discomfort intensity score and PDS score in three groups showed a significant reduction after treatment (P<0.001), especially in the combined treatment group. Compared with Mosapride group, the scores in Combizym(®) group decreased significantly after one or two weeks [discomfort intensity score: after one week, 4.0(2.5, 8.0) vs. 6.0(3.0, 10.0); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 6.0); all P<0.05. PDS score: after one week, 6.0(3.0, 9.0) vs. 7.0(3.5, 10.5); after two weeks, 3.0(0.0, 5.0) vs. 4.0(2.0, 7.0); all P<0.05]. The efficacy rate in all patients after first week of treatment was over 15.0%. The efficacy rates after two weeks were 55.2%, 68.8% and 73.4% in Mosapride group, Combizym(®) group and combined treatment group, respectively. After two week treatment, the efficacy rates in Combizym(®) group (P=0.041) and combined group (P=0.006) were higher than that of Mosapride group. The recurrence rate of Mosapride group was 9.5%, which was significantly higher than that of Combizym(®) group (1.8%, P<0.05) and combined treatment group (1.8%, P<0.05). There were no serious adverse effects in the three groups. Conclusions: The efficacy of Oryz-Aspergillus enzyme and pancreatin tablets is comparable with that of Mosapride in elderly PDS patients, with fewer adverse effects and low recurrence rate. Combination regimen indicates better efficacy than that of Oryz-Aspergillus enzyme and pancreatin tablets or Mosapride alone.

Decreased expression of SorCS1 in colorectal cancer: An independent predictor of poor prognosis

Previously, we identified that sortilin related VPS10 domain containing receptor 1 (SorCS1) was hypermethylated in colorectal cancer (CRC) tissues. Here, we aimed to investigate the association between CRC and SorCS1. DNA methylation was determined by methylation-specific polymerase chain reaction (MSP) or quantitative real-time methylation analysis (MethyLight). Colorectal cancer tissue specimens from 239 patients that had undergone surgical treatment were evaluated using immunohistochemistry (IHC) analysis for the expression of SorCS1 and correlated with clinicopathological variables and prognosis. We found that SorCS1 was hypermethylated in CRC cell lines and 67.5% (27/40) CRC tumor tissues. The loss of SorCS1 mRNA (p<0.001) and protein expression (p=0.033) were highly correlated with promoter methylation. In addition, SorCS1 expression was significantly increased in younger patients (p=0.006), low CEA level (p<0.001) and pT1-2 stage (p=0.005). Survival analysis revealed that decreased expression of SorCS1 was an independent factor for predicting the increased risk of recurrence (p=0.024) and poor overall survival (p=0.006). Subgroup analysis for CEA level, pT and pN classifications showed that SorCS1 retained its stratified significance only in patients with low CEA level, pT3-4 tumors and pN1-2 lymph node status. Our findings suggest that SorCS1 is epigenetically inactivated in a substantial fraction of CRC, and its expression may be a promising prognostic factor in CRC patients.

[The application of parental version of pediatric voice-related quality of life in children with voice disorders]

Objective:To evaluate the influence of voice disorders on children's quality of life through the parental version of pediatric voice-related quality of life（pVRQOL）. Method:Three hundred and eighty-six children from August 2017 to December 2018 were enrolled in this study. A total of 214 parents of children had voice disorders（dysphonic group）, and 172 parents of children were without voice disorders（control group）. Both groups were filled out the questionnaire containing the parental version of pVRQOL. Result:① The most common disease in children with voice disorder was vocal fold nodule, and boys were more susceptible to voice disorder than girls（71.5%, 28.5%）; ②In dysphonic group, the scores of total（91.40±8.63, 97.94±4.23）, physiology and function（87.55±10.98, 96.99±6.10）, social emotion（98.86 ±3.29, 99.73±1.08） were lower than those in control group（P<0.01）; ③In dysphonic group, there was a correlation between the parents' overall evaluation of the children's voice quality and the three dimensions of the parental version of pVRQOL（total: r=-0.398, P<0.01, physical function: r=-0.448, P<0.01, social-emotion: r=-0.125, P<0.05）. Conclusion:Voice disorders could cause a negative impact on children's voice related quality of life. pVRQOL could be applied to assess the voice-related quality of life in children with voice disorders.

Design, synthesis and biological evaluation of new steroidal β-triazoly enones as potent antiproliferative agents

β-Triazoly enones are biologically interesting scaffolds, incorporation of such scaffolds into the steroid nucleus may generate new bioactive steroids and further enrich structural types of steroids. In this work, a series of new steroidal β-triazoly enones were synthesized based on click chemistry and Claisen-Schmidt condensation reaction and further evaluated for their antiproliferative activity against a panel of cancer cells. Most of these compounds showed better potency against PC-3 and MGC-803 cells. Particularly, compound 5a inhibited PC-3 and MGC-803 cells potently with the IC₅₀ values of 1.61 and 1.16 μM, respectively, and was less toxic toward GES-1 with an IC₅₀ value of 20.72 μM. Further mechanistic studies showed that compound 5a inhibited migration and invasion of MGC-803 and PC-3 dose-dependently. Treatment with compound 5a varied mRNA levels and protein expression of EMT markers in both cells. Collectively, the steroidal β-triazoly enones could be potentially utilized to develop new anticancer agents with the ability of inhibiting cell migration and invasion.

[The application of pediatric voice handicap index in children with voice disorders]

Objective: To access the influence of voice disorders on children's voice-related quality of life through the parental version of pediatric voice handicap index (pVHI). Methods: From April 2017 to March 2018, a total of 192 children with voice disorders (dysphonic group) and 111 children without voice disorders (control group) were enrolled in this work. Parents of children in both groups were asked for fill out the questionnaire containing the parental version of pVHI and the data of non-normal distribution were analyzed by Mann-Whitney U test. Spearman test was used for correlation analysis. Results: (1)Vocal cord nodule was the most common voice disorder in children, and boys were more susceptible to voice disorder than girls in this study (70.3%(135/192) vs 29.7%(57/192)). (2)The most common voice abuse or misuse habit was "Shouting loudly". (3)In dysphonic group, the scores of function, physiology, emotion and total were higher than those in control group (all P<0.05). (4)In dysphonic group, there was a weak correlation between the parents' overall evaluation of the children's voice status and the three dimensions of the parental version of pVHI (function: r=0.339, physiology: r=0.334, emotion: r=0.208, all P<0.001). Conclusions: Voice disorders can cause a negative impact on children's quality of life. Parental version of pVHI can be used to assess the voice-related quality of life in children with voice disorders.

[Differential expression and clinical significance of calretinin in total colonic aganglionosis]

Objective: To evaluate the differential calretinin immunostaining in different segments of total colonic aganglionosis and its utility in the diagnosis. Methods: Nine specimens including ileum and colon segments were obtained from 9 patients with total colonic aganglionosis (TCA), from 2010 to 2016 year, in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology. Another 9 ganglionic specimens including the same segments from patients with non-Hirschsprung disease (non-HD) patients were collected as control. All cases were immunostained with calretinin. The patterns of calretinin immunostaining were observed, and morphometric analysis of each sample was performed by image analysis program (Image-Pro-Plus). The mean absorbance was evaluated by calculating the areas of the lamina propria occupied by the positively stained area of the calretinin at high power field. Results: The same pattern of calretinin immunostaining was seen in ganglionic ileum and ganglionic colon segments, with staining seen in intrinsic nerves fibers (INF), and in granular aggregates in the lamina propria and muscularis mucosae. There was no significant difference in the numbers of calretinin-positive INF from the ganglionic segments. In contrast, the number of calretinin-positive INF and granular aggregates in aganglionic segments were significantly lower than those in the ganglionic group (P<0.01). In the ileum transitional zone, scattered calretinin staining was observed, and the amount of calretinin-positive INF was significantly lower than those in the proximal segment of ganlionic ileum (P<0.01). Conclusions: Since there is significant different expression of calretinin among the different segments from TCA, calretinin immunostaining has potential value in detecting TCA. It could be an important adjunctive method in detecting TCA in the future.

[Quantity of Treg cells and Th17 cells in spleen of primary immune thrombocytopenic purpura patients]

Objective: To observe the quantity of Treg cells and Th17 cells in spleen of adult primary immune thrombocytopenic purpura (ITP) patients. Methods: 43 ITP cases with splenectomy treatment were enrolled from December 2008 to June 2016 at Union Hospital of Fujian Medical University, including 20 males and 23 females with a median age of 36 (18-76) years. The controls were thirty patients who underwent splenectomy because of pancreatic diseases or splenic impairment, including 21 males and 9 females with a median age of 47 (21-69) years. The quantity and ratio of Treg cells and Th17 cells were examined by immunohistochemistry between ITP patients and controls. Results: ①The quantity of Treg cells in ITP were less than controls[ (11.3±4.7) /mm(2) vs (59.0±15.0) /mm(2), t=-22.894, P<0.001], but Th17 cells were more than controls[ (235.2±69.4) /mm(2) vs (181.1±23.7) /mm(2), t=13.768, P<0.001]. So the ratio of Treg/Th17 in ITP was lower than controls (0.048±0.027 vs 0.328±0.086, t=19.522, P<0.001) . ② The quantity of Treg cells in cases without response after splenectomy were less than cases with response[ (9.5±5.0) /mm(2) vs (11.6±4.7) /mm(2), t=2.723, P=0.010], and there is no statistical differences between the two groups about the quantity of Th17 cells and the ratio of Treg/Th17 cells[ (232.3±80.8) /mm(2) vs (239.6±66.9) /mm(2), t=1.108, P=0.277; 0.040±0.024 vs 0.053±0.027, t=0.540, P=0.592]. Conclusions: There is a significant difference about the quantity of Treg cells and Th17 cells in spleen between ITP patients and healthy controls, and they are relevant to the response after splenectomy.

Avoiding perioperative dexamethasone may improve the outcome of patients with rectal cancer

BACKGROUND

Perioperative administration of dexamethasone may augment recurrence and mortality after tumor resection possibly by immunosuppression, which, unfortunately, has never been noted. We therefore carried out a retrospective study in rectal cancer to validate the hypothesis.

METHODS

Five hundreds and fifteen patients with stage I to III rectal cancers who underwent a curative resection from June 2007 and June 2011 were enrolled in the current study. Patients who had been given intravenous (IV) dexamethasone (4-10 mg) postoperatively and/or intraoperatively were assigned to dexamethasone group. The outcome of dexamethasone group and non-dexamethasone group were compared. The primary outcome was disease-free survival (DFS) and overall survival (OS).

RESULTS

dexamethasone group had significant lower three-year DFS (62.3% vs 71.8%, P = 0.026) and OS (74.1% vs 82.9%, P = 0.031) rate in comparison to non-dexamethasone group, the hazard ratios (HRs) of which were 1.59 (95% CI 1.05-2.39, P = 0.028) and 1.77 (95% CI 1.05-3.01, P = 0.034), respectively. Multivariate analysis revealed that administration of systemic dexamethasone were independently associated with DFS [adjusted HR 1.60 (95% CI 1.03-2.49, p = 0.039)], but for OS, dexamethasone didn't remain significant in this model. In the analyses of a subgroup of 428 patients (55/428 in dexamethasone group) without perioperative blood transfusion, dexamethasone had independently impact on both DFS and OS.

CONCLUSION

Patients not given dexamethasone had better three-year survival outcomes compared with patients given dexamethasone perioperatively. Our results indicate that rectal cancer patients treated with curative surgery may get survival benefit from avoiding low-dose perioperative dexamethasone.

Thelohanellus testudineus n. sp. (Myxosporea: Bivalvulida) infecting the skin of allogynogenetic gibel carp Carassius auratus gibelio (Bloch) in China

A Thelohanellus species was encountered during a survey on Thelohanellus diversity of Carassius auratus gibelio (Bloch) in China. The infection is characterized by the presence of large cysts of 1.4-3.2 cm in diameter in the skin of host. Mature spores were ampullaceous in frontal view and testudinate in lateral view, measuring 19.7 ± 0.7 (18.6-20.8) μm long, 7.6 ± 0.4 (6.6-8.4) μm wide and 7.3 ± 0.5 (6.6-8.8) μm thick. The single polar capsule was elongated pyriform, with 11.1 ± 0.5 (10.0-11.9) μm long and 5.3 ± 0.3 (4.3-5.8) μm wide. Polar filaments coiled with 7-8 turns. Scanning electron microscopy revealed a smooth spore surface with flat side and convex side. The sutural line was straight or 'S' like, running near the middle of the valves. Histologically, the large cysts consisting of numerous small plasmodia developed in the dermis of the skin. The BLAST search indicated that the newly obtained ssrRNA gene sequences did not match any available sequences in GenBank and phylogenetic analysis placed it in the Thelohanellus clade. Based on morphology and molecular differences with reported Thelohanellus spp., this parasite was described as a new species of genus Thelohanellus.

[Plasma fibroblast growth factor-21 and abdominal obesity]

OBJECTIVE

To investigate the association of plasma fibroblast growth factor-21 (FGF-21) with abdominal obesity and other metabolic indicators.

METHODS

Sixty one people with abdominal obesity and 113 healthy controls were recruited. The stature, avoirdupois, waist circumference and blood pressure of the participants were measured. Serum lipid, glucose, insulin and plasma FGF-21 levels of those participants were also determined.

RESULTS

1) The participants with abdominal obesity had significantly higher FGF-21 levels than the healthy controls [(1.91 +/- 0.40) ng/mL vs. (1.75 +/- 0.45) ng/mL, P = 0.020]. 2) Plasma FGF-21 levels were positively associated with BMI (r = 0.24, P = 0.001), waist circumference (r = 0.16, P = 0.033), body fat contents (r = 0.24, P = 0.001), and triglycerides (r = 0.16, P = 0.036) after adjustment for age and sex. The multiple liner regression analysis identified BMI, waist circumference, body fat contents, and triglycerides as factors associated with FGF-21 (P < 0.05). 3) Plasma FGF-21 levels were found to be independently associated with abdominal obesity (OR = 2.413, 95% CI 1.115-5.221, P = 0.025).

CONCLUSION

FGF-21 is an independent risk factor for abdominal obesity. It is perhaps an important factor in the occurrence and development of abdominal obesity.

Regional phase unwrapping algorithm for photoelastic phase map

In this paper, a simple isoclinic phase map unwrapping method is proposed to retrieve map with ambiguities at photoelastic isotropic points. Regional phase unwrapping method is also utilized to enhance the retrieving efficiency after all phase inconsistencies have been fully detected and branch cutting works have been properly done to ensure blockings of all the paths which could cause incorrect integrations while involuntarily crossing them. The correctly retrieved isoclinic data are then fed into isochromatic formulation, and as a consequence an inconsistency free isochromatic phase map will be obtained. This map can be unwrapped by any simple and fast unwrapping algorithm accurately and effectively. Circular disk and ring under diametric compression samples are both applied for the verification of the proposed algorithm. The experimental results show the proposed algorithm can successfully solve the annoying problems occurred at photoelastic isotropic points with a processing time of roughly 2 seconds for a 420 x 420 pixels map by a general personal computer.

[Relationship of 25(OH)VD with bone mass and other indicators in male patients with diabetes mellitus]

OBJECTIVE

To investigate the relationship of serum 25- Hydroxy D with bone mass density and other indicators in male patients with diabetes.

METHODS

Bone mass density (BMD), serum 25- HydroxyD (25 (OH)VD) and several other biochemical indicators were measured in 82 male patients with diabetes, among whom 49 had osteoporosis.

RESULTS

The diabetic patients with osteoporosis had higher tartrate-resistant acid phosphatase-5b (TRCAP-5b) and lower 25(OH)VD, testosterone (T), Dehydroepiandrosterone sulfate (DHEA-S), and bone-specific alkaline phosphatase (B-ALP) than those without osteoporosis (P < 0.05). The Parathormone (PTH) and albumin-creatinine ratio (UAlb/Cr) also increased in the diabetic patients with osteoporosis, but with no statistical significance. No difference was observed in glycosylated hemoglobin (HBA1c) between the diabetic patients with and without osteoporosis. The serum 25(OH)VD was negatively correlated with the duration of diabetes in both groups (P < 0.05), which was independent from the increase of age. The serum 25(OH)VD was positively correlated with T score of neck, ward, greater trochanter of femur and vertebrae lumbales, and T and DHEA-S in both patients with and without osteoporosis (P < 0.05). The 25(OH)VD was also positively correlated with PTH in the patients with osteoporosis. Negative correlation was noted between 25(OH)VD and B-ALP. There were no correlations between 25(OH)VD and TRCAP-5b, HBA1c and UAlb/Cr.

CONCLUSION

Serum 25(OH)VD, T and DHEA-S may play an important role in the development of osteoporosis in male patients with diabetes mellitus.

Reliability of π–π Stacking Interactions in Crystal Engineering: Synthesis and Structure of a Hemidirected Lead Complex

A new three-dimensional polymeric supramolecular PbII complex, {[Pb3(bpy)3(ip)3](H2O)}n, (bpy = 2,2′-bipyridine and ip = isophthalate), has been synthesised and characterised. Single-crystal analysis shows that {[Pb3(bpy)3(ip)3](H2O)}n contains a one-dimensional chain polymeric framework and all the Pb centres with a coordination number of six possess an electron lone pair. The coordination sphere is hemidirected which gives a highly distorted geometry. The arrangement of O- and N- atoms towards Pb atoms suggests a gap or hole in the coordination geometry around these atoms. Moreover, there are three types of π–π interactions between aromatic rings and the one-dimensional chains, which are connected by these interactions to form a three dimensional supramolecular network with the channels occupied by water molecules.

Scoliosis and severe pelvic obliquity in a patient with cerebral palsy: surgical treatment utilizing halo-femoral traction

STUDY DESIGN

Case report of severe scoliosis and associated pelvic obliquity in a 14-year-old patient with cerebral palsy.

OBJECTIVES

To report the presentation of the case, the operative considerations, and the management of this spinal deformity.

SUMMARY OF BACKGROUND DATA

Spinal deformity in cerebral palsy may include scoliosis, kyphosis, and hyperlordosis. Pelvic obliquity is a frequent feature associated with neuromuscular scoliosis. The severity of the pelvic obliquity deformity presented here is unusual, and this case study delineates an effective surgical treatment plan for these patients using intraoperative halo-femoral traction.

METHODS

A same-day, two-stage surgical reconstruction was performed to effectively correct this spinal deformity. The patient underwent an anterior spinal fusion from T10 to S1 and a posterior spinal fusion from T2 to the pelvis; the posterior procedure was performed with the patient in intraoperative halo-femoral traction. Sacral fixation was obtained using the Galveston technique bilaterally.

RESULTS

The patient responded well to surgical intervention, had no complications, and continues to have stable correction of his pelvic obliquity deformity 2 years after surgery.

CONCLUSION

It is concluded that scoliosis with associated severe pelvic obliquity deformities can be treated with anterior and posterior spinal fusion and instrumentation with intraoperative halo-femoral traction in the properly selected and prepared patient with cerebral palsy.

Immunogene therapy of tumors with vaccine based on Xenopus homologous vascular endothelial growth factor as a model antigen

Overcoming immune tolerance of the growth factors associated with tumor growth should be a useful approach to cancer therapy by active immunity. We used vascular endothelial growth factor (VEGF) as a model antigen to explore the feasibility of the immunogene tumor therapy with a vaccine based on a single xenogeneic homologous gene, targeting the growth factors associated with angiogenesis. To test this concept, we constructed a plasmid DNA encoding Xenopus homologous VEGF (XVEGF-p) and control vectors. We found that immunogene tumor therapy with a vaccine based on XVEGF was effective at both protective and therapeutic antitumor immunity in several tumor models in mice. VEGF-specific autoantibodies in sera of mice immunized with XVEGF-p could be found in Western blotting analysis and ELISA assay. The purified immunoglobulins were effective at the inhibition of VEGF-mediated endothelial cell proliferation in vitro, and at antitumor activity and the inhibition of angiogenesis by adoptive transfer in vivo. The elevation of VEGF in the sera of the tumor-bearing mice could be abrogated with XVEGF-p immunization. The antitumor activity and production of VEGF-specific autoantibodies, significantly elevated IgG1 and IgG2b, could be abrogated by the depletion of CD4(+) T lymphocytes. The observations may provide a vaccine strategy for cancer therapy through the induction of autoimmunity against the growth factors associated with tumor growth in a cross reaction with single xenogeneic homologous gene and may be of importance in the further exploration of the applications of other xenogeneic homologous genes identified in human and other animal genome sequence projects in cancer therapy.

[Advances in the fiber coating of solid phase micro-extraction]

Solid phase micro-extraction (SPME) is a simple and effective sample preparation technique and fiber coatings play a very important role in SPME process. The discussion begins with a brief historical perspective from the very early work conducted almost a decade ago. At the moment, more than 20 alternatives of fiber coatings and size are available. In this paper, the coatings are divided into two categories: commercial fibers and custom-made fibers. A novel so-gel method has been introduced for the preparation of the coatings.

An ab initio theoretical study of the stereoisomers of tetrahydrocannabinols

An extensive theoretical study of the stereoisomers of tetrahydrocannabinols has been performed at the ab initio HF/6-31G* and B3LYP/6-31G* levels. Effects of solvation were calculated with the Onsager model (with full geometry optimization), SCRF with Tomasi's PCM, and isodensity polarization continuum models. Single-point MP2//HF/6-31G* calculations were carried out. Frequency calculations for all the isomers at the HF/6-31G* level and for two natural isomers delta1-THC-RR and delta6-THC-RR at the B3LYP/6-31G* level were performed. Our results support the findings of the previous AM1 studies that the orientation of the carbocyclic ring and its C1 substituent with respect to the phenyl group hydroxyl oxygen play the major role in the activity. The calculated values of the LUMO energy (lowest unoccupied molecular orbital) and the hardness of the stereoisomers show that for the trans isomers it is easier to remove one electron from its HOMO (highest occupied molecular orbital) to the LUMO and easier to accept an electron from the receptor binding site than for the cis isomers. Combining geometric features (the orientation of the carbocyclic ring and its C1 substituent with respect to the phenyl group hydroxyl oxygen) with electronic features (LUMO and hardness), we explain the activity differences among the stereoisomers.

Immunotherapy of tumors with xenogeneic endothelial cells as a vaccine

The breaking of immune tolerance against autologous angiogenic endothelial cells should be a useful approach for cancer therapy. Here we show that immunotherapy of tumors using fixed xenogeneic whole endothelial cells as a vaccine was effective in affording protection from tumor growth, inducing regression of established tumors and prolonging survival of tumor-bearing mice. Furthermore, autoreactive immunity targeting to microvessels in solid tumors was induced and was probably responsible for the anti-tumor activity. These observations may provide a new vaccine strategy for cancer therapy through the induction of an autoimmune response against the tumor endothelium in a cross-reaction.

Successful treatment of all-trans retinoic acid resistant and chemotherapy naïve acute promyelocytic patients with arsenic trioxide--two case reports

Arsenic trioxide(As2O3) has proved highly effective in treating both refractory or primary cases of acute promyelocytic leukemia (APL). The role of arsenic trioxide in APL treatment has been confirmed by study groups in China and in the USA. However, what is the role of As2O3 in treating APL? Should it be used as first line therapy, or should it be used as a second line drug. This still remains to be defined. Here, we report two cases of APL, who were treated successfully with As2O3 when they relapsed. Initially, both received all-trans retinoic acid (ATRA) for primary remission induction therapy, and obtained a complete remission. For ethical or personal reasons, they did not receive chemotherapy as consolidation therapy and when they relapsed at 23 months and 12 months later respectively, they both received As2O3 therapy after being resistant to ATRA treatment. Two courses of As2O3 were given and both reached complete remission. There were very few adverse reactions to the drug, only mild abdominal cramps, mild fluid retention, and transient elevation of transaminases. They both had rather good quality of life throughout the treatment and both remain in remission for 32 months and 10 months since therapy, respectively.

Retinoic acid syndrome induced by arsenic trioxide in treating recurrent all-trans retinoic acid resistant acute promyelocytic leukemia

Arsenic Trioxide (As2O3) is an effective agent for treating acute promyelocytic leukemia achieving a complete remission rate of about 60% to 90%. It is similar to all-trans retinoic acid (ATRA) when treating acute promyelocytic leukemia (APL), because both agents have limited side effects compared to conventional chemotherapy, although the treatment period is more prolonged. During treatment, both agents may induce leukocytosis, and in patients taking ATRA, leukocytosis appears to be related to the development of retinoic acid syndrome (RAS). We report here a case of APL treated with ATRA in combination with chemotherapy 3 years earlier. During treatment, an episode of RAS with fever, edema, pericardiac effusion etc. was encountered. Recently, she had a relapse of leukemia, and As2O3 therapy was used. Leukocytosis developed again, and symptoms of fever, skin rash, edema resembling a RAS also developed, which was quickly relieved by steroid administration in a manner resembling response to RAS.

Factors related to the survival of papillary and follicular thyroid carcinoma patients with distant metastases

There is limited clinical information comparing presentations and results of treatment of papillary and follicular thyroid carcinoma patients with distant metastases. We retrospectively analyzed data of 1,257 thyroid cancer patients who received their treatment and follow-up at Chang Gung Memorial Hospital. We found 992 patients with papillary carcinoma and 205 patients with follicular thyroid carcinoma. Of these, 68 patients with papillary thyroid carcinoma (6.9%) had distant metastases at the time of diagnosis or during the follow-up period. Of the follicular thyroid carcinoma patients, 69 (33.7%) had distant metastases. Of the 68 patients with papillary carcinoma, only 33 were categorized as stage IV at the time of diagnosis. Nine of the patients were categorized as clinical stage I carcinoma, 10 as stage II, and 16 as stage III. Sixteen patients (23.5%) died during the study period, all but 2 of thyroid cancer. Twelve of the 68 patients were disease-free after treatment. Of the 69 patients with follicular thyroid carcinoma, 58 were categorized as stage IV at the time of diagnosis. Six of the patients were categorized as clinical stage I carcinoma, 2 as stage II, and 3 as stage III at the time of diagnosis; all of these patients deteriorated to stage IV during the follow-up period. Of the 42 patients with follicular thyroid carcinoma involving bone, 24 presented with bone metastases during the initial diagnosis. After treatment, 25 of 69 patients with follicular carcinoma died of follicular carcinoma. Only 3 patients were disease-free after the treatment. In patients with follicular carcinoma, only tumor size was an important prognostic factor. In this study, 8 patients categorized as clinical stages I to III at the time of operation had thyroglobulin (Tg) levels less than 5 ng/mL and developed distant metastases during the follow-up period. In conclusion, at diagnosis a large group of Asian patients with metastatic well-differentiated thyroid cancer was more likely to have follicular than papillary histology, and that, as expected, metastases from follicular cancer were present earlier and more frequently, were more likely to involve bone, were more likely to be associated with mortality, and were linked to tumor size but not gender. Also unlike some other reports, treatment producing a low Tg did not always produce a good outcome. More aggressive surgical procedures may be able to improve outcomes.

Ectopic ACTH syndrome due to thymic carcinoid tumor in a girl

An 8 year-old girl had a cushingoid appearance for six months. Hormone study showed extremely high serum levels of cortisol (> 60 micrograms/dl) and adrenocorticotropic hormone (930 pg/ml). Initial chest X-ray showed nothing unusual, but a technetium-99mm MIBI scan showed an accumulation lesion in the left upper chest cavity. Chest magnetic resonance imaging demonstrated that the mass was in the superior anterior mediastinum. She had complete removal of the tumor with partial thymectomy. The pathology revealed a thymic carcinoid tumor. Carcinoid tumors of the thymus are extremely rare in children and they usually present with Cushing's syndrome. To our knowledge, this is the youngest patient who has ever been reported with this disease.

Preparation of poly(acrylic acid) modified polyurethane membrane for biomaterial by UV radiation without degassing

Poly(acrylic acid) modified polyurethane (AA/PU) membranes were prepared by UV radiation without degassing. The chemical composition of the AA/PU membrane was studied by IR spectroscopy. In addition to those absorption peaks associated with pure PU, the absorption peak at 2400 cm-1 of poly(AA) was also found. The morphology of AA/PU membrane was studied by optical polarizing microscopy. We also measured the glass transition temperature and the decomposition temperature of the AA/PU membrane by differential scanning calorimetry and thermogravimetric analysis. A significant domain was found in the AA/PU membrane, which resulted in different glass transition temperature and decomposition temperature between AA/PU and pure PU membrane. The effect of AA content on the contact angle and water absorption of the AA/PU membrane was determined. It was found that the water content of AA/PU membrane increased with increasing AA content, whereas the contact angle decreased. By using Kaeble's equation and the contact angle data, the surface free energy of AA/PU membrane was determined. The increase of surface free energy resulted from the increase of the dispersion (gammad) term and polar (gammap) term. In order to evaluate the biocompatibility of these membranes, a cytotoxicity test and a cell adhesion and proliferation assay were conducted in cell culture. Immortal cells and primary lymphocytes were both used in this study. The results showed that these AA/PU membranes exhibited very low cytotoxicity and could support cell adhesion and growth. An animal primary test was also done in this study. It was found that the AA/PU membrane could possibly be employed in the treatment of bowel defect.

Prevalence and significance of thyroid autoantibodies in patients with chronic hepatitis C virus infection: a prospective controlled study

OBJECTIVE

To clarify controversies on the prevalence and clinical significance of thyroid autoimmunity in hepatitis C virus (HCV) infection.

DESIGN

A prospective controlled and follow-up study.

PATIENTS AND MEASUREMENTS

Serum thyroid microsomal antibody (TMA) and thyroid stimulating hormone were assayed and compared in a consecutive, unselected series of 130 patients with chronic HCV infection, 130 sex/age (+/- 2 years)-matched patients with chronic hepatitis B virus (HBV) infection and 260 matched normal controls.

RESULTS

The prevalence of thyroid autoantibodies in male patients with chronic HCV was < 2%. The prevalence of TMA (< 1:400) in female patients with chronic HCV infection was significantly higher than that of HBV controls (22.1 vs. 1.6%; P < 0.001), and higher but not significant compared with normal controls (13.5%). However, the trend of increasing prevalence with age in normal controls was not observed in HCV patients. TMA seropositive female HCV patients were not different from seronegative counterparts in age, duration of infection, HLA haplotype, associated autoantibodies and liver histology but had a significantly higher prevalence of genotype 1b/2b mixed infection (P < 0.01) and anti-GOR (P < 0.05). Of the 23 HCV patients seropositive for thyroid autoantibodies, seven had Hashimoto's thyroiditis, two had Graves' disease and three had received subtotal thyroidectomy. During follow-up, four of 15 female patients showed a 14-16-fold increase in TMA titre and one developed hyperthyroidism. Patients with thyroid autoantibodies did not show a propensity to develop thyroid dysfunction during interferon therapy.

CONCLUSIONS

These results suggest a weak association between HCV and thyroid autoimmunity in females. As in the ordinary population with thyroid autoantibodies, they should be evaluated for thyroid status and be followed-up if thyroid autoimmunity is evident. However, seropositivity of thyroid autoantibodies is not a contraindication to interferon therapy.

Surgical treatment of severe perthes disease: comparison of triple osteotomy and shelf augmentation

The optimal management of the severe form of Perthes disease is controversial. This retrospective study evaluated the results of two procedures in two groups of patients with Perthes disease. The Catterall classification was adopted for grouping of patients before treatment. The Herring classification was used for comparison of the follow-up radiographs. Under the concept of surgical containment, triple innominate osteotomy was performed in 14 patients at an average age of 8 years 7 months with a mean follow-up period of 4 years 3 months. Staheli's shelf augmentation was performed in 14 patients at an average age of 10 years 2 months with a follow-up period of 3 years 8 months. Radiologically, femoral head subluxation, acetabular coverage, acetabular angle, and center-edge angle were markedly improved in both groups. In the clinical evaluation using modified Sundt's criteria, both procedures were effective. Satisfactory results were achieved in 79% of 14 patients (5 good, 6 fair, and 3 poor) in the triple osteotomy group, and 100% of 14 patients (two good, 12 fair) in the shelf augmentation group. Nevertheless, triple innominate osteotomy is technically more demanding with a longer operating time and resulted in more complications. Staheli's shelf augmentation is a simpler procedure with better coverage of the acetabulum. However, asphericity of the femoral heads was observed more frequently in this group. The Herring lateral pillar classification was better than the Catterall classification in predicting the final outcomes in this study.

Papillary and follicular thyroid carcinomas with bone metastases: a series of 39 cases during a period of 18 years

BACKGROUND

Bone metastases can cause death in patients with papillary or follicular thyroid carcinoma. There is, however, limited information about the clinical presentations and prognoses of patients with papillary and follicular thyroid carcinomas with bone metastases in Taiwan.

MATERIALS AND METHODS

A series of 39 patients with papillary or follicular thyroid carcinomas with bone metastases treated at our center from 1977 through 1995 was retrospectively reviewed to elucidate the clinical presentations and results of treatment of this disease.

RESULTS

The occurrence rate of bone metastasis in papillary and follicular thyroid carcinomas was 4.3%. Of the 39 patients, whose mean age was 57.5 years, 28 (71.8%) had follicular and 11 (28.2%) had papillary carcinomas. Thirty-two patients (82.1%) were female and 7 (17.9%) were male. Twenty-nine patients (74.4%) presented with bone metastases before the thyroid cancers were diagnosed. Bone metastases were detected using radiography in 33 patients and using 131I scans in 28 patients. Thirty-one patients (79.5%) had multiple bone metastases. The spine was the most frequently involved site (53.8%). Three patients were disease-free and 14 patients died during the course of treatment. Using the Kaplan-Meier method, the 5-year survival rate was estimated to be 64.9%.

CONCLUSION

Bone metastasis, although rare in patients with papillary carcinoma, was not very uncommon in patients with follicular carcinoma. Bone metastases occurred more often in older patients. Multiple bone metastases were noted more often than single bone metastasis. Most patients had symptoms and signs resulting from metastatic bone lesions. Although multimodality therapy was tried, the prognoses for most patients with bone metastases were poor.

Relative value of thallium-201 and iodine-131 scans in the detection of recurrence or distant metastasis of well differentiated thyroid carcinoma

Radioactive iodine (131I) has been found to be more sensitive and more specific than thallium-201 for the detection of distant metastases and thyroid remnants in the neck in cases of well-differentiated thyroid carcinoma. 201Tl has been deemed particularly useful in localizing metastases or recurrence in patients with a negative 131I scan and abnormal levels of serum thyroglobulin (Tg). This study aimed to: (1) determine the value of 201Tl imaging in localizing metastases or recurrence in patients with well-differentiated thyroid carcinoma, and (2) evaluate the false-positive and false-negative results of 131I and 201Tl scintigraphy. Sixty-two thyroid remnant ablated patients who underwent simultaneous postoperative 201Tl and 131I scans and and serum Tg determinations were evaluated. Fifty patients had papillary thyroid carcinomas and 12 had follicular thyroid carcinomas. 201Tl imaging was performed before the 131I studies. Of the 62 patients who underwent 201Tl imaging studies, 24 were found to have positive results, with local recurrence or distant metastases. Patients with positive results in the 201Tl imaging studies tended to be older, were mor often male, had higher Tg levels and had a higher recurrence rate. Of these 24 patients, ten had negative diagnostic or therapeutic 131I scans. Concurrently, serum Tg levels were less than 5 ng/ml in five of these ten patients. Three patients were deemed false positive by 201Tl scans; one had a parotid tumour, one a periodontal abscess and one lung metastasis. Among the 38 patients with negative 201Tl scans, 11 had positive findings on 131I scans. Three had distant metastases: two with lung metastases and one with bone metastases. Patients with false-positive results on 131I scans included those with biliary tract stones, ovarian cysts, and breast secretion. Of the 27 patients with negative 201Tl and 131I scans, 15 had elevated serum Tg levels. Among these, local recurrence followed by lung metastases was manifested in a 49-year-old male with papillary thyroid carcinoma. In conclusion, both 131I and 201Tl scans are useful in the detection of recurrence or distant metastasis of well differentiated thyroid cancers. 201Tl scan could in particular be used in patients with a negative 131I scan in conjunction with an elevated Tg level.

Endocrinological aspects of Langerhans cell histiocytosis complicated with diabetes insipidus

Langerhans cell histiocytosis (LCH) is a rare disorder and may be complicated with hypopituitarism and diabetes insipidus (DI) due to invasion of the hypothalamic-pituitary area. In this study, 10 patients with complete (4) and partial (6) type central DI were found among 125 LCH patients in our hospital records. The water deprivation test, followed by the pitressin test, was performed to confirm DI. Hypothalamic-pituitary endocrine function tests were carried out on these 10 patients at the initial diagnosis and during follow-up. All patients revealed growth hormone insufficiency in the insulin hypoglycemic tolerance test. Four patients had impairment of cortisol secretion, demonstrated by insulin hypoglycemic stimulating test results. Two patients had poor response in the thyrotropin releasing hormone stimulating test. Two patients had only partial responses in the luteinizing hormone releasing hormone test. Four patients had hyperprolactinemia. All patients underwent surgical treatment followed by chemotherapy and/or radiotherapy. One patient completely recovered from the endocrine disorder, 3 patients required smaller doses of desmopressin, and one patient had normal adrenal, thyroid, and gonadal function. Hypothalamic-pituitary disorders in LCH should not be neglected. Treatment of LCH can partially or completely reverse associated endocrine disorders. Therefore, endocrine studies and hormone replacement should be mandatory for patients with LCH.

Content of reduced glutathione and consequences in recipients of glucose-6-phosphate dehydrogenase deficient red blood cells

The red blood cell glucose-6-phosphate dehydrogenase (G6PD) activity of every donor was examined with automatic enzyme-coupled method. The technique of molecular biology was applied to determine the DNA mutations for the 97 donors with undetectable G6PD activity. The concentration of reduced glutathione (GSH) in the stored RBC of the 97 G6PD-deficient donors and 124 normal donors was determined with the technique of high performance liquid chromatography. Routine blood counts, bilirubin and haptoglobin levels were used to evaluate posttransfusional hemolysis for the 48 adult patients transfused with 1 U G6PD deficient and 1 U normal RBC. Most (88, 90.7%) of the 97 donors were confirmed to be G6PD deficient at the DNA level. At each age interval of storage, the GSH concentration of G6PD-deficient RBC was significantly different from that of normal RBC. The total average value of GSH (pmol/gHb) was 2.52 +/- 0.95 (mean +/- 1 standard deviation) vs. 3.74 +/- 1.43 (P < 0.001). Hemoglobin, hematocrit, bilirubin, and haptoglobin levels in the patients receiving G6PD-deficient RBC were not statistically different from those in the recipients of normal RBC; even though the age of stored blood was 26-35 days. Within the same group of patients, the results of bilirubin and haptoglobin were not significantly changed before and after transfusion. The results of this study show that the GSH concentration in the stored blood of G6PD deficient donors was 67% of that in the normal donors. However, hemolysis does not occur in adult patients transfused with 1 U G6PD-deficient RBC. It seems unnecessary to screen G6PD activity for donors of adult recipients in Taiwan.

Use of radioactive iodine for thyroid remnant ablation in well-differentiated thyroid carcinoma to replace thyroid reoperation

Complete thyroidectomy was recommended for patients with well-differentiated thyroid carcinoma to remove any potential residual contralateral cancer tissue and to facilitate detection of metastatic lesions by radioactive iodide (131I). Unfortunately, 8-32% incidence of severe complications were noted after reoperation. At present, there are still not enough data about the ablative effect of 131I for such conservative surgical treatment of well-differentiated thyroid cancers. The major goal of the present study was to examine the effects of 311I for ablation of thyroid remnants in order to obviate the severe complications associated with reoperation. From January 1977 to December 1995, 210 papillary or follicular thyroid carcinoma patients received subtotal thyroidectomy or lobectomy. After the operation, 46 of the 210 patients received 131I for remnant ablation. At doses of > or = 30 mCi 131I, 38 thyroid remnants were successfully ablated; 25 of 38 (65.8%) patients successfully ablated patients received 30 mCi 131I one-four times. Five patients expired during the follow-up period, including two follicular carcinoma patients who were misinterpreted as having benign lesions in the first operation. Patients in the overall failure versus success group for thyroid remnant ablation revealed increased age, histopathology of follicular carcinoma, higher postoperative 131I uptake in the neck bed, higher postoperative thyroglobulin levels, bigger tumor size, and higher mortality. In conclusion, repeated 30 mCi 131I treatments were adequate for most thyroid remnant ablations following subtotal thyroidectomy or lobectomy in well-differentiated thyroid cancer patients. Misinterpretation of follicular cancer as benign lesions and unresectable tumor comprised the main reasons for mortality.

Acute suppurative thyroiditis and aggressive malignant thyroid tumors: differences in clinical presentation

BACKGROUND AND OBJECTIVES

Aggressive malignant thyroid tumors (AMTT) may mimic the clinical symptoms and signs of acute suppurative thyroiditis (AST) in the early course of the disease process. Our objective was to analyze the clinical features of these two conditions, to assess the best way of early diagnosis, and to propose proper treatment.

METHODS

We retrospectively reviewed and analyzed the clinical features of 30 patients, who had similar clinical pictures of AST and were managed at Chang Gung Memorial Medical Center in Linkou, Taiwan, during the period from 1983 to 1996. These patients were consequently diagnosed as either AST or AMTT. The data were analyzed by the Mann-Whitney U, chi-square and Fisher's exact tests.

RESULTS

Among the 30 patients, 25 patients (Male/Female (M/F) ratio = 9/16) were diagnosed as having AST and 5 (M/F ratio = 1/4) as AMTT. After statistical analysis we concluded that the presence of the following factors, namely, older age at diagnosis (P = 0.0155), history of dysphonia (P = 0.0325), right thyroid lobe involvement (P = 0.0151), large size of lesions (P = 0.0013), presence of anemia (P = 0.0075), and sterile pus cultures from thyroid aspirates (P = 0.0013) were cause to suspect a malignancy if the condition did not improve after antibiotics. Delay in diagnosis and management of AMTT may result in a poor prognosis (P = 0.0082).

CONCLUSION

Due to the high mortality rate of AMTT, we should closely observe the patients with poor prognostic variables of acute thyroiditis. Earlier detection and aggressive surgical intervention for AMTT might improve the outcome.

Computer-assisted design of new drugs based on retrometabolic concepts

Retrometabolic drug design approaches incorporate metabolic and toxicological considerations into the drug design process and represent a novel, systematic methodology for the design of safe compounds. Two major design concepts aimed to increase the therapeutic index (the activity/toxicity ratio) of drugs were developed. Chemical delivery systems (CDS) are primarily used to allow targeting of the active biological molecules to specific target sites or organs based on predictable enzymatic activation. Soft drug approaches are used to design new drugs by building in the molecule, in addition to the activity, the most desired way in which the molecule is to be deactivated and detoxified subsequent to exerting its biological effects. Special computer programs were developed that starting from a lead compound generate complete libraries of possible soft analogs and then help ranking these candidates based on isosteric-isoelectronic comparisons, predicted solubility/partition properties, and estimated metabolic rates. The novel field of large peptide-CDSs imposes special challenges, but a new, remarkably simple model was developed to estimate partition properties for a wide range of compounds, including quite large peptide derivatives. A suggested change of about five order of magnitudes in the distribution coefficient can explain the "lock in" mechanism of brain-targeting delivery systems.