Metastatic sarcoma mimicking pulmonary tuberculous.

Due to high incidence of tuberculosis in Taiwan, there is a tendency for overdiagnosis of tuberculosis. Differential diagnosis between malignant diseases and pulmonary tuberculosis is extremely important for us.

Acute fulminant hepatitis associated with osimertinib administration in a lung cancer patient with chronic hepatitis B: The first mortality case report.

Osimertinib is the most efficient first-line drug, with least adverse effects, for metastatic non-small-cell lung carcinoma (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations with exon 19 deletion or exon 21 L858R mutations. Herein, we present a 68-year-old woman who had chronic hepatitis B with aggressive NSCLC and received osimertinib as cancer treatment for 4.5 months. This is the first report of mortality due to osimertinib-related acute fulminant hepatitis. Clinicians should routinely arrange for hepatitis B virus (HBV) screening and prescribe antiviral drugs to patients with chronic HBV infection before osimertinib administration.

Harnessing Fluorescent Moenomycin A Antibiotics for Bacterial Cell Wall Imaging Studies.

The imaging of peptidoglycan (PGN) dynamics in living bacteria facilitates the understanding of PGN biosynthesis and wall-targeting antibiotics. The main tools for imaging bacterial PGN are fluorescent probes, such as the well-known PGN metabolic labeling probes. However, fluorescent small-molecule probes for labeling key PGN-synthesizing enzymes, especially for transglycosylases (TGases), remain to be explored. In this work, the first imaging probe for labeling TGase in bacterial cell wall studies is reported. We synthesized various fluorescent MoeA-based molecules by derivatizing the natural antibiotic moenomycin A (MoeA), and used them to label TGases in living bacteria, monitor bacterial growth and division cycles by time-lapse imaging, and study cell wall growth in the mecA-carrying methicillin-resistant Staphylococcus aureus (MRSA) strains when the ß-lactam-based probes were unsuitable.

Procedural and post-operative complications associated with laparoscopic versus open abdominal surgery for right-sided colonic cancer resection: A systematic review and meta-analysis.

BACKGROUND: In this analysis, we aimed to systematically compare the procedural and post-operative complications (POC) associated with laparoscopic versus open abdominal surgery for right-sided colonic cancer resection. METHODS: We searched MEDLINE, http://www.ClinicalTrials.gov, EMBASE, Web of Science, Cochrane Central, and Google scholar for English studies comparing the POC in patients who underwent laparoscopic versus open surgery (OS) for right colonic cancer. Data were assessed by the Cochrane-based RevMan 5.4 software (The Cochrane Community, London, UK). Mean difference (MD) with 95% confidence intervals (CIs) were used to represent the results for continuous variables, whereas risk ratios (RR) with 95% CIs were used for dichotomous data. RESULTS: Twenty-six studies involving a total number of 3410 participants with right colonic carcinoma were included in this analysis. One thousand five hundred and fifteen participants were assigned to undergo invasive laparoscopic surgery whereas 1895 participants were assigned to the open abdominal surgery. Our results showed that the open resection was associated with a shorter length of surgery (MD: 48.63, 95% CI: 30.15-67.12; P = .00001) whereas laparoscopic intervention was associated with a shorter hospital stay [MD (-3.09), 95% CI [-5.82 to (-0.37)]; P = .03]. In addition, POC such as anastomotic leak (RR: 0.96, 95% CI: 0.60-1.55; P = .88), abdominal abscess (RR: 1.13, 95% CI: 0.52-2.49; P = .75), pulmonary embolism (RR: 0.40, 95% CI: 0.09-1.69; P = .21) and deep vein thrombosis (RR: 0.94, 95% CI: 0.39-2.28; P = .89) were not significantly different. Paralytic ileus (RR: 0.87, 95% CI: 0.67-1.11; P = .26), intra-abdominal infection (RR: 0.82, 95% CI: 0.15-4.48; P = .82), pulmonary complications (RR: 0.83, 95% CI: 0.57-1.20; P = .32), cardiac complications (RR: 0.73, 95% CI: 0.42-1.27; P = .27) and urological complications (RR: 0.83, 95% CI: 0.52-1.33; P = .44) were also similarly manifested. Our analysis also showed 30-day re-admission and re-operation, and mortality to be similar between laparoscopic versus OS for right colonic carcinoma resection. However, surgical wound infection (RR: 0.65, 95% CI: 0.50-0.86; P = .002) was significantly higher with the OS. CONCLUSIONS: In conclusion, laparoscopic surgery was almost comparable to OS in terms of post-operative outcomes for right-sided colonic cancer resection and was not associated with higher unwanted outcomes. Therefore, laparoscopic intervention should be considered as safe as the open abdominal surgery for right-sided colonic cancer resection, with a decreased hospital stay.

Further Insights on Structural Modifications of Muramyl Dipeptides to Study the Human NOD2 Stimulating Activity.

A series of muramyl dipeptide (MDP) analogues with structural modifications at the C4 position of MurNAc and on the d-iso-glutamine (isoGln) residue of the peptide part were synthesized. The C4-diversification of MurNAc was conveniently achieved by using CuAAC click strategy to conjugate an azido muramyl dipeptide precursor with structurally diverse alkynes. d-Glutamic acid (Glu), replaced with isoGln, was applied for the structural diversity through esterification or amidation of the carboxylic acid. In total, 26 MDP analogues were synthesized and bio-evaluated for the study of human NOD2 stimulation activity in the innate immune response. Interestingly, MDP derivatives with an ester moiety are found to be more potent than reference compound MDP itself or MDP analogues containing an amide moiety. Among the varied lengths of the alkyl chain in ester derivatives, the MDP analogue bearing the d-glutamate dodecyl (C12) ester moiety showed the best NOD2 stimulation potency.

Non-Apnea Sleep Disorder associates with increased risk of incident heart failure-A nationwide population-based cohort study.

PURPOSE: Non-apnea sleep disorder (NASD) increases the risk of cardiovascular events, such as hypertension and ischemic heart disease (IHD). Patients with heart failure (HF) are at higher risk for sleep disorder; however, there is no documentation on NASD's association with HF to date. Therefore, our study aimed to determine whether NASD increases the risk of incident HF. MATERIALS AND METHODS: Using the outpatient and inpatient data from Taiwan's Longitudinal Health Insurance Database, we conducted a nationwide cohort study of patients with a first-time diagnosis of NASD in the year 2000 and followed up the risk of incident heart failure until December 31, 2013. We calculated risks and incidence ratios of HF for patients with NASD compared with the general population. The cumulative incidence of NASD and the subsequent risk of HF are assessed by the Kaplan-Meier method and Cox regression using a matched comparison cohort of HF patients without NASD. RESULTS: The NASD cohort had an adjusted hazard ratio (HR) of incident HF 19.7% higher than that of the cohort without NASD (95% CI = 1.130-1.270; p<0.001). In the NASD population, the mean interval to HF in males and females were 5.00±3.69 years and 5.00±3.66 years, respectively. The Kaplan-Meier analysis indicated that after the seventh year, the incidence of HF was higher in the NASD cohort than in the control cohort till the end of the follow up. CONCLUSIONS: Our study demonstrates that NASD patients are associated with a higher risk of incident HF.

Liquiritigenin Inhibits Colorectal Cancer Proliferation, Invasion, and Epithelial-to-Mesenchymal Transition by Decreasing Expression of Runt-Related Transcription Factor 2.

Inhibition of tumor metastasis is one of the most important purposes in colorectal cancer (CRC) treatment. This study aimed to explore the effects of liquiritigenin, a flavonoid extracted from the roots of Glycyrrhiza uralensis Fisch, on HCT116 cell proliferation, invasion, and epithelial-to-mesenchymal transition (EMT). We found that liquiritigenin significantly inhibited HCT116 cell proliferation, invasion, and the EMT process, but had no influence on cell apoptosis. Moreover, liquiritigenin remarkably reduced the expression of runt-related transcription factor 2 (Runx2) in HCT116 cells. Overexpression of Runx2 obviously reversed the liquiritigenin-induced invasion and EMT inhibition. Furthermore, liquiritigenin inactivated the phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) pathway in HCT116 cells. Upregulation of Runx2 reversed the liquiritigenin-induced PI3K/AKT pathway inactivation. In conclusion, our research verified that liquiritigenin exerted significant inhibitory effects on CRC invasion and EMT process by downregulating the expression of Runx2 and inactivating the PI3K/AKT signaling pathway. Liquiritigenin could be an effective therapeutic and preventative medicine for CRC treatment.

Association of preexisting hypertension with the morality in patients with systolic heart failure in Taiwan: The TSOC-HFrEF registry.

PURPOSE: To investigate the association of preexisting hypertension at admission with the mortality in patients with systolic heart failure (HF). METHOD: We prospectively investigated the association of preexisting hypertension with the mortality among 1351 patients with HF in Taiwan during an average 12 months (range: 8 months-18 months) follow-up period. A multivariate cox regression analysis for the overall cohort and a subgroup analysis by age were performed. RESULTS: After adjustment for all potential risk factors, the associations of preexisting hypertension with cardiovascular mortality were significantly reduced in the overall cohort and those aged less than 65 years (hazard ratios (HR): 0.53, 95% confidence intervals (CI): 0.33-0.84, and 0.28, 95% CI: 0.11-0.67, respectively). However, the associations with all-cause mortality were not significantly different in these two groups (HR: 0.77, 95% CI: 0.54-1.09, and 0.59, 95% CI: 0.32-1.07, respectively). Furthermore, the associations were all nonsignificant in the patients aged older than 65 years. CONCLUSION: Preexisting hypertension have an inverse association with cardiovascular mortality in the Asian patients with systolic HF, particularly for those with younger ages.

Sex-Specific Association between Metabolic Abnormalities and Elevated Alanine Aminotransferase Levels in a Military Cohort: The CHIEF Study.

The association of metabolic syndrome (MetS) components with elevated serum alanine aminotransferase (ALT) levels, a marker of hepatic injury, may differ between men and women. However, the sex-specific association in a military young population which has a low prevalence of MetS was unclear. We conducted a cross-sectional examination in 6738 men and 766 women, aged 18-50 years, from the cardiorespiratory fitness study in armed forces (CHIEF) in eastern Taiwan. The components of MetS were defined according to the updated International Diabetes Federation (IDF) ethnic criteria for Asians. Elevated ALT levels were defined as ≥40 U/L for both sexes and ≥30 U/L for women alternatively. Multivariate logistic regression analysis was performed to determine the sex-specific association between MetS components and elevated ALT. The prevalence of MetS and elevated ALT in men were 11.9% and 12.7% respectively, and in women were 3.5%, and 3.8% respectively. In men, high-density lipoprotein < 40 mg/dL, blood pressures ≥ 130/85 mmHg, serum triglycerides ≥ 150 mg/dL, and waist size ≥ 90 cm were associated with elevated ALT (odds ratios (OR) and 95% confidence intervals: 1.59 (1.34-1.90), 1.40 (1.19-1.65), 2.00 (1.68-2.39), and 1.68 (1.38-2.04); all p < 0.001); whereas in women, only fasting plasma glucose ≥ 100 mg/dL was associated with elevated ALT ≥ 40 U/L (OR: 7.59 (2.35-24.51), p = 0.001) and ALT ≥ 30 U/L (2.67 (0.89-7.95), p = 0.08). Our findings suggest that the relationship between metabolic abnormalities and elevated ALT may differ by sex, possibly due to the MetS more prevalent in young adult men than in women.

Dried salted plum consumption ameliorates hyperbaric oxygen therapy-induced otalgia severity at the first chamber session: a prospective randomized controlled study.

PURPOSE: One of the most common complications of hyperbaric oxygen (HBO2) therapy is middle ear barotrauma (MEB), occasionally causing otalgia. The objective of this study was to evaluate the effect of dried salted plum consumption on MEB and otalgia associated with HBO2 therapy. MATERIALS AND METHODS: Patients undergoing the first chamber session of HBO2 therapy were included in the present prospective randomized controlled trial. The Valsalva maneuver was administered to all patients before HBO2. The patients were randomly divided into two groups: one that ate a dried salted plum during HBO2 treatment and the other that did not. An otoscopic examination was performed after HBO2 therapy. The MEB was graded according to Teed scores. The degree of otalgia was recorded using the Visual Analog Scale (VAS). RESULTS: Ninety patients were enrolled. The overall incidence of MEB (Teed score grade 1~4) was 39.6% (21 of 53) for patients administered a dried salted plum versus 37.8% (14 of 37) for the control group (P=1.000). The incidence of mild MEB (Teed score grade 1~2) and severe MEB (Teed score Grade 3~4) between the two groups was not significantly different. Otalgia was present in 5.7% (3 of 53) of patients administered a dried salted plum versus 18.9% (7 of 37) for the control group (P=.085). No patients administered a dried salted plum had a VAS score ≥4 for otalgia versus 10.8% (4 of 37) for the control group (P=.026). CONCLUSIONS: Dried salted plum consumption does not decrease the incidence of MEB, but may ameliorate the severity of first chamber session HBO2-induced otalgia.

Electrocardiographic characteristics in young male patients with left primary spontaneous pneumothorax estimated by the collins equation.

OBJECTIVE: To investigate the 12-lead surface electrocardiographic (ECG) findings in young male patients with left primary spontaneous pneumothorax (PSP) estimated by the Collins equation. METHODS: From 2003 through 2008, 60 young male patients who had left PSP and 61 age-matched unaffected males were included for 12-lead ECG analyses. The PSP size was estimated by the Collins equation. Those with left PSP were divided into two groups: 1) large PSP ≥30% (n=37), and 2) small PSP <30% (n=23). The ECG in the unaffected was used as the normal control. Baseline demographic, anthropometric, and electrocardiographic findings including heart rate, P-QRS-T axes, wave intervals, and RS voltages were compared among three groups. RESULTS: As compared to the unaffected, patients with left PSP had faster heart rate, longer QTc interval, greater QRS and T axes. With regard to RS amplitudes, greater R in lead aVR and V1, and deeper S in lead II indicating predominant rightward forces, and smaller R in lead I and V3-V6 indicating inferior leftward forces were present in patients with left PSP. Of these ECG findings, heart rate, S voltage in lead II and R voltage in V1 in the large PSP but not in the small PSP had greater values than that in the unaffected group. CONCLUSION: Among young male patients with left PSP estimated by the Collins method, the ECG showed faster heart beat and predominant rightward forces especially for those with large PSP.

Chronic hepatitis B, nonalcoholic steatohepatitis and physical fitness of military males: CHIEF study.

AIM: To investigate the association of chronic hepatitis B and nonalcoholic steatohepatitis with physical fitness in a Taiwanese military male cohort. METHODS: We made a cross-sectional examination of this association using 3669 young adult military males according to cardiorespiratory fitness and hospitalization events recorded in the Taiwan Armed Forces study. Cases of chronic hepatitis B (n = 121) were defined by personal history and positive detection of hepatitis B surface antigen. Cases of nonalcoholic steatohepatitis (n = 129) were defined by alanine transaminase level > 60 U/L, liver ultrasound finding of steatosis, and absence of viral hepatitis A, B or C infection. All other study participants were defined as unaffected (n = 3419). Physical fitness was evaluated by performance in 3000-m run, 2-min sit-ups, and 2-min push-ups exercises, with all the procedures standardized by a computerized scoring system. Multiple linear regression analysis was used to determine the relationship. RESULTS: Chronic hepatitis B negatively correlated with 2-min push-up numbers (ß = -2.49, P = 0.019) after adjusting for age, service specialty, body mass index, systolic and diastolic blood pressures, current cigarette smoking, alcohol intake status, serum hemoglobin, and average weekly exercise times. Nonalcoholic steatohepatitis was borderline positively correlated with 3000-m running time (ß = 11.96, P = 0.084) and negatively correlated with 2-min sit-up numbers (ß = -1.47, P = 0.040). CONCLUSION: Chronic hepatitis B viral infection and nonalcoholic steatohepatitis affects different physical performances in young adult military males, and future study should determine the underlying mechanism.

A comparison of Cornell and Sokolow-Lyon electrocardiographic criteria for left ventricular hypertrophy in a military male population in Taiwan: the Cardiorespiratory fitness and HospItalization Events in armed Forces study.

BACKGROUND: The Cornell and Sokolow-Lyon electrocardiography (ECG) criteria have been widely used for diagnosing left ventricular hypertrophy (LVH) in patients with hypertension. However, the correlations of these ECG criteria with LVH were rarely compared in military members who received rigorous training, particularly of the Asian male population. METHODS: We compared the Cornell voltage and product criteria with the Sokolow-Lyon criteria for the echocardiographic LVH in 539 military male members, ages 18-50 years and free of hypertension in the Cardiorespiratory fitness and HospItalization Events in armed Forces (CHIEF) study in Taiwan. Pearson's correlation coefficient was used to determine the association of each ECG criterion with the index of left ventricular mass (LVM, g)/height (m)2.7. The sensitivities and specificities were estimated using a receiver-operating characteristics (ROC) curve in relation to the echocardiographic LVH which was defined as LVM index ≥49 g/m2.7. RESULTS: The correlations of the Cornell voltage and product criteria (r=0.24 and 0.26 respectively, both P<0.0001) were stronger than that of the Sokolow-Lyon criteria (r=0.049 and 0.095, and P=0.26 and 0.03 respectively) with the LVM index. Similarly the performances of the Cornell voltage and product criteria for the echocardiographic LVH [area under curve (AUC): 0.66 and 0.68, both P<0.0001] were superior to that of the Sokolow-Lyon criteria (AUC: 0.54 and 0.53, both P>0.1) in the area under the ROC curve analysis. CONCLUSIONS: The Cornell ECG criteria for the echocardiographic LVH had better performance than the Sokolow-Lyon criteria in a young military male cohort in Taiwan.

Association between electrocardiographic and echocardiographic right ventricular hypertrophy in a military cohort in Taiwan: The CHIEF study: ECG criteria for RVH.

We compared electrocardiographic and echocardiographic right ventricular hypertrophy (RVH) in 264 military members in Taiwan. The correlations of the Myers et al. and Sokolow-Lyon criteria with RV wall thickness were low (r<0.1). Our data supported the American guidance that RVH voltage criteria violations should not receive further echocardiographic investigation.

Hepatic xanthoma associated with pasireotide administration: a first case report.

Hepatic xanthoma is an extremely rare lesion worldwide. We herein present a case of hepatic xanthoma that developed in a 27-year-old Taiwanese man who had participated in a clinical trial of pasireotide. This is, to the best of our knowledge, the first case of pasireotide-induced hepatic xanthoma. Following discontinuation of the drug, the tumor continued to decrease in size (98.2% decrease in tumor volume). We suggest that, in patients receiving pasireotide, the liver should be checked using periodic radiological examinations, even if the patient does not exhibit any risk factors, and that medical or surgical intervention may not be needed.

Total synthesis of polyprenyl N-glycolyl lipid II as a mycobacterial transglycosylase substrate.

A feasible synthetic approach toward the Mycobacterium tuberculosis (Mtb) N-glycolyl lipid II-like molecule 1 is described. Compound 1 bears pendant undecaprenol and l-lysin moieties instead of the naturally occurring decaprenol and meso-diaminopimelic acid, which are not readily available. Functionalization of 1 with a fluorophore on the peptide side chain gave 14, which was found to be recognized as an Mtb TGase substrate. This result suggests it has tremendous utility for mechanistic studies, the characterization of mycobacterial enzymes, and mycobacterial TGase inhibitor evaluation.