Epidermal Growth Factor Receptor Mutation and Anaplastic Lymphoma Kinase Gene Fusion: Detection in Malignant Pleural Effusion by RNA or PNA Analysis.

Analyzing EGFR mutations and detecting ALK gene fusion are indispensable when planning to treat pulmonary adenocarcinoma. Malignant pleural effusion (MPE) is a devastating complication of lung cancer and sometimes the only source for mutation analysis. The percentage of tumor cells in the pleural effusion may be low; therefore, mutant enrichment is required for a successful analysis. The EGFR mutation status in MPE was determined using three methods: (1) PCR sequencing of genomic DNA (direct sequencing), (2) mutant-enriched PCR sequencing of genomic DNA using peptide nucleic acid (PNA-sequencing), and (3) PCR sequencing of cDNA after reverse transcription for cellular RNA (RNA-sequencing). RT-PCR was also used to test cases for ALK gene fusion. PNA-sequencing and RNA-sequencing had similar analytical sensitivities (< 1%), which indicates similar enrichment capabilities. The clinical sensitivity in 133 cases when detecting the common EGFR exon 19 and exon 21 mutations was 56.4% (75/133) for direct sequencing, 63.2% (84/133) for PNA-sequencing, and 65.4% (87/133) for RNA-sequencing. RT-PCR and sequencing showed 5 cases (3.8%) with ALK gene fusion. All had wild-type EGFR. For EGFR analysis of MPE, RNA-sequencing is at least as sensitive as PNA-sequencing but not limited to specific mutations. Detecting ALK fusion can be incorporated in the same RNA workflow. Therefore, RNA is a better source for comprehensive molecular diagnoses in MPE.

Prescription patterns of traditional Chinese medicine for peptic ulcer disease in Taiwan: A nationwide population-based study.

ETHNOPHARMACOLOGICAL RELEVANCE: Peptic ulcer disease is a common digestive disease. There is a lack of large-scale survey on the use of traditional Chinese medicine (TCM) for the treatment of peptic ulcer disease. This study aimed to investigate the utilization of TCM for the treatment of peptic ulcer disease in Taiwan. MATERIALS AND METHODS: We analyzed a random sample comprised of one million individuals with newly diagnosed peptic ulcer disease between 2001 and 2010 from the National Health Insurance Research Database in Taiwan. Demographic characteristics and TCM usage, including Chinese herbal formulas and the single herbs prescribed for patients with peptic ulcer disease, were analyzed. RESULTS: A total of 96,624 newly diagnosed subjects with peptic ulcer disease were included. 14,983 (15.5%) patients were TCM users. People residing in highly urbanized areas, younger people and female (compared with male) were more likely to use TCM. With regard to the comorbidities, TCM users had a lower prevalence of coronary artery disease, chronic obstructive lung disease, diabetes mellitus and liver cirrhosis and stroke. The average time between onset of peptic ulcer disease and the first visit to a TCM clinic was 4.7 months. Majority of the patients (n=14,449; 96.4%) received only Chinese herbal remedies. The most frequently prescribed Chinese herbal formula and single herb was Ban-Xia-Xie-Xin-Tang (Pinelliae Decoction to Drain the Epigastrium) and Hai-Piao-Xiao (Os Sepiae), respectively. The core pattern analysis showed that combination of Ban-Xia-Xie-Xin-Tang, Hai-Piao-Xiao (Os Sepiae), Yan-Hu-Suo (Rhizoma Corydalis), Bei-Mu (Bulbus Fritillariae Thunbergii) and Chuan-Lian-Zi (Fructus Toosendan) was most frequently used for peptic ulcer disease. CONCLUSIONS: Our study identified the core prescription patterns of TCM for patients with peptic ulcer disease in Taiwan. Further basic and clinical studies are necessary to elucidate the efficacy and mechanisms.

Traditional Chinese Medicine Decreases the Stroke Risk of Systemic Corticosteroid Treatment in Dermatitis: A Nationwide Population-Based Study.

Epidemiological studies have shown a strong association between dermatitis and stroke. Systemic corticosteroid, the mainstay treatment for dermatitis, could enhance the atherosclerotic process. Traditional Chinese Medicine (TCM) has been used for dermatitis to decrease the side effects of corticosteroid. However, the different stroke risk in dermatitis patients treated with systemic corticosteroid or TCM remains unclear. This study identified 235,220 dermatitis patients and same comorbidity matched subjects between 2000 and 2009 from database of NHRI in Taiwan. The two cohorts were followed until December 31, 2011. The primary outcome of interest was new diagnosis of stroke. The crude hazard ratio (HR) for future stroke among dermatitis patients treated with systemic corticosteroid was 1.40 (95% CI, 1.34-1.45; P < 0.0001) and TCM was 1.09 (95% CI, 1.05-1.13; P < 0.0001). The log-rank test showed a higher cumulative incidence of ischemic stroke in the patient treated with only systemic corticosteroid group than that treated with systemic corticosteroid and TCM, only TCM, and neither systemic corticosteroid nor TCM in the matched cohort during the follow-up period (P < 0.0001). We demonstrated that patients treated with systemic corticosteroid had an increased risk of stroke and that the risk probably decreased by TCM treatment.

Acoustic features for identifying constitutions in traditional Chinese medicine.

OBJECTIVES: Constitutions are Traditional Chinese Medicine syndromes that are used to classify symptoms. The present study sought to identify objective acoustic features for eight commonly occurring abnormal constitutions. METHODS: Speech signals were obtained from 281 subjects through a 1-second vowel sound, /a/, uttered by the subjects. For each constitution, differences in acoustic parameters between the low-score and high-score groups were compared. RESULTS: Subjects in the high-score groups for Yin-deficiency, Qi-deficiency, Phlegm-wet, Blood-stasis, and Qi-depression showed lower acoustic intensities than subjects in the corresponding low-score groups (all p<0.05). Subjects in the high-score groups of Qi-deficiency and Blood-stasis exhibited higher maximum pitches and higher minimum pitches than subjects in the low-score groups (all p<0.01). The average number of zero-crossings was lower in the high-score groups of Qi-deficiency and Blood-stasis than in the low-score groups for both constitutions (p<0.05). Subjects in the high-score group of special diathesis demonstrated higher low-spectral-energy ratios than subjects in the low-score group (p<0.05), and subjects in the high-score group of Blood-stasis had higher middle spectral energy ratios than subjects in the low-score group (p<0.05). In contrast, the middle spectral energy ratio in the high-score group of special diathesis was lower than in its corresponding low-score group (p<0.05). The high spectral energy ratios were lower in the high-score groups for Yin-deficiency and Blood-stasis (both p<0.05) than in the low-score groups. CONCLUSIONS: The present study identified acoustic features for constitutions and established objective methods for constitutional diagnosis. These acoustic features can potentially be applied in the expert system of Traditional Chinese Medicine for the diagnosis of constitutions in the general population.

Spinal infection in intravenous drug abusers.

The number of intravenous (IV) drug abusers has been increasing in recent years. They are generally younger and healthier than the typical patient with a spinal infection. Reviewing the English language literature, there are only a few articles discussing the relationship between IV drug abuse and spinal infection. We studied 21 IV drug abusers with spinal infection. All were male, 19 were in their 30s and 40s with a mean age of 44 years. The mean follow-up period was 41 months after surgical intervention. Mild and severe neurologic deficit were seen in 5 and 13 patients (Frankel Grade C in 5, Grade D in 8), respectively. The overall positive culture rate was 17 out of 21 (81%). Twelve patients were infected with Staphylococcus aureus and 3 with Pseudomonas aeruginosa. Two had Mycobacterium tuberculosis. All were treated with anterior debridement and strut bone grafting with or without posterior instrumentation, laminectomy and abscess excision, or with additional discectomy. All patients with neurologic deficit recovered to a normal status. At the most recent follow-up, all the spine segments had fused and no one complained of any recurrent back pain. There were no postoperative complications. Physicians need to be more alert to the possibility of spinal infection in IV drug abusers with back pain. In addition to Staphylococcus aureus, Pseudomonas aeruginosa and Mycobacterium tuberculosis may be seen among IV drug abusers.