Necrolytic migratory erythema and glucagonoma rising from pancreatic head.

Glucagonoma syndrome encompasses necrolytic migratory erythema (NME), hyperglucagonemia, diabetes mellitus, anemia, weight loss, glossitis, angular cheilitis, steatorrhea, diarrhea, venous thrombosis, and neuropsychiatric disturbance. Of all the symptoms, NME is a rare skin disorder which is pathognomonic for glucagonoma. We present a 61-year-old woman diagnosed initially as pancreatic head adenocarcinoma with liver metastasis prior to the skin eruption. From the dermatologic finding and other clues, glucagonoma was diagnosed finally.

Morphologic improvement of the PBDTTT-C and PC71BM blend film with mixed solvent for high-performance inverted polymer solar cells.

Tracing the evolution of the bulk heterojunction structure, a dramatic promotion in the efficiency of polymer solar cells has been obtained in recent years. The active layer morphology of low-bandgap polymer solar cells is one of the critical factors for high-efficiency performance. In the past, the relationship between morphology improvement and the device's characteristics (such as efficiency, fill factor and short-circuit current) in low-bandgap polymer solar cells has been studied intensively with regards to the conventional structure. Here we demonstrate the morphologic improvement of the poly[(4,8-bis-(2-ethylhexyloxy)-benzo[1,2-b;4,5-b']dithiophene)-2,6-diyl-alt-(4-(2-ethylhexanoyl)-thieno[3,4-b]thiopene)-2,6-diyl]/[6,6]-phenyl C71 butyric acid methyl ester (PBDTTT-C/PC71BM) blend film for inverted solar cells. By utilizing a mixed solvent of dichlorobenzene/chlorobenzene with (1,8-diiodooctane) additives, the device efficiency can be significantly enhanced, from 0.92% to 4.43%. This enhancement is attributed to active layer morphologic improvement promoting carrier transport. Furthermore, the thickness optimization of the active layer and the electron blocking layer MoO3 further contributes to efficiency. The device performance could be achieved with an efficiency as high as 5.35%, an open-circuit voltage of 0.70 V, a short-circuit current density of 13.5 mA cm(-2), and a fill factor of 57%.

Enhanced Cell Osteogenic Differentiation in Alendronate Acid and Flufenamic Acid Drug-Impregnated Nanoparticles of Mesoporous Bioactive Glass Composite Calcium Phosphate Bone Cement In Vitro.

This study aims to compare the anti-osteoporotic drugs alendronic acid (ALN) and flufenamic acid (FA) alone impregnate into nanoparticles of mesoporous bioactive glass (nMBG), which further composites calcium phosphate cement (CPC) and investigates their in vitro performance. The drug release, physicochemical properties, and biocompatibility of nMBG@CPC composite bone cement are tested, and the effect of the composites on improving the proliferation and differentiation efficiency of mouse precursor osteoblasts (D1 cells) is also investigated. Drug release shows that FA impregnates nMBG@CPC composite, a large amount of FA is released rapidly within 8 h, gradually reaching a stable release within 12 h, followed by a slow and sustained release within 14 days, and then reaches a plateau within 21 days. The release phenomenon confirms that the drug-impregnated nBMG@CPC composite bone cement effectively achieves slow drug delivery. The working time and setting time of each composite are within 4-10 min and 10-20 min, respectively, meeting the operational requirements of clinical applications. The addition of nMBG nanoparticles in the CPC matrix did not prevent the aggregation phenomenon under microstructural observation, thus resulting in a decrease in the strength of the nMBG@CPC composite. However, after 24 h of immersed reaction, the strength of each 5 wt.% nMBG impregnated with different concentrations of FA and ALN is still greater than 30 MPa, which is higher than the general trabecular bone strength. The drug-impregnated nMBG@CPC composites did not hinder the product formation and exhibit biocompatibility. Based on the proliferation and mineralization of D1 cells, the combination of nMBG with abundant FA and ALN in CPC is not conducive to the proliferation of D1 cells. However, when D1 cells are contact cultured for 21 days, alkaline phosphatase (ALP) enzyme activity shows higher ALP secretion from drug-impregnated nMBG@CPC composites than drug-free composites. Accordingly, this study confirms that nMBG can effectively impregnate the anti-osteoporosis drugs FA and ALN, and enhance the mineralization ability of osteoblasts. Furthermore, drug-impregnated nMBG applications can be used alone or in combination with CPC as a new option for osteoporotic bone-filling surgery.

Patients With Rheumatoid Arthritis With an Inadequate Response to Disease-Modifying Antirheumatic Drugs at a Higher Risk of Acute Coronary Syndrome.

Background Cardiovascular disease is the most common cause of death in patients with rheumatoid arthritis. It is believed that using disease-modifying antirheumatic drugs (DMARDs) to control inflammation can reduce the risk of cardiovascular disease. In this study, we investigated whether patients who responded differently to DMARDs might sustain different cardiovascular events. Methods and Results We designed a cohort study using the Chang Gung Research Database. We identified 7114 patients diagnosed with rheumatoid arthritis. After strict exclusion criteria, we collected 663 individuals as an inadequate response to DMARDs group. Then, 2034 individuals were included as the control group. The end point was composite vascular outcomes, including acute coronary syndrome or ischemic stroke. We used the inverse probability of treatment weighting to keep the covariates between these 2 groups well balanced. We compared the risk of these outcomes using the Cox proportional hazards model. The mean follow-up time was 4.7 years. During follow-up, there were 7.5% and 6.4% of patients with composite vascular outcomes in the DMARD-inadequate response and control groups, respectively. There was no significant difference in the risk of composite vascular outcomes (95% CI, 0.94-1.41) and ischemic stroke (95% CI, 0.84-1.36). The risk of acute coronary syndrome was significantly higher in the DMARD-inadequate response group (hazard ratio, 1.45; 95% CI, 1.02-2.05). Conclusions Patients with DMARD-inadequate response rheumatoid arthritis have a higher risk of developing acute coronary syndrome than those whose disease can be controlled by DMARDs.

Facial epidermal inclusion cysts are associated with smoking in men: a hospital-based case-control study.

BACKGROUND: Epidermal inclusion cysts (EICs) are a common cutaneous disorder in adults. The etiology of EICs remains obscure. Our clinical experience suggests that smoking may be a risk factor for the development of EICs. OBJECTIVE To determine whether the number and sites of EICs are related to smoking behavior and quantity. METHODS AND MATERIALS: We retrospectively surveyed patients pathologically diagnosed with EICs at our hospital. A control group comprised patients who underwent surgical procedures for diagnoses other than EICs. Smoking history was obtained through telephone or clinical interviews. RESULTS: Three hundred one patients with EICs were identified in our archives: 217 men (mean age 37.1, range 9-77) and 84 women (mean age 41.3, range 9-82). Detailed medical records and smoking history were available for 225 patients. Two hundred twenty-five age- and sex-matched patients were enrolled in the control group. Results showed that a higher percentage of men with facial EICs than of control subjects were smokers (p<.01). No such association was found in women with EICs. CONCLUSION: Smoking may contribute to the development of EICs.

Erythromycin as a Safe and Effective Treatment Option for Erythema Annulare Centrifugum.

BACKGROUND: Erythema annulare centrifugum (EAC) is an inflammatory dermatosis with unknown etiology. It is usually self-limited, but chronic disease may be difficult to treat. We observed incidentally the therapeutic effect of erythromycin for EAC among patients taking erythromycin for other diseases. AIM: To evaluate the treatment response of erythromycin for EAC. MATERIALS AND METHODS: During the study period, from July 2007 to February 2011, all patients with EAC were assigned to erythromycin stearate tablet 1000 mg per day for two weeks. EAC was diagnosed by a constellation of clinical and pathological findings. The efficacy (before and after the treatment) was assessed clinically by one dermatologist and photographically by two blinded dermatologists. Secondary outcomes included adverse drug effects and recurrence. RESULTS: Eight patients were enrolled in this study. Most patients had chronic relapsing disease with poor response to previous treatment. All the patients showed rapid response with profound reduction in the size of lesion and erythema two weeks after initiation of erythromycin treatment. The response was so obvious and complete that a coincidental response was less likely. Three patients had recurrence of disease and they tended to have more extensive lesions. Readministration of erythromycin was effective. All patients tolerated the treatment well. CONCLUSION: Our study documented erythromycin as a safe and cost-effective treatment for EAC.

Prurigo pigmentosa: a clinical and histopathologic study of 11 cases.

BACKGROUND: Prurigo pigmentosa is a rare inflammatory dermatosis of unknown etiology. It is characterized by a recurrent pruritic rash and net like pigmentation. Most of the reported cases have been from Japan; however, here we report on several cases from Taiwan. METHODS: This was a single hospital-based retrospective study conducted in a tertiary medical center in Southern Taiwan, recruiting 14 patients with a clinical diagnosis of prurigo pigmentosa between January 1, 2000 and December 31, 2007. Clinical information was collected and reviewed, and skin biopsies were performed for all cases. RESULTS: Of the 14 cases, 11 exhibited clinical and histopathological correlation with prurigo pigmentosa and were enrolled in our study. The age of the patients at diagnosis ranged from 16 to 30 years (mean, 22.3) with female predominance (female: male ratio, 8:3). Patient lesions were primarily distributed symmetrically over the chest and back area and they responded well to doxycycline treatment. The biopsy specimens of all patients showed nonspecific lymphocytic infiltration; folliculitis was noted in 7 specimens and both superficial and deep perivascular lymphocytic infiltration was found in 8 specimens. CONCLUSION: Although far more prevalent in Japan, prurigo pigmentosa can be seen in Taiwan. In our study, patients were predominantly young females who had been initially diagnosed as having eczema. Therefore, young females who present with intractable eczema distributed symmetrically over the trunk should prompt physicians to consider prurigo pigmentosa.