Detection and Mitigation of SYN Flooding Attacks through SYN/ACK Packets and Black/White Lists.

Software-defined networking (SDN) is a new network architecture that provides programmable networks, more efficient network management, and centralized control than traditional networks. The TCP SYN flooding attack is one of the most aggressive network attacks that can seriously degrade network performance. This paper proposes detection and mitigation modules against SYN flooding attacks in SDN. We combine those modules, which have evolved from the cuckoo hashing method and innovative whitelist, to get better performance compared to current methods Our approach reduces the traffic through the switch and improves detection accuracy, also the required register size is reduced by half for the same accuracy.

Elevated plasma osteopontin level is associated with occurrence of psoriasis and is an unfavorable cardiovascular risk factor in patients with psoriasis.

BACKGROUND: The association between psoriasis and cardiovascular diseases is well documented yet the underlying mechanisms remain elusive. OBJECTIVES: We sought to study the role of circulating osteopontin (OPN) in the pathogenesis of cardiovascular diseases in patients with psoriasis. METHODS: Plasma samples from 40 patients with psoriasis and 37 control subjects were collected for enzyme-linked immunosorbent assays. The clinical significance of OPN levels in patients with psoriasis versus control subjects was analyzed using the Mann-Whitney U test and logistic regression. DNA samples from 268 patients with psoriasis and 146 control subjects were collected for genotyping of the OPN gene. RESULTS: Higher body mass index values (P = .047) and hypertension (odds ratio [OR] 2.68, P = .05) were observed in patients with psoriasis. Increased plasma OPN levels (>or=62.95 ng/mL) were significantly associated with psoriasis (OR 6.24, P = .001), hypertension (OR 3.05, P = .03), and diabetes mellitus (OR 3.13, P = .05). Occurrence of psoriasis (OR 5.12, P = .003) appeared to be the single independent risk factor for high plasma OPN values after multivariate logistic regression. Among patients with psoriasis, increased plasma OPN values were associated with the presence of hypertension (OR 4.69, P = .05). However, no significantly different allelic distributions of single nucleotide polymorphisms of the OPN gene were found between psoriasis and control groups. LIMITATIONS: The number of patients evaluated was relatively small. CONCLUSIONS: High plasma OPN levels are an unfavorable factor for development of cardiovascular disease in patients with psoriasis.

An outbreak of foodborne botulism in Taiwan.

Botulism is a rare but serious paralytic disease caused by botulinum toxin. We report an outbreak of type B botulism in Taiwan in 2006. There were five cases involved in this outbreak. They present ileus and acute cranial nerve dysfunction including dysphagia and blurred vision. One of them had severe neurologic impairment and required mechanical ventilatory support. No patient received antitoxin administration because of delayed diagnosis. The food specimen revealed positive botulism toxin B. There were no fatalities. Consumption of fermented food was significantly associated with this outbreak. We also reviewed the characteristics of cases with botulism in Taiwan since 1985.

Pediatric Malignant Atrophic Papulosis.

Malignant atrophic papulosis (MAP), also known as Degos disease, is an extremely rare disease that is characterized by its unique skin presentation (namely, central, porcelain-white atrophic lesions with a telangiectatic rim). MAP has the following 2 variants: cutaneous MAP is manifested in the skin alone, whereas systemic MAP affects the gastrointestinal tract, central nervous system, lungs, and other internal organs. Some patients who presented with only cutaneous symptoms at first may develop systemic symptoms several years later. Although the exact pathologic mechanisms are unclear, Magro et al suggested in a recent study that MAP is a vascular injury syndrome that involves complement component C5b-9 complex deposition and high expression of interferon-α. The prognosis of systemic MAP is poor and typically fatal within a few years. Nonetheless, because the C5b-9 complex is detected in MAP, some researchers have suggested combined treatment with eculizumab (a humanized monoclonal antibody against C5) and treprostinil (a prostacyclin analog). Here, we report on a girl with systemic MAP who had severe central nervous system involvement and responded to eculizumab.

Epithelioid angiosarcoma arising in a deep-seated plexiform schwannoma: a case report and literature review.

Angiosarcoma developing within a schwannoma is rare, and only 8 cases have been reported in the literature. Its association with a plexiform schwannoma has never been reported. We describe an epithelioid angiosarcoma arising in a plexiform schwannoma of the sciatic nerve in a 73-year-old man not known to have von Recklinghausen disease. Grossly, the tumor forms a long tubular mass with a multinodular growth pattern on the cut surface. Microscopically, these nodules display characteristics of a schwannoma, including Antoni A, Antoni B, and Verocay bodies. Adjacent to these nodules are high-grade anaplastic epithelioid cells growing in solid sheets, cords, and nests with focal vasoformative channels. The anaplastic cells are immunoreactive to CD31, CD34, and factor VIII related antigen, supporting their endothelial differentiation. Local recurrence and multiple pulmonary metastasis occurred 3 months after complete excision of the tumor. This case demonstrates the first occurrence of an epithelioid angiosarcoma in a deep-seated plexiform schwannoma with an aggressive clinical behavior.

Thyroid involvement in Rosai-Dorfman disease.

Rosai-Dorfman disease (RDD) with thyroid involvement is extremely rare; we herein present the sixth known case with a review of the previously reported five cases and discuss the clinicopathological characteristics of this entity. RDD with thyroid involvement has occurred only in females with a mean age of 56.3 years, which is significantly different from nodal RDD predominantly seen in young males. Besides this, autoimmune thyroiditis is frequently associated in RDD with thyroid involvement, which raises a suspicion of a common pathogenesis of both entities. RDD with thyroid involvement is commonly misdiagnosed preoperatively as thyroid malignancy with lymph node metastasis, which may lead to overtreatment and postoperative complication. Clinical presentations might be helpful for a preoperative differential diagnosis; while thyroid function, sonography, thyroid isotope scan, and fine needle aspiration have been less useful. All six cases were treated by surgery and complete remission was seen. However, two patients with a preoperative diagnosis of benign disease suffered from hypothyroidism due to total thyroidectomy.

Synchronous gastric gastrointestinal stromal tumor and signet-ring cell adenocarcinoma: a case report.

Synchronous tumors of the stomach are uncommon. We present a unique case of gastric synchronous tumors composed of signet-ring cell adenocarcinoma and gastrointestinal stromal tumor (GIST). The two tumors arose at the same site and were sharply juxtaposed without intermingling of morphologically distinct elements. Coincidence probably accounts for this occurrence, even if a common carcinogenic agent had been hypothesized. Preoperative imaging and endoscopic biopsy could lead to the suspicion of synchronous tumors, and an accurate histological identification of both tumors could be achieved by multiple deep endoscopic biopsies. The presence in our case of diffuse carcinomatosis indicates that the signet-ring cell adenocarcinoma had a greater adverse effect on the prognosis than the GIST.

Pathological features and their prognostic impacts on oral cavity cancer patients among different subsites - A singe institute's experience in Taiwan.

We investigated the relationship of different primary subsites together with their pathological features on the survival of oral cavity squamous cell carcinoma (OCSCC) patients. We retrospectively reviewed OCSCC patients and documented their demographic data, pathological features and clinical outcome. The Cox proportional hazard model was used to examine the influence of various pathological features on the prognosis in different subsites of oral cavity. There were totally 1,383 OCSCC patients enrolled for final analysis. Perineural invasion had a poor prognosis at the early stage of OCSCC patients especially those with primary at the tongue. In addition, lymphovascular invasion was associated with poor survival at the late stage especially those with primary at the buccal mucosa and the tongue. The impact of pathological features on the survival of OCSCC patients varied in different subsites. Further investigation is warranted to validate our finding in a multicenter study. Grouping the different markers to establish a prognostic scoring system may provide more accurate evaluation of the prognosis in OCSCC patients.

Langerhans Cell Sarcoma in a Chronic Myelogenous Leukemia Patient Undergoing Imatinib Mesylate Therapy: A Case Study and Review of the Literature.

Langerhans cell sarcoma (LCS) is a rare malignancy requiring differential diagnosis from other high-grade nonhematologic and hematologic tumors. The pathogenesis of LCS remains unknown. Notably, LCS and its benign counterpart, Langerhans cell histiocytosis (LCH), are frequently associated with other malignancies. To the best of our knowledge, we describe the first case of LCS in a chronic myelogenous leukemia (CML) patient undergoing imatinib mesylate therapy. We performed molecular cytogenetic analyses for investigating the association between LCS and CML. In our case, molecular cytogenetic analysis did not reveal BCR-ABL1 fusion and BRAF V600E mutation, suggesting that LCS may be coincident in this patient. However, recurrent BRAF V600E mutation has been found in LCH. Published reports have revealed the clonal relationship between LCH/LCS and other hematologic malignancies, especially lymphoid neoplasms. However, there are only 2 reports demonstrating the clonal relationship between LCH and myeloid neoplasms. The association of LCH/LCS with myeloid neoplasms and the role of BRAF V600E mutation in LCS are discussed.

Extraosseous benign notochordal cell tumor presenting as bilateral pulmonary nodules.

Intraosseous benign notochordal cell tumors are rare and the likely precursors of chordoma. Extraosseous benign notochordal cell tumors have been reported in only 2 patients, and both presented as solitary pulmonary nodules. Here, we report a 53-year-old woman with an incidental finding of small nodules bilaterally in the lungs. The clinician suggested the tumors were metastases; however, histologic examination of both tumors showed benign notochordal cell tumor, characterized by adipocyte-like vacuolated cells with bland nuclei and lacking an intercellular myxoid matrix. Although extraosseous benign notochordal cell tumors are extremely rare, the diagnosis should be recognized by pathologists to avoid overtreatment of patients.

A 28 year old lady with a pituitary mass.

We present a case of an atypical pituitary adenoma with prominent lymphocyte infiltration and germinal center formation. Histologically, the tumor revealed clusters of large pleomorphic cells with vesicular nuclei, prominent nucleoli, smudgy chromatin, and abundant eosinophilic cytoplasm. There was heavy lymphocyte infiltration and prominent germinal center formation. Mitoses were rare, and the Ki-67 index was 15%. The lymphocytes were composed of both CD3-positive T lymphocytes and CD20-positive B-cells. The diagnosis was atypical pituitary adenoma. Germinal centers have not previously been reported in these tumors. It is important to correlate histology and immunohistochemistry to differentiate this adenoma from other pituitary lesions with prominent lymphocyte infiltration, such as germinoma and lymphocytic hypophysitis.

A 32-year-old man with a fourth ventricular mass.

Lipoastrocytomas are rare and only four cases have been reported previously. Our case is in the fourth ventricle of a 32 year-old man.Many areas showed tumor cells with a signet-ring appearance and focally formed perivascular arrangements. Eosinophilic granular bodies were frequent. There was strong positive immunoreactivity to GFAP and S-100 protein, even in those vacuolated tumor cells.The proliferation index was less than 10%. Ultrastructural studies showed that the signet-ring cells had large lipid droplets as well as intermediate filaments. Ultrastructural features characteristic of ependymomas were not seen. These findings confirm that the vacuoles were lipid droplets in astrocytic tumor cells. The features noted are suggestive of a probable better prognosis in this variant of low-grade astrocytoma.