Localized autoimmune pancreatitis mimicking pancreatic cancer: Case report and literature review.

Autoimmune pancreatitis (AP) is a rare autoimmune pancreatic manifestation of systemic immunoglobulin G4 (IgG4)-related sclerosing disease. Distinguishing between AP and pancreatic cancer is crucial because the clinical courses, treatments, and prognoses of these two disease entities are quite different. We herein report a case involving a 52-year-old man with subacute epigastralgia who visited our hospital for evaluation of a suspicious pancreatic mass found during esophagogastroduodenoscopy. Enhanced computed tomography (CT) revealed an enlarged lesion in the pancreatic head with encasement of hepatic vessels. The lesion also exhibited increased 18F-fluorodeoxyglucose accumulation on positron emission tomography/CT imaging, which was highly suggestive of pancreatic cancer. After open biopsy, morphologic examination showed an inflammatory infiltrate in the pancreas, which was compatible with chronic sclerotic pancreatitis. Further laboratory tests revealed an elevated serum IgG4 level, and the diagnosis of sclerotic pancreatitis was then confirmed. After corticosteroid treatment, the pancreatic lesion showed shrinkage on follow-up CT, and the serum IgG4 titer decreased to the normal range. This case suggests that clinicians should be familiar with the clinical presentations and diagnostic criteria of AP versus pancreatic cancer. An awareness of the differences between these diseases may avoid misdiagnosis and unnecessary surgical intervention.

Nitric oxide participates in plant flowering repression by ascorbate.

In Oncidium, redox homeostasis involved in flowering is mainly due to ascorbic acid (AsA). Here, we discovered that Oncidium floral repression is caused by an increase in AsA-mediated NO levels, which is directed by the enzymatic activities of nitrate reductase (NaR) and nitrite reducatase (NiR). Through Solexa transcriptomic analysis of two libraries, 'pseudobulb with inflorescent bud' (PIB) and 'pseudobulb with axillary bud' (PAB), we identified differentially expressed genes related to NO metabolism. Subsequently, we showed a significant reduction of NaR enzymatic activities and NO levels during bolting and blooming stage, suggesting that NO controlled the phase transition and flowering process. Applying AsA to Oncidium PLB (protocorm-like bodies) significantly elevated the NO content and enzyme activities. Application of sodium nitroprusside (-NO donor) on Arabidopsis vtc1 mutant caused late flowering and expression level of flowering-associated genes (CO, FT and LFY) were reduced, suggesting NO signaling is vital for flowering repression. Conversely, the flowering time of noa1, an Arabidopsis NO-deficient mutant, was not altered after treatment with L-galacturonate, a precursor of AsA, suggesting AsA is required for NO-biosynthesis involved in the NO-mediated flowering-repression pathway. Altogether, Oncidium bolting is tightly regulated by AsA-mediated NO level and downregulation of transcriptional levels of NO metabolism genes.

Natural orifice transluminal endoscopic surgery-assisted versus laparoscopic ovarian cystectomy (NAOC vs. LOC): a case-matched study.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) has shown its prospection as a minimally invasive endoscopic surgery. This study aimed to examine the safety and efficacy of combined NOTES and vaginal approach, natural orifice transluminal endoscopic surgery-assisted ovarian cystectomy (NAOC), in the conservative management of benign ovarian tumors. METHODS: Records were reviewed for the 34 consecutive NAOC procedures between May 2011 and March 2014. Age, body mass index, parity, size of the mass, and bilaterality of the mass were used to select comparable patient who had undergone laparoscopic ovarian cystectomy (LOC). RESULTS: A total of 277 patients were recruited in this study (243 LOCs and 34 NAOCs, respectively). There was no incidence of switching to abdominal laparotomy. Length of operation and length of postoperative stay were significantly greater in the LOC group than in the NAOC group, but total hospital charges were similar in both groups. There was no difference in febrile morbidity between the two groups but more estimated blood loss (EBL) in NAOC group, although EBL was <50 mL in the two groups. Linear correlations of mass size with operating time and EBL existed in LOC group, but not in NAOC group. CONCLUSION: NAOC can be safely performed for benign and large ovarian tumors. Besides, NAOC offers a superior operative efficiency compared with LOC.

Analysis of microsatellites in the vulnerable orchid Gastrodia flavilabella: the development of microsatellite markers, and cross-species amplification in Gastrodia.

BACKGROUND: Gastrodia flabilabella is a mycoheterotrophic orchid that obtains carbohydrates and nutrients from its symbiotic mycorrhizal fungi. The species is an endemic and vulnerable species enlisted in the "A Preliminary Red List of Taiwanese Vascular Plants" according to the IUCN Red List Categories and Criteria Version 3.1. G. flabilabella dwells the underground of broadleaf and coniferous forest with richness litter. Based on herbarium records, this species is distributed in central Taiwan. Twenty eight microsatellite loci were developed in G. flabilabella and were tested for cross-species amplification in additional taxa of G. confusoides, G. elata, and G. javanica. We estimated the genetic variation that is valuable for conservation management and the development of the molecular identification system for G. elata, a traditional Chinese medicine herb. RESULTS: Microsatellite primer sets were developed from G. flabilabella using the modified AFLP and magnetic bead enrichment method. In total, 257 microsatellite loci were obtained from a magnetic bead enrichment SSR library. Of the 28 microsatellite loci, 16 were polymorphic, in which the number of alleles ranged from 2 to 15, with the observed heterozygosity ranging from 0.02 to 1.00. In total, 15, 13, and 7 of the loci were found to be interspecifically amplifiable to G. confusoides, G. elata, and G. javanica, respectively. CONCLUSIONS: Amplifiable and transferable microsatellite loci are potentially useful for future studies in investigating intraspecific genetic variation, reconstructing phylogeographic patterns among closely related species, and establishing the standard operating system of molecular identification in Gastrodia.

Effects of commercial citrate-containing juices on urolithiasis in a Drosophila model.

Diet modification plays an important role in nephrolithiasis. Development of an easy, ready-to-use beverage such as a commercial juice drink to use as a preventive treatment for renal calculi formation would be widely welcomed. We previously developed a novel Drosophila model for the study of nephrolithiasis. It provides a new well-established drug discovery platform for this common disease. In our current study, we used the Drosophila model to investigate the preventive effects of various commercial juices as potential treatments for nephrolithiasis. Our results showed that apple, cranberry, orange, and pomegranate juices failed to reduce calcium oxalate (CaOx) crystal formation, whereas our positive control-potassium citrate (K-citrate)-significantly prevented CaOx crystal formation. Unlike the commercial fruit juices that were tested, the administration of K-citrate significantly ameliorated the ethylene glycol (EG)-induced life-span reduction in treated flies. These results indicate that EG-induced CaOx nephrolithiasis in Drosophila can be prevented by K-citrate, but not by commercial citrate-containing juices. However, the inhibitory capability of citrate-containing juices to reduce renal stone formation in humans requires further elucidation.

Transcervical drainage for descending necrotizing mediastinitis may be sufficient.

OBJECTIVE: Descending necrotizing mediastinitis (DNM) is a serious form of mediastinitis with a high mortality rate. It is caused by the downward spread of an oropharyngeal or cervicofascial infection. The optimal surgical approach for this often fatal disease is controversial. This article describes the authors' experience and characterizes the surgical strategies and treatment outcomes of patients with DNM. STUDY DESIGN: Case series with chart review. SETTING: A tertiary referral medical center. SUBJECTS AND METHODS: This study conducted a retrospective chart review of patients with deep neck infections treated at a medical center from 1994 to 2007 and identified 29 patients with DNM. The clinical characteristics and outcomes were compared between patients treated with transcervical drainage alone (group I) and those with both cervical and thoracic drainage (group II). RESULTS: There were 20 patients in group I and 9 patients in group II. The overall mortality rate was 10.3%. The mean duration of the hospital stay was 29.3 ± 15.5 days. There was no statistically significant difference in age, sex distribution, or duration from the appearance of symptoms to hospital admission between the 2 groups. The duration of hospital stay, tracheotomy rate, and mortality rate also did not differ significantly between the 2 groups. However, the numbers of surgeries were significantly higher in group II than in group I. CONCLUSION: Transthoracic mediastinal drainage is not a compulsory therapy, but timely, aggressive, transcervical mediastinal drainage with extensive debridement is very important for a good outcome when treating DNM patients.

Genetic population structure of the alpine species Rhododendron pseudochrysanthum sensu lato (Ericaceae) inferred from chloroplast and nuclear DNA.

BACKGROUND: A complex of incipient species with different degrees of morphological or ecological differentiation provides an ideal model for studying species divergence. We examined the phylogeography and the evolutionary history of the Rhododendron pseudochrysanthum s. l. RESULTS: Systematic inconsistency was detected between gene genealogies of the cpDNA and nrDNA. Rooted at R. hyperythrum and R. formosana, both trees lacked reciprocal monophyly for all members of the complex. For R. pseudochrysanthum s.l., the spatial distribution of the cpDNA had a noteworthy pattern showing high genetic differentiation (FST=0.56-0.72) between populations in the Yushan Mountain Range and populations of the other mountain ranges. CONCLUSION: Both incomplete lineage sorting and interspecific hybridization/introgression may have contributed to the lack of monophyly among R. hyperythrum, R. formosana and R. pseudochrysanthum s.l. Independent colonizations, plus low capabilities of seed dispersal in current environments, may have resulted in the genetic differentiation between populations of different mountain ranges. At the population level, the populations of Central, and Sheishan Mountains may have undergone postglacial demographic expansion, while populations of the Yushan Mountain Range are likely to have remained stable ever since the colonization. In contrast, the single population of the Alishan Mountain Range with a fixed cpDNA haplotype may have experienced bottleneck/founder's events.

Endoscopic laser anterior commissurotomy for anterior glottic web: one-stage procedure.

OBJECTIVES: The conventional method for preventing web formation after anterior glottic web surgery is keel insertion. However, this presents risks of airway compromise and granulation tissue formation, which could necessitate tracheotomy in addition to a secondary procedure for keel removal. We introduce a novel, 1-stage endoscopic laser anterior commissurotomy for preventing anterior glottic web re-formation. METHODS: Twenty patients with glottic webs involving the anterior commissure were studied. The lesions were removed by transoral carbon dioxide laser microsurgery. In all patients, the anterior glottic web was vaporized along with the inner perichondrium of the thyroid cartilage over the anterior commissure area, creating a raw vertical break "alley" between the anterior vocal folds that measured between 0.3 and 0.5 cm in width and between 0.8 and 2 cm in length. The preoperative and postoperative vocal folds and voice quality were evaluated by videostrobolaryngoscopy and voice recordings. RESULTS: All 20 patients had anterior glottic webs ranging from 11% to 64% of the length from the anterior commissure to the vocal process. None of the patients developed restenosis at the anterior commissure of a severity similar to that of the initial lesion during follow-up (mean, 13 months; range, 3 to 44 months).All patients except 1 reported satisfaction with their voice improvement. Outcome analysis revealed that partial re-formation of the web was noted in 4 patients. CONCLUSIONS: One-stage, endoscopic laser anterior commissurotomy was effective and relatively safe for removing glottic webs, for preventing anterior glottic web re-formation, and for improving vocal fold performance among our patients.

Functional outcomes of patients with advanced pyriform sinus cancer treated with extended near-total laryngopharyngectomy and free fasciocutaneous flap reconstruction.

The objective of this study was to evaluate the functional results in patients with advanced pyriform sinus cancer treated with extended near-total laryngopharyngectomy (ENTLP) and free fasciocutaneous flap reconstruction. We reviewed the medical records of patients with pyriform sinus cancer who were treated at Kaohsiung Chang Gung Memorial Hospital, a tertiary medical center in Taiwan, between June 1998 and December 2008. This retrospective study enrolled the patients who had a stage III or IV pyriform sinus cancer and was surgically treated with ENTLP and free fasciocutaneous flap reconstruction. Thirteen patients meeting the inclusion criteria were enrolled. Three patients had stage III cancer, and ten had IVa. All were men with the age distribution ranged from 38 to 75 years. The average length of hospitalization was 19 days. Twelve (92.3%) patients could develop shunt speech postoperatively, and eight (61.5%) patients used shunt speech for their routine conversation. Eleven (84.6%) patients could ultimately return to an oral diet; the remaining two (15.4%) patients stayed dependent on a feeding tube for part or all of their nutrition. Two patients died from distant metastases, and one patient died from complications of postoperative concurrent chemoradiotherapy, while the other ten patients survived until the last follow-up without evidence of locoregional tumor recurrence. In conclusion, in the surgical treatment of patients with locally advanced pyriform sinus cancer, ENTLP and free fasciocutaneous flap reconstruction is an oncologically safe, voice-conserving, and prosthesis-free procedure which offers satisfactory functional speech and swallowing outcomes.

Difference of Helicobacter pylori colonization in recurrent inflammatory and simple hyperplastic tonsil tissues.

OBJECTIVE: To investigate the difference in colonization by Helicobacter pylori between recurrent inflammatory and normal hyperplastic human palatine tonsil tissues. DESIGN: A retrospective review of a prospective data set. SETTING: Tertiary referral center. PATIENTS: Patients undergoing tonsillectomy for a variety of reasons had routine screening for H pylori. Medical records of all patients who underwent tonsillectomy were reviewed to identify (1) indications for surgery and (2) presence or absence of H pylori in the specimen. All medical records that had information on H pylori were included. Patients were divided into the following 2 groups: those having tonsillectomy for chronic recurrent tonsillitis and those having tonsillectomy for sleep-related breathing disorders (SRBDs) with no recent history of tonsillitis. RESULTS: There were 44 patients in the tonsillitis group (18 women and 26 men; mean age, 28.6 years) and 50 patients in the SRBD group (11 women and 39 men; mean age, 33.6 years). Of 94 patients the Pronto Dry test results were positive in 33 (35%) and negative in 61 (65%). The H pylori positive rates in the tonsillitis and SRBD groups were 48% (21 of 44) and 24% (12 of 50), respectively (P < .001). CONCLUSIONS: Helicobacter pylori can colonize in human palatine tonsil tissues. A significantly higher positive H pylori rate was present in the tonsillitis group (48%) compared with the SRBD group (24%). Based on this finding, future studies should be performed to elucidate whether eradication therapy for H pylori is effective in decreasing recurrent inflammation of human palatine tonsils.

Transoral laser ventricular fold resection and thyroarytenoid myoneurectomy for adductor spasmodic dysphonia: long-term outcome.

OBJECTIVES: A transoral approach to laser myoneurectomy of the thyroarytenoid muscles was recently reported as an effective technique for treatment of adductor spasmodic dysphonia (ASD). The short-term results were encouraging. In this study, a long-term surgical outcome of this technique is investigated. STUDY DESIGN: A prospective clinical series. METHODS: Fifty-two patients with ASD underwent transoral laryngomicrosurgery with a CO(2) laser to resect the ventricular folds followed by myoneurectomy of the thyroarytenoid muscles. The nerve fibers of recurrent laryngeal nerve terminating at the thyroarytenoid muscle, which were frequently found branching deeply among the posterior belly of this muscle, were vaporized. Care was taken not to damage the vocal ligaments, lateral cricoarytenoid muscles, or arytenoid cartilages. Pre- and postoperative subjective voice assessments, and acoustic and aerodynamic measurements, were performed and statistically analyzed. RESULTS: Twenty-nine of the 52 patients who were followed up for more than 12 months (range, 12-63 months; mean, 31 months) were studied. Moderate and marked vocal improvement was achieved in 90% (26/29) of the patients. Three patients had 30% improvement, which was reported as unsuccessful. Eight of the 26 patients who were satisfied with their postoperative voice still had a mild strain during phonation. Of the eight patients, seven achieved normal or nearly normal voice quality after revision laser surgery. No significant vocal deficit or paralysis was observed in any patient. CONCLUSIONS: After long-term follow-up of 31 months on average, approximately 90% of the ASD patients obtained moderate to marked improvement of vocal performance after transoral laser surgery. The long-lasting outcome is encouraging.

Extraction of Aflatoxin from Peanut Meal and Kernels by CO2-Methanol Using a Highly Pressurized Fluid Extraction Process.

Peanut kernels infected with Aspergillus parasiticus after milling into meals were used as toxin-contaminated material for aflatoxin extraction using CO2-methanol. The percentage of aflatoxin recovery increased with CO2-60% methanol and decreased with CO2-100% methanol with an increase in the methanol/peanut meal ratio. One gram of peanut meal and 6 ml of 60% methanol were deposited in an extraction chamber (ca. 13 ml), pressurized with CO2 to 3,000 psi at 50°C, and held for 15 min, followed by releasing and collecting the extraction medium. The extracted solution was applied to an affinity column for aflatoxin adsorption and to thin-layer chromatography for separation and fluorescence densitometry for component quantitation; an average of 97.6% of the aflatoxin was recovered. When this procedure and a commercialized immunochemical method were used for quantitation of aflatoxin in discolored peanut kernels collected from a commercial processing line, comparable results were observed.