Great potential of a panel of multiple hMTH1, SPD, ITGA11 and COL11A1 markers for diagnosis of patients with non-small cell lung cancer.

Research on molecular mechanisms underlying the carcinogenesis of non-small cell lung cancer (NSCLC) may provide gene targets in critical pathways valuable for improving the efficacy of therapy and survival of patients with NSCLC. However, the molecular markers highly sensitive for the prognosis and treatment evaluation of NSCLC are not yet available. To explore candidates, we conducted an oligonucleotide microarray study with three pairs of NSCLC and normal lung tissue, and determined 8 differentially expressed genes including the Human MutT homologue (hMTH1), Surfactant protein D (SPD), Human hyaluronan binding protein 2 (HABP2), Crystalline-mu (CRYM), Ceruloplasmin (CP), Integrin alpha-11 subunit (ITGA11), Collagen type XI alpha I (COL11A1), and Lung-specific X protein (Lun X). Four lung cancer-related markers MUC-1, hTERT, hnRNP B1, and CK-19 were also incorporated for further analysis. The expression profiles of the twelve genes in seventy pairs of NSCLC tumor and normal lung tissue were then detected quantitatively by using membrane array and quantitative real-time PCR (qRT-PCR). The data of the membrane array and qRT-PCR were compared for consistency and the potential of these mRNA markers in clinical application. The results showed that membrane array and qRT-PCR obtained consistent data for the tested genes in both sensitivity and specificity (correlation coefficient 0.921, p<0.0001). For patients' clinicopathological characteristics, the overexpression of hMTH1, SPD, HABP 2, ITGA11, COL11A1, and CK-19 was significantly correlated with the pathological stage (p<0.05). In addition, the overexpression of hMTH1, SPD, ITGA11, and COL11A1 was correlated with lymph node metastasis and poor prognosis. This is the first report relating SPD to a prognosis marker for NSCLC. Moreover, the combined detection of these four mRNA markers by membrane array had a sensitivity of 89% and a specificity of 84% for NSCLC, significantly higher than these markers had achieved separately. In conclusion, we identified mRNA markers for NSCLC prognosis and therapy evaluation from differentially expressed genes determined by using micro-array. Further studies are needed to collect the data of the mRNA markers used in clinical practice.

A subset of clinical status of pulmonary tuberculosis in Southern Taiwan.

The aims of this study were to present the clinical status of pulmonary tuberculosis in Southern Taiwan and to analyze the reasons for failure of antituberculosis treatment in order to achieve a higher rate of success after treatment. Two hundred and senventeen adult patients, aged 15 to 90 years old who presented to the Chest Division, Kaohsiung Medical University Hospital from 1999 to 2002 with a diagnosis of Pulmonary Tuberculosis, were retrospectively studied. We compared the rate of recurrence of pulmonary tuberculosis by dividing the cases into 2 groups: those who completed treatment and those who did not. We also determined the age distributions for when initial diagnosis of pulmonary tuberculosis was made among these 217 cases. In 90 culture proven cases, antituberculosis drug susceptibility was tested to determine the rate of drug resistance. We also assessed the reasons for failure of treatment. Age distribution analysis showed that initial infection began at a young age, was widely spread, and occurred regardless of age. There were 116 cases that completed antituberculosis treatment and 101 cases that did not. Of the 116 cases, only 16 relapsed, whereas 79 of the 101 cases relapsed. In cases where completely treated patients relapsed, the period before recurrence was indefinite. Most of the cases of incompletely treated patients relapsed earlier. In the 90 culture proven cases in which antituberculosis drug susceptibility was tested, 39 patients showed resistance to at least one drug, 9 patients were resistant to only one drug, 9 patients were resistant to two drugs and 21 patients were resistant to more than 3 drugs. The common reasons for failure of treatments were: 1) poor patient compliance to medication: 50 cases, 2) multiple drug resistance: 30 cases, 3) delayed treatment: 19 cases. Some cases included a combination of the above.

Splenic abscesses: review of 29 cases.

Splenic abscess is an unusual and potentially life-threatening disease. Due to the nonspecific clinical picture, it remains a diagnostic challenge. Splenic abscess should be suspected in febrile patients with left upper quadrant tenderness and leukocytosis, and diagnosis confirmed based mostly on imaging studies, microbiologic and / or pathologic evidence, or by response to antibiotic or antifungal treatment. We present 29 cases of splenic abscess treated in our hospital from 1990 to 2001. There were 18 male patients (62%) and 11 female patients (38%). Ages ranged from 4 to 85 years, with a median of 44 years. There were five pediatric patients (17%) and 24 adults (83%). The most common associated condition was leukemia. Most patients were immunocompromised (72%). The more common signs and symptoms were fever (90%), chills (41%), abdominal pain (31%), and leukocytosis (38%). Ultrasonography of the abdominal cavity was positive in 27 cases (93%); computerized tomography or magnetic resonance imaging was used in 26 patients (90%) and was positive in all patients. The abscess was solitary in 21 cases (72%) and multiple in eight cases (28%). Positive blood cultures were found in only seven patients (24%). According to the literature, the treatment of choice is still splenectomy, but in our study, the success rate of 75% with antibiotics alone indicates that antibiotic therapy should be considered an important alternative treatment modality in patients not suitable for percutaneous drainage and splenectomy.

Removal of a mis-swallowed long spoon via gastrotomy--a case report.

Foreign body ingestions are a frequent occurrence, a common presentation at emergency departments, but long, pointed-end metallic spoon swallowing is an uncommon occurrence. Unlike most cases of foreign-body ingestion, there have been no cases of spontaneous passage reported. Consequently, prompt removal is recommended before complications develop. We report a case of accidental ingestion of a long, pointed metallic spoon which failed to pass through the gastrointestinal tract and be excreted. This patient was managed successfully with gastrotomy to remove the object. We recommend this approach for the removal of long pointed foreign bodies to avoid complications developing.

Exogenous lipoid pneumonia: serial chest plain roentgenography and high-resolution computerized tomography findings.

Between May 1988 and July 2002, six patients with pneumonia due to diesel, animal, or vegetable oil aspiration were admitted to Kaohsiung Medical University Hospital. The purpose of this study was to demonstrate distinctive radiographic findings of oil-induced lipoid pneumonitis on initial serial chest roentgenograms and high-resolution computerized tomography (CT) scans. Initial chest roentgenograms (n = 6), CT scans (n = 6), and roentgenography and CT follow-up studies were analyzed retrospectively by two chest radiologists and two surgeons, focusing on the pattern and distribution of parenchymal abnormalities. The most common location was the right middle lobe, followed by the right lower lobe, the left lower lobe, and the lingular lobe. Follow-up chest roentgenograms (n = 6) showed complete disappearance of the parenchymal lesions in only one patient and partial decrease in the extent of lesions in five patients. Lipoid pneumonia presents non-specific findings on chest roentgenography. It is commonly located in both lower and the right middle lobes. On high-resolution CT, the lesions appear most commonly as areas of consolidation, ground-glass attenuation mixed with paving pattern, and poorly defined nodules.

Paraoxonase activities in Minnan and Hakka.

Three phenotypes of paraoxonase (PON) have been found in population studies. The B type gene frequency varies among different populations. The Singaporean Chinese gene frequency is trimodal. The gene frequency of British Chinese populations was neither bimodal nor trimodal. We conducted a study to determine the frequency distribution of PON in the Minnan and Hakka populations. We collected blood samples and questionnaires from Minnan and Hakka subjects from Nantou County, Taiwan, excluding those with PON confounding factors. The blood samples were then examined for PON-non-NaCl (PON without salt stimulation), PON-NaCl (PON with salt stimulation) and arylesterase activities. We compared median differences in age, sex, PON-non-NaCl, PON-NaCl, arylesterase, and PON-NaCl/arylesterase between Minnan and Hakka populations using chi-square and rank analysis of variance (ANOVA), adjusted for age. There were 258 Minnan and 67 Hakka subjects without confounding factors. None of the frequency distributions for PON-non-NaCl, PON-NaCl, or PON-NaCl/arylesterase was clearly bimodal or trimodal. Hakka were older and had increased PON-non-NaCl, PON-NaCl, and PON-NaCl/arylesterase when compared with Minnan, but only age and PON-non-NaCl were significantly different. Hakka and Minnan may have more heterozygous AB phenotype for PON, which might explain why the frequency distribution is not trimodal or bimodal. Marriage among Minnan, Hakka, Aborigines, and other Mainland Chinese in Taiwan may be responsible for difficulty in differentiating gene frequencies among subpopulations by PON phenotype. Nonetheless, the Hakka appeared to have greater PON activity than the Minnan. Subpopulation in itself may be a factor for higher PON activity among the Hakka after controlling for confounding factors.

Relationship of paraoxonase and serum lipids in Taiwan.

Paraoxonase (PON) is structurally associated with the high-density lipoprotein fraction of serum, suggesting a role for this enzyme in lipoprotein metabolism. In Chinese Singaporeans, triglycerides (TG) had significant positive correlation with PON but high-density lipoprotein cholesterol (HDL-C) did not. Our paper investigates the influence of PON on serum lipids under controlling confounding factors in Taiwanese. Blood samples and questionnaires were collected from 476 Taiwanese with no participant excluded for any reason. Cases were examined for biochemistry, PON, TG, cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and HDL-C. PON phenotypes were determined by Hardy-Weinberg equilibrium. We compared median differences in PON, TG, TC, HDL-C and LDL-C between genders by means of the Wilcoxon Rank Sums test. Relationships among PON, TG, TC, HDL-C and LDL-C were represented by Pearson's correlation. A rank multiple regression analysis was also used to analyze the association between PON, TG, TC, HDL-C and LDL-C adjusted for age, gender and diabetes mellitus, since no uremia, acute myocardial infarction or peripheral neuropathy was present in our cases. Median TG and LDL-C were higher in males than in females, but median HDL-C was higher in females. For women and the total group, TC and HDL-C showed a significant positive correlation with PON. Only HDL-C showed a positive correlation with PON adjusted for age, gender and diabetes mellitus. PON is influenced by many confounding factors. Only after adjusting for the confounding factors in this study, HDL-C is positively correlated to PON like the structural relationship.

Analysis of factors associated with successful cardiopulmonary resuscitation in non-traumatic dead-on-arrival patients in emergency department.

Out-of-hospital cardiopulmonary arrest has a dismal prognosis. Successful resuscitation of these patients depends on the "chain of survival". In Taiwan, the emergency medical services (EMS) system is under development and the links of "chain of survival" are weak and frequently broken. A 2-year retrospective study was conducted from January, 1999, to December, 2000 to evaluate the factors of successful cardiopulmonary resuscitation (CPR) in non-traumatic DOA patients in ED. Of 175 studied patients, 51 patients (29.1%) were successfully resuscitated with return of spontaneous circulation (ROSC), but only 7 patients (4%) survived to hospital discharge. Most successfully resuscitated patients (84.3%) regained their vital signs within 30 minutes. There were no significant differences in age, sex, vehicle of transportation, administration of prehospital CPR or not, EMS response interval, on-scene duration, and scene-to-hospital interval between patients with ROSC and without ROSC. Compared with asystole cardiac rhythm, patients with pulseless electrical activity (PEA) had a higher successful resuscitation rate (p = 0.001), but no significant differences existed between patients with ventricular fibrillation/ventricular tachycardia (VF/VT) and PEA or VF/VT and asystole. However, there were no significant differences in the survival discharge rate among patients with different initial cardiac rhythms in ED.

Alveolar hemorrhage after scuba diving: a case report.

Self-contained underwater breathing apparatus (scuba) diving is increasingly popular in Taiwan. There are few references in the literature regarding pulmonary hemorrhage as the sole manifestation of pulmonary barotrauma in scuba divers, and no study from Taiwan was found in the literature. We present the case of a 25-year-old man who suffered alveolar hemorrhage related to pulmonary barotrauma as a complication of scuba diving. To our knowledge, this is the first case report describing a Taiwanese subject suffering from non-fatal pulmonary hemorrhage after scuba diving.

Hepatotoxicity caused by Breynia officinalis.

Breynia officinalis has the Chinese proprietary name, Chi R Yun, which means dizziness or vertigo for 7 d. In daily practice, it has been used to treat venereal diseases, contusion, heart failure, growth retardation and conjunctivitis in combination with other traditional Chinese medicines. Two hospital-based cases of Breynia officinalis poisoning have been reported to the Poison Control Center. Case 1 was a 43-y-old female who consumed a mixture of 1500 g lower stem and root of Ji Mu Ju in boiled water in a suicide attempt. Her AST reached 264 and ALT reached 2443. Case 2 was a 51-y-old female who consumed 20 pieces of lower stem and root of Ji Mu Ju stewed with meat and 100 ml of wine to treat chronic contact dermatitis. Her AST reached 3815 and ALT reached 6625. In both cases Breynia officinalis was identified as the cause of poisoning. Poisoning in humans involves the neurologic, gastrointestinal, hepatic, urinary and respiratory systems. Hepatotoxic effects have been reported for some Chinese herbal medicines, but not Breynia officinalis: Breynia officinalis poisoning causes hepatocellular liver injury rather than cholestatic liver injury.

Acute poisonings with Breynia officinalis--an outbreak of hepatotoxicity.

BACKGROUND: In combination with other traditional Chinese medicines, Breynia officinalis, a species of Euphorbiaceae, has long been used to treat contusions, heart failure, venereal diseases, growth retardation, and conjunctivitis. B. officinalis, regarded as a poison, was mistaken for a similar plant, Securinega suffruticosa, and cooked in a soup used for the treatment of muscle soreness, lumbago, and as a tonic in this outbreak. CASE SERIES: Nineteen patients, 11 males and 8 females (average age 49.2 +/- 9.1 years) consumed an average of 130 mL (30-900 mL) of soup containing B. officinalis stems. Fourteen patients developed diarrhea, 10 experienced nausea and chilly sensations, 9 had sensations of abdominal fullness, and 7 suffered from vomiting. The results of liver function tests (LFTs) indicated that the observed maximum median level of alanine aminotransferase (ALT) was 647U/L (range 89-9440 U/L), aspartate aminotransferase (AST) 314 U/L (range 47-7756 U/L), alkaline phosphatase 251 U/L (range 224-278 U/L), and gamma glutamyl transpeptidase 106 U/L (range 84-313 U/L). The median time to the observed median peak levels was 3 days for ALT, 2 days for AST, 5 days for alkaline phosphatase, and 12 days for gamma glutamyl transpeptidase. With supportive treatment, the majority of abnormalities in 14 of the cases resolved within 6 months of exposure. CONCLUSIONS: The consumption of a soup containing B. officinalis Hemsley resulted in dose-related toxic effects. Clinical toxicity consisted primarily of gastrointestinal symptoms and signs and hepatotoxicity. Hepatocellular liver injury rather than cholestatic liver injury was observed. Marked jaundice did not develop.