Merkel cell carcinoma in Taiwan: A rare tumour with a better prognosis in those harbouring Merkel cell polyomavirus.

Merkel cell carcinoma (MCC) is a rare malignant cutaneous neuroendocrine tumour affecting mainly elderly patients and is more common in the West than in Asia. It is associated with Merkel cell polyomavirus (MCPyV), immunosuppression, and ultraviolet light. In this study, we retrospectively investigated the first series of MCC from Taiwan and identified 19 cases from three tertiary centres. All patients were males with a median age of 67.5. Twelve (63%) cases occurred in the extremities, with one unique case presenting initially as nodal metastasis of unknown primary. Immunohistochemically, the great majority of tumours expressed CK20 (89%), synaptophysin (89%), and INSM1 (84%), with none positive for TTF1. Eleven (58%) cases were positive for MCPyV by immunohistochemistry (clone CM2B4). All patients were treated with excision, including four with additional radiotherapy and one with radiotherapy and chemotherapy. Nodal status and treatment modalities significantly affected survival. The median survival time of MCPyV-positive cases was much longer than the negative cases (median 40 vs. 10 months). In summary, we presented the first report on the clinicopathological features of MCC in Taiwan, with 58% cases associated with MCPyV. The prognosis of patients with MCPyV-positive tumours was better than those negative for MCPyV.

Frequent loss of CD10 expression in follicular lymphoma with leukaemic presentation.

INTRODUCTION: Follicular lymphoma (FL) is usually a nodal lymphoma expressing CD10, rarely with leukaemic presentation (FL-LP). MATERIALS AND METHODS: We searched for FL-LP in our institution from 2000 to 2018 and characterised the neoplastic cells by flow cytometry, immunohistochemistry and fluorescence in situ hybridization. Thirteen (6.1%) of 212 FL cases were FL-LP, all de novo neoplasms. The leukaemic cells were small in 12 cases and large in one. All had concurrent FL, mostly (92%; 12/13) low-grade. The single case with large leukaemic cells had a concurrent primary splenic low-grade FL and a double-hit large B-cell lymphoma in the marrow. RESULTS: CD10 was expressed in the leukaemic cells in 38% (5/13) cases by flow cytometry and in 77% (10/13) cases in tumours (p= 0.0471). IGH/BCL2 reciprocal translocation was identified in 85% (11/13) cases. Most patients were treated with chemotherapy. In a median follow-up time of 36 months, nine patients were in complete remission. The 2- and 5-year survival rates were at 100% and 83%, respectively. In this study, we characterised a series of de novo FL-LP in Taiwan. All patients had concurrent nodal and/or tissue tumours, which might suggest that these patients seek medical help too late. CONCLUSION: The lower CD10 expression rate by flow cytometry than by immunohistochemistry might be due to different epitopes for these assays. Alternatively, loss of CD10 expression might play a role in the pathogenesis of leukaemic change. The clinical course of FL-LP could be aggressive, but a significant proportion of the patients obtained complete remission with chemotherapy.

Computed tomography has low sensitivity for the diagnosis of early colon cancer.

AIM: The accuracy of computed tomography (CT) in detecting local invasion (T status) and nodal metastasis (N status) of colon cancer was determined. METHOD: Data on the preoperative CT scan of 153 lesions from 152 patients with colon cancer were reviewed retrospectively. Evaluation included the T stage and N stage of the TNM system. The results were compared with those obtained by histopathological examination of the resected tumour. RESULTS: Of the 153 tumours, 117 (76.5%) were correctly classified as Stage T1 and T2 (33 tumours) and Stage T3 and T4 (84 tumours) by CT. The sensitivity and specificity were 70.2% and 79.2%, respectively, and the positive and negative predictive values were 85.7% and 60.0%. When analysed according to the individual T stage (Tx/Tis, T1, 2, 3, 4) and N stage (N0, 1, 2), the kappa coefficient with linear weighting was 0.208 (fair agreement) for T stage and 0.154 (slight agreement) for N stage. The estimation of tumour size showed good agreement with histopathology (Spearman correlation coefficient 0.865). CONCLUSION: CT scanning of colonic cancer showed 75% accuracy in identifying T1 and T2 cancers combined, but gave poor agreement between CT and histopathology for individual T stages.

TCAD simulations for thin film solar cells with nanoplate structures.

The novel thin film solar cell with a nanoplate structure that can solve the conflict between the light absorption and the carrier transport in amorphous silicon thin film solar cell was investigated by TCAD simulations. This new structure has n-type amorphous silicon nanoplate array on the substrate, and p-type amorphous silicon-carbon as window layer and intrinsic amorphous silicon as absorption layer are sequentially grown along the surface of each n-type amorphous silicon nanoplate. Under AM 1.5 G sunlight illumination, the light is absorbed along the vertical direction of nanoplate while the carrier transport is along the horizontal direction. Therefore, nanoplate with the larger height can absorb most of the sunlight. The advantage of this novel structure is that the thickness of the solar cell can be used as thin as possible for effective transport of photo-generated carriers in comparison with the planer one.

Impact of strain engineering on nanoscale strained III-V PMOSFETs.

Stress distributions in the strained InGaAs PMOSFET with source/drain (S/D) stressors for various lengths and widths were studied with 3D stress simulations. The resulting mobility improvement was analyzed. Compressive stress along the transport direction was found to dominate the hole mobility improvement for the wide width devices. Stress along the vertical direction perpendicular to the gate oxide was found to affect the mobility the least, while stress along the width direction enhanced in the middle wide width region. The impact of channel width and length on performance improvements such as the mobility gain was analyzed using the Kubo-Greenwood formalism accounting for nonpolar hole-phonon scattering (acoustic and optical), surface roughness scattering, polar phonon scattering, alloy scattering and remote phonon scattering. The novelty of this paper is studying the impact of channel width and length on the performance of InGaAs PMOSFET such as mobility and exploring physical insight for scaling the future III-V CMOS devices.

Impact of the nanorod structure on the tandem thin-film solar cell.

The novel thin-film solar cell was investigated with a nanorod structure that could solve the conflict between light absorption and carrier transport in the amorphous silicon (a-Si)/amorphous silicon-germanium (a-SiGe) tandem thin-film solar cell. This structure has an n-type a-Si nanorod array on the substrate, and an a-SiOx p-layer and an a-SiGe i-layer are sequentially grown along the surface of each n-type a-Si nanorod, for the bottom cell. After the above bottom-cell process, a similar process is used to fabricate an amorphous Si p-i-n top cell on the bottom cell. Under sunlight illumination, the light is absorbed along the vertical direction of the nanorod, but as the carrier transport is along the horizontal direction, the nanorod may absorb most of the sunlight. In the meantime, the solar cell is still thin enough for the effective transport of photogenerated carriers.

Analysis and modeling of nano-crystalline silicon TFTs on flexible substrate with mechanical strain.

The gap state density of nano-crystalline silicon active layers on a flexible substrate was redistributed with mechanical bending. The weak or broken bonds may contribute to the redistribution of trap states. During mechanical strain, the deep states redistributed in a Gaussian distribution, and are dissimilar to ordinary acceptor-like deep states, which manifest with exponential distributions. We conclude that the gap state density with TCAD modeling under mechanical strain is the fundamental reliability issue for the development of flexible electronics.

Beneficial response to gabapentin portraying with interval change of brain SPECT imaging in a case with failed back surgery syndrome.

WHAT IS KNOWN AND OBJECTIVE: Failed back surgery syndrome (FBSS) is a well-recognized consequence of surgery of the lumbar spine. Here, we present a case with FBSS associated neuropathic pain. CASE SUMMARY: During hospital stay, the patient was stabilized with gabapentin 200 mg twice a day and this was titrated to a dose of 1200 mg per day over the period of 1 week. The treatment produced a substantial reduction in his episodic pain. We assessed regional cerebral blood flow (rCBF) by using brain single photon emission computed tomography (SPECT) scans, which were performed before and after gabapentin treatment 1 week later. The examination of the first SPECT showed decreased uptake in left fronto-temporal-parietal region. The latter one showed much improvement of the above areas. WHAT IS NEW AND CONCLUSION: The gabapentin has beneficial effect in the FBSS associated neuropathic pain. Besides, this case suggests the association between rCBF and pain associated with FBSS, as well as the association of gabapentin and altered blood flow of brain cortex.

Methylprednisolone worsening neuropathic pain in non-traumatic thoracic myelopathy.

Methylprednisolone (MP) is the only neuroprotective medication currently in widespread use for the treatment of spinal cord injury. Increasingly, published studies challenge its clinical effects in view of its serious side-effects including wound infection, pneumonia, sepsis and steroid myopathy. Most cases with spontaneous spinal epidural haematoma (SSEH) need emergency evacuation, and typically show good neurologic recovery. Some patients with SSEH given preoperative or postoperative MP within hours of the onset of symptoms, and have had good motor recovery, although no mention was made of sensory function. Severe, intractable neuropathic pain has not been reported in patients with SSEH. We present a case of SSEH treated with a high-dose MP 16 h after onset of symptoms. Surgical decompression was performed 1 h after MP treatment. Motor recovery was good; however, intractable neuropathic pain developed 5 weeks postoperatively. We discuss the factors contributing to intractable pain. We speculate that the severe, intractable pain might be due to misuse of large-dose steroids in this case of non-traumatic spinal myelopathy, and not because of the injury per se.

First Report of Anthracnose Caused by Colletotrichum acutatum on Mung Bean Sprouts in Taiwan.

Mung bean sprouts (Vigna radiata (L.) R. Wilczek) are a commonly consumed vegetable in Asian countries. Anthracnose lesions on mung bean sprouts (cv. You-lu-dou from Mayamar) were found in an indoor sprouting facility in Taichung County, Taiwan in May of 2009. The incidence of disease exceeded 90% in some lots. Infected hypocotyls had smooth, diamond-shaped to fusiform brown spots, which became further depressed and enlarged with age. A fungus was isolated on potato dextrose agar (PDA) from symptomatic hypocotyls after surface sterilization in 0.6% NaOCl. Fungal colonies were initially salmon to orange in color and became greenish gray on the surface within a week. Setae were not produced in acervuli that developed on PDA. Conidia in the acervuli were one-celled, cylindrical, and hyaline with an average length and width of 14.8 (7.0 to 23.7) × 4.9 (3.3 to 6.7) µm (n = 53). The internal transcribed spacer (ITS) region was amplified with primers ITS1 and ITS4 (4). The sequence was deposited in GenBank (Accession No. GQ889269). The sequence was 99% identical to that of ATCC 56816 strain of Glomerella acutata (Guerber & J. C. Correll), the teleomorph of Colletotrichum acutatum (J. H. Simmonds) over a 522-bp alignment. Thus, the mung bean pathogen was identified as C. acutatum based on morphological (1) and molecular characters. Pathogenicity of the strain was determined by inoculating mung bean seeds from I-Mei Foods Co. (imported from Australia). The seeds were disinfested in 0.6% NaOCl for 10 min, rinsed with sterile distilled water twice, and immersed in a conidial suspension (1.5 × 104 conidia/ml) of C. acutatum for 10 min. Fifteen inoculated seeds were placed on moistened paper towels, distributed into three flasks, and stored in the dark at 32°C. Symptoms similar to those observed on the original sprouts appeared 3 days later on the hypocotyls of the seedlings and all seedlings were infected by day five. Conidia of C. acutatum were produced on all lesions and colonies of C. acutatum were recovered from symptomatic tissues, fulfilling Koch's postulates. Controls (seed immersed in water) remained symptomless. The pathogenicity test was repeated with similar results. The pathogen has been recorded on mung bean sprouts in Korea (2) and on other Vigna spp. in India (3). To our knowledge, this is the first report of sprout rot of mung bean caused by C. acutatum in Taiwan. References: (1) B. J. Dyko and J. E. M. Mordue. No. 630 in: Descriptions of Pathogenic Fungi and Bacteria. CMI, Kew, Surrey, UK, 1979. (2) D. K. Kim et al. Plant Pathol. J. 19:203, 2003. (3) K. P. R. Prasanna. Seed Sci. Technol. 13:821, 1985. (4) T. J. White et al. Page 315 in: PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds. Academic Press, New York, 1990.

Hemichorea associated with gabapentin therapy with hypoperfusion in contralateral basal ganglion - a case of a paraplegic patient with neuropathic pain.

Functional imaging in patients with movement disorders has suggested abnormalities of regional cerebral blood flow (rCBF). We describe a patient with thoracic cord lesion with subsequent severe neuropathic pain. Right hemichorea developed and was related to adjunctive therapy with gabapentin. The patient's hemichorea decreased gradually after cessation of gabapentin. The study of rCBF revealed hypoperfusion in the contralateral basal ganglia compared with the previous study of rCBF. Our patient is the first patient with neuropathic pain, treated with gabapentin who developed hemichorea, in the absence of brain lesions. Imaging studies of rCBF showed a perfusion defect in the contralateral basal ganglion.

Effects of piroxicam-beta-cyclodextrin sachets on abnormal postural sway in patients with chronic low back pain.

BACKGROUND: The clinical effects of piroxicam-beta-cyclodextrin (PBC) in sachet form have been surveyed in patients with osteoarthritic or acute pain in western countries, but scarcely studied in those with chronic low back pain (LBP), and never investigated in the field of postural sway. The aim of this study was to evaluate the clinical effects of PBC in sachet form prescribed in patients with chronic backache in local Asian when compared with those of plain piroxicam. METHODS: After randomized allocation and experimental exclusion, a total of 42 eligible patients were randomized into two groups, the sachet group (n = 23) and the piroxicam tablet group (n = 19). Both groups were administered the same dosage, orally per day (daily dose = 20 mg). The duration of trial was 28 days. Efficacy was assessed with pain score, disability index and postural sway. RESULTS: The patients in sachet group showed greater improvement in pain score and disability index than those who took piroxicam tablets. There were significantly lower sway velocity and intensity at almost all different conditions than baseline profiles in both groups (P < 0.05). However, there was no significant difference of sway velocity and intensity in the piroxicam tablets group with regard to eyes open or eyes closed in 20 degrees dorsiflexion. CONCLUSIONS: Piroxicam-beta-cyclodextrin (PBC) sachet may have greater improvement in the treatment of chronic LBP and possess the extended effects on postural abnormality relevant to chronic LBP.

Sudden death in Wolff-Parkinson-White syndrome combined with syncope: a case report.

Electrocardiogram showing Wolff-Parkinson-White (WPW) pattern in an asymptomatic patient is common, but it is difficult to assess the potential risk of sudden death in such cases. Although the incidence of sudden death in these patients is extremely low, an interventional approach is suggested for all patients despite its controversial nature. Syncope, despite being induced by various mechanisms, has been considered an alarming sign of sudden death of WPW syndrome. We describe a 16-year-old female patient with an electrocardiogram that demonstrated a WPW pattern combined with unexplained syncope. None of the examinations, including biochemical profiles, brain computed tomography, transthoracic echocardiography, head-up tilt table test and exercise electrocardiogram, clarified her syncope. Consequently, no further electrophysiologic study was performed for this patient. Unfortunately, the patient suffered sudden death while running. The case highlights the need for vigilance when unexplained syncope combined with WPW syndrome. Such cases have high risk of sudden death, and thus, further interventional study and treatment is indicated.

Polysaccharide-peptide complexes from the cultured mycelia of the mushroom Coriolus versicolor and their culture medium activate mouse lymphocytes and macrophages.

The aim of this study was to investigate the effects of the mushroom Coriolus versicolor on cells of the immune system. The cultured mycelia of the mushroom Coriolus versicolor and their culture medium were separately extracted with boiling water. The resulting polysaccharopeptide preparations were designated intramycelial (IM) and extramycelial materials (EM), and were separated by gel filtration before determining their effects on lymphocytes and macrophages in vitro and in vivo. After gel filtration on Sepharose 6B, only a single peak with a molecular weight of 13-19 KDa was obtained. Gel filtration of IM and EM on Sephadex G-50 revealed the presence of a larger peak of 28 KDa (from IM) and 15 KDa (from EM) and a smaller peak of 3.5 KDa. IM, EM and their large molecular peaks enhanced the mitogenic response of T-cells from BALB/c mice in vitro. Splenocytes from C57BL/6 mice pre-treated by force-feeding with IM and EM demonstrated an augmented mitogenic response to Con A. The macrophages of C57BL/6 mice that had been pre-treated with IM or EM showed an enhanced production of nitrite ions. The results indicate that both mouse lymphocytes and macrophages were activated by preparations of polysaccharopeptide from cultured mycelia and culture medium of C. versicolor. However, no direct cytotoxic activity against fibroblasts, hepatoma cells and choriocarcinoma cells could be demonstrated.

Sulbactam/ampicillin followed by oral treatment with sultamicillin for medical and surgical infections.

This study was conducted to evaluate the efficacy and safety of intravenous sulbactam/ampicillin followed by oral sultamicillin. Parenteral sulbactam/ampicillin was administered for 7 to 14 days to 152 in-patients with moderate to severe infections. All patients were treated with sulbactam/ampicillin, but only 140 patients received oral sultamicillin therapy. Eighty-nine men and 63 women participated in this study. Infections included intraabdominal (42 cases), respiratory tract (52 cases), skin and soft tissue (29 cases), urinary tract (16 cases), and miscellaneous infections (14 cases) that included typhoid fever, gastroenteritis, septicemia, and surgical wound infection. Six (4%) patients reported six study drug-related adverse experiences. Gastrointestinal side effects were most common and included epigastric burning and indigestion. Diarrhea was not reported and no patient discontinued drug therapy because of an adverse event. Laboratory abnormalities were infrequent and clinically insignificant. Overall, 98% of the 114 evaluable patients achieved clinical cure or improvement following treatment with sulbactam/ampicillin and sultamicillin. Cured or improved patients in each diagnostic group were 97% for intraabdominal infections, 100% for respiratory tract infections, 100% for skin and soft tissue infections, 100% for urinary tract infection, and 91% for other types of infections. Only 2 (2%) patients were judged to be treatment failures. Microbiologic efficacy, or eradication, was 86% overall, ranging from 75 to 100%. Persistence of pathogens occurred in 5%, and eradication with development of a superinfection occurred in 4%. Fifty-seven percent (30/50) of the isolates tested were resistant to ampicillin alone whereas only 21% (9/42) were resistant to sulbactam/ampicillin (p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Soil biosensor for the detection of PAH toxicity using an immobilized recombinant bacterium and a biosurfactant.

A biosensor for detecting the toxicity of polycylic aromatic hydrocarbons (PAHs) contaminated soil has been successfully constructed using an immobilized recombinant bioluminescent bacterium, GC2 (lac::luxCDABE), which constitutively produces bioluminescence. The biosurfactant, rhamnolipids, was used to extract a model PAH, phenanthrene, and was found to enhance the bioavailability of phenanthrene via an increase in its rate of mass transfer from sorbed soil to the aqueous phase. The monitoring of phenanthrene toxicity was achieved through the measurement of the decrease in bioluminescence when a sample extracted with the biosurfactant was injected into the minibioreactor. The concentrations of phenanthrene in the aqueous phase were found to correlate well with the corresponding toxicity data obtained by using this toxicity biosensor. In addition, it was also found that the addition of glass beads to the agar media enhanced the stability of the immobilized cells. This biosensor system using a biosurfactant may be applied as an in-situ biosensor to detect the toxicity of hydrophobic contaminants in soils and for performance evaluation of PAH degradation in soils.

A biosensor for the detection of gas toxicity using a recombinant bioluminescent bacterium.

A whole-cell biosensor was developed for the detection of gas toxicity using a recombinant bioluminescent Escherichia coli harboring a lac::luxCDABE fusion. Immobilization of the cells within LB agar has been done to maintain the activity of the microorganisms and to detect the toxicity of chemicals through the direct contact with gas. Benzene, known as a representative volatile organic compound, was chosen as a sample toxic gas to evaluate the performance of this biosensor based on the bioluminescent response. This biosensor showed a dose-dependent response, and was found to be reproducible. The immobilizing matrices of this biosensor were stored at 4 degrees C and were maintained for at least a month without any noticeable change in its activity. The optimal temperature for sensing was 37 degrees C. A small size of this sensor kit has been successfully fabricated, and found to be applicable as a disposable and portable biosensor to monitor the atmospheric environment of a workplace in which high concentrations of toxic gases could be discharged.

Comparative study of cefoperazone and amikacin.

A comparative study of cefoperazone and amikacin in severe surgical infections was conducted with 60 patients equally allocated to two groups. The daily dosage of cefoperazone ranged from 2 to 4 gm in two equally divided doses, and the daily dosage of amikacin ranged from 900 to 1,000 mg in two equally divided doses. All patients were given antibiotics for five to ten days. With cefoperazone, there were satisfactory clinical responses in 83% (29/35) of the infections; with amikacin, 74% (23/31). Cefoperazone was more effective than amikacin in biliary tract infections. On bacteriological examination, 7.5% of the organisms isolated were resistant to cefoperazone and 10% to amikacin. In mixed infections, cefoperazone and amikacin had failure rates of 29% and 36%, respectively. Further trials are needed to define the role of cefoperazone in anaerobic and in mixed infections.

Neuronal supernumerary and dendritic sprouting of the nucleus ambiguus after chronic alteration of peripheral targets in cats.

Anatomic changes of neuronal profiles in response to chronic alteration of peripheral targets were investigated in the nucleus ambiguus (NA) of cats. Unilateral vagal-hypoglossal nerve anastomosis was performed by suturing the transected proximal stump of the vagus nerve to the transected distal stump of the hypoglossal nerve. After comparing horseradish peroxidase (HRP)-labeled neurons on the ipsilateral operated side of the NA with the contralateral unoperated NA and the NA following transection and reuniting to the vagus itself, a remarkable ramification and elongation of the dendritic trees was observed in the HRP-positive neurons on the ipsilateral NA. Quantitative analysis of neuronal profiles revealed that the number of the medium and large neurons on the ipsilateral NA was greater than the contralateral NA and the NA following autologous suturing of the vagus. Comparisons of variable dendritic lengths of the medium and large neurons on the ipsilateral NA revealed longer distances and more branches of the tertiary and perisomatic dendrites than those of the contralateral NA and the NA ipsilateral to autologous reunion. Our results suggest that remarkable sprouting and elongation of the dendritic trees as well as cell supernumerary occurred in the dominant NA motoneurons ipsilateral to the nerve anastomosis. In conclusion, there is a trophic influence in the tongue musculature, which was retrogradely transported to the NA neurons via the regenerating axons and caused the morphological changes in the NA in response to the rerouting of efferents from the vagus nerve to the hypoglossal nerve to innervate intimate tongue musculature.