Considerations about L2- and L1-norm regularizations for ultrasound reverberation characteristics imaging and vectoral Doppler measurement.

The L1-norm regularization is applied to ultrasonic reverberation characteristics imaging and vectoral Doppler measurement, of which performances are compared with those of L2-norm regularizations. The L1 regularization yields the sharper image than the L2 regularization. Alternatively, for the Doppler measurement, the L1 regularization yields less accuracy than the L2 regularization. Clinical Relevance- This study will permit us to perform quantitative ultrasonic reverberation characteristics and accurate vectoral Doppler observation.

A study on the expression of FGF-21 and NF-κB pathway in the tissues of atherosclerotic mice.

OBJECTIVE: To study the relationship between the expressions of fibroblast growth factor (FGF)-21 and NF-κB signal transduction pathway in the tissues of atherosclerotic mice. MATERIALS AND METHODS: A total of 40 apoE-/- male mice at 8 weeks were selected and randomly divided into 4 groups. 10 mice in group A were normally fed with diet. 10 mice in group B were fed with high-fat diet. 10 mice in group C were fed with high-fat diet + pravastatin. 10 mice in group D were fed with high-fat diet + subcutaneous injection of exogenous recombinant FGF-21 protein. Another 10 C57BL/6J mice at 8 weeks were normally fed with diet (group E). They were killed after 12 weeks to collect retinal venous blood. ELISA method was applied to detect the levels of serum FGF-21, NF-κB, monocyte chemo attractant protein (MCP-1), matrix metalloproteinase (MMP)-9 and TNF-α. Immunohistochemical staining and RT-PCR method were applied to detect the expression of FGF-21 in aortic arch and liver tissues. RT-PCR method and Western blot method were applied to detect the expression of NF-κB, MCP-1, MMP-9 and TNF-α in aortic arch and liver tissues. RESULTS: The levels of serum FGF-21, NF-κB, MCP-1, MMP-9 and TNF-α in group B were higher than those of group A and group E, and those of group C and group D were lower than those of group B (except FGF-21 in group D). The differences had statistical significance (p<0.05). The positive staining rates of FGF-21 in endothelial cells of aortic arch and liver tissues in group B were higher than those group A and group E, and those of group C and group D were lower than those of group B. The differences had statistical significance (p<0.05). The expression levels of FGF-21mRNA, NF-κB, MCP-1, MMP-9, TNF-αmRNA and protein in endothelial cells of aortic arch and liver tissues in group B were higher than those group A and group E, and those of group C and group D were lower than those of group B. The differences had statistical significance (p<0.05). CONCLUSIONS: FGF-21 may participate in the occurrence of atherosclerosis (AS), which is related to the activation of the NF-κB pathway. Lipid-lowering therapy can inhibit the activation of FGF-21 and NF-κB. Exogenous FGF-21 can also lower the activation of NF-κB and interpose in atherosclerosis process.

Analysis of the safety and efficacy of combined extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for the treatment of complex renal calculus.

OBJECTIVE: To investigate the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) combined with percutaneous nephrolithotomy (PCNL) for treatment of complex renal calculus. PATIENTS AND METHODS: Seventy-eight patients diagnosed with complex renal calculus and who accepted treatment in our hospital were consecutively selected. Patients were divided randomly into the observation group (n=40) treated by combined ESWL and PCNL and the control group (n=38) treated by PCNL. The effect of treatment between the two groups was compared. RESULTS: The stone-free rate at 3 months after surgery was higher in the observation group than in the control group. There were no differences in the rates of complications (including infection, hemorrhage, collection system perforation and laceration, peripheral organ impairment, and urination extravasation). There were gradual decreases of serum creatinine in the observation group at 4 weeks after extubation of the double J catheter and at 3 months after surgery, while there were no apparent decreases in the control group. The levels of cysteine protease inhibitor and neutrophil gelatinase-associated lipocalin in both groups increased at 4 weeks after extubation of the double J catheter, and decreased at 3 months after surgery. The decreases were more apparent in the observation group compared with the control group, and the differences were statistically significant (p<0.05). CONCLUSIONS: Combined use of ESWL and PCNL to treat complex renal calculus can improve the stone-free rate and renal function, and does not increase the complication rate. It is, therefore, safe and effective.

Increased level of MSU crystal-bound protein apolipoprotein A-I in acute gouty arthritis.

BACKGROUND: Gout is a common form of inflammatory arthritis that is triggered by the crystallization of monosodium urate (MSU). We investigated the potential proteins that relate to the pathogenesis or the spontaneous resolution of acute gouty arthritis. METHOD: We screened for differentially expressed proteins in the plasma of patients with acute gouty arthritis using two-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS) identification. We confirmed these findings in a population study of 209 subjects, and further determined the protein profile of the synovial fluid (SF) from 24 gouty patients during acute attack by liquid chromatography coupled with tandem MS (LC/MS/MS). RESULTS: The highly expressed apolipoprotein A-I (apoA-I) was identified in the plasma of acute gouty patients compared with healthy controls. Moreover, we detected high levels of SF apoA-I in 83.3% of acute gouty patients during attack. From the population study, apoA-I was increasingly associated with normouricaemia, hyperuricaemia, and acute gouty arthritis (ptrend < 0.001), and plasma uric acid (UA) and apoA-I were positively correlated (p = 0.0156). We used a human liver cell model and found that UA enhanced the hepatic apoA-I mRNA expression level (ptrend < 0.01) and apoA-I secretion level (ptrend = 0.002) in a dose-dependent manner. An elevated MSU concentration caused the endogenous apoA-I to deplete gradually. CONCLUSIONS: Based on the role of apoA-I in anti-inflammation, our observational data in acute gout support the hypothesis that apoA-I expression can be induced under the condition of a high concentration of UA and its elevated level may be implicated in the spontaneous resolution of acute gouty arthritis.

Elizabethkingia meningoseptica: an important emerging pathogen causing healthcare-associated infections.

Elizabethkingia meningoseptica has been deemed a potentially important threat to patients in critical care areas because of its multidrug-resistant phenotype and its ability to adapt to various environments. This review considers the incidence, factors which predispose to, and clinical features of, E. meningoseptica sepsis, along with antimicrobial susceptibility patterns of clinical E. meningoseptica isolates and reportedly successful measures for the prevention and control of infections caused by this bacterium. The English-language literature from the PubMed database was reviewed. The incidence of E. meningoseptica bacteraemia has increased over the last decade. Patients at high risk of E. meningoseptica infection include preterm children, the immunocompromised and those exposed to antibiotics in critical care units. Vancomycin, rifampicin, newer fluoroquinolones, piperacillin-tazobactam, minocycline and possibly tigecycline are preferred empirical choices for E. meningoseptica infection according to in-vitro susceptibility data. Combination therapy has been used for infections not responding to single agents. Saline, lipid, and chlorhexidine gluconate solutions as well as contaminated sinks have been implicated as sources of infection following outbreak investigations. In addition to reinforcement of standard infection control measures, actions that have successfully terminated E. meningoseptica outbreaks include pre-emptive contact isolation, systematic investigations to identify the source of the bacterium and thorough cleaning of equipment and environmental surfaces. As the clinical complexity and incidence of E. meningoseptica infections increase, there is a need for heightened awareness of the potential for this bacterium to cause outbreaks. This will permit timely initiation of active surveillance for infected/colonized patients as well as investigations to identify the likely source of the bacterium, which will, in turn, allow implementation of appropriate infection control measures.

Hepatocellular carcinoma with colonic metastasis.

Hepatocellular carcinoma with colonic metastasis is rare. It mainly occurs by direct invasion and presents with bloody stools. We describe a patient with haematogenous metastasis to the rectum who presented with tenesmus. To our knowledge, such an association has not been reported previously. Colonic metastasis should be considered when patients with hepatocellular carcinoma present with bloody stools or tenesmus.

Distribution and predictive factors of seizure types in 104 cases.

REASONS FOR PERFORMING THE STUDY: Although many studies have been performed to classify seizures by type in man and small animals, a similar study in horses is lacking. OBJECTIVES: The aims of this study were as follows: 1) to characterise the distribution of seizure types in 104 horses presented for seizure disorders to a referral veterinary hospital; and 2) to characterise the various types of seizures by identifying associated clinical factors. STUDY DESIGN: Retrospective analysis of clinical records. METHODS: Seizures were classified based on seizure type, according to the most recent accepted definitions in both human and small animal epileptology. History, clinical and neurological examinations, diagnostic investigations and post mortem examinations, when available, were recorded for univariable and multivariable logistic regression analyses. RESULTS: Seizures were categorised as primary generalised in 23% of horses, focal without secondary generalisation in 42% of cases and secondary generalised in 24% of cases. The type of seizure could not be classified in 11% of cases. Significant associations were found between seizure type and the following characteristics: 1) gender; 2) frequency of seizures; and 3) presence of seizures during hospitalisation. Seizure type was not significantly associated with aetiology. For a horse with recurrent seizures, the odds of having focal seizures was 3.7 times higher (P = 0.02) than in a similar horse with nonrecurring seizures in the final logistic regression model. CONCLUSIONS: The majority of the seizures described were focal seizures with or without secondary generalisation. The clinical presentation was independent of the underlying disease.

Defective Mycobacterium tuberculosis antigen presentation by monocytes from tuberculosis patients.

OBJECTIVE: To determine whether there were any defects in the presentation of the Mycobacterium tuberculosis antigen by monocytes from patients with tuberculosis (TB) and the role of vitamin D in the defence against M. tuberculosis. DESIGN: A prospective study aimed at analysing the presentation of the M. tuberculosis antigen by monocytes and the response to vitamin D treatment in three groups of participants: 1) those with active TB, 2) those with healed TB and 3) those with frequent TB contact. RESULTS: The antigen presentation ability of monocytes of persons in the frequent contact group was significantly higher than that of the active TB and healed TB groups. There was no difference between patients with active and healed TB. In addition, 1,25(OH)2D3 increased the presentation of mycobacterial antigens by monocytes from participants with frequent TB contact, but not those with active or healed TB. CONCLUSION: Patients with active and healed TB exhibit defective M. tuberculosis presentation in monocytes. The administration of vitamin D did not correct this defect in monocytes from participants with active or healed TB, but could increase antigen presentation by monocytes in participants with frequent TB contact.

Global DNA methylation, DNMT1, and MBD2 in patients with systemic lupus erythematosus.

To investigate the associations of DNA methylation levels and mRNA expressions of DNA cytosine-5-methyltransferase 1 (DNMT1) and methyl CpG-binding domain 2 (MBD2) with systemic lupus erythematosus (SLE), 108 patients with SLE and 97 healthy controls were enrolled in this study. DNA and total RNA were extracted from the peripheral blood mononuclear cells of the SLE patients and the controls. The global methylation levels of DNA were measured in 63 patients with SLE and 68 healthy controls by the ELISA method. DNMT1 and MBD2 mRNA were also detected in 108 SLE patients and 97 controls using the quantitative real-time polymerase chain reaction method. The global methylation level of DNA was significantly decreased in the SLE patients in comparison with that in the controls (p < 0.001, 95% CI = 0.1573-0.5052). The patients with SLE have higher expressions of DNMT1 and MBD2 mRNA than the controls (p < 0.001, 95% CI = -0.0049 - -0.0019 and p = 0.001, 95% CI = -0.0119 - -0.0029, respectively). We also found that there were no significant differences in the methylation level and the expression of DNMT1 and MBD2 mRNA between the active and the inactive SLE patients. A positive correlation was also found between DNMT1 and MBD2 mRNA expressions in the SLE patients (p < 0.001). This study demonstrated that the patients with SLE had a significantly lower level of DNA methylation than the controls. The expression of both DNMT1 and MBD2 mRNA was significantly increased in the SLE patients compared with the controls. This study also showed a positive correlation between DNMT1 and MBD2 mRNA levels in the patients with SLE.

Clonal spread of CC17 vancomycin-resistant Enterococcus faecium with multilocus sequence type 78 (ST78) and a novel ST444 in Taiwan.

From May 2007 to January 2008, 30 isolates of vancomycin-resistant enterococci (VRE), including 29 Enterococcus faecium (96.7%) and 1 E. faecalis (3.3%) were obtained from various clinical specimens of 30 patients treated at a university hospital in Taiwan. Among these patients, 27 had VRE infections, including urinary tract infection (n = 16), bacteremia (n = 5), wound infection (n = 5), and central nervous system infection (n = 1). Three patients had VRE colonization. All of these isolates belonged to the vanA genotype with vancomycin minimum inhibitory concentrations of 64>or=128 microg/ml. The isolate of E. faecalis had VanB phenotype-vanA genotype. All these isolates were susceptible to linezolid and were inhibited by tigecycline at 0.25 microg/ml. Multilocus sequence typing (MLST) analysis of the E. faecium isolates showed that 82.8% were ST78, which belongs to lineage C1. Transposon typing classified the 30 isolates of VRE into three types and most of the Tn1546-like elements contained an IS1251-like insertion sequence. Mating experiments showed that the vanA gene clusters were transferable at a frequency of about 10(-6) to 10(-7). Our findings indicate that nosocomial spread of VRE resulted from dissemination of lineage C1 E. faecium clones, including a novel E. faecium MLST type (ST444), and the horizontal transfer of Tn1546 elements among enterococci.

IkappaBalpha promoter polymorphisms in patients with rheumatoid arthritis.

To investigate the role of inhibitor of kappaBalpha promoter polymorphisms in the pathogenesis of rheumatoid arthritis (RA), 140 patients with RA and 115 healthy controls were enrolled in this study. The IkappaBalpha promoter polymorphisms were determined using the polymerase chain reaction/restriction fragment length polymorphisms method. In comparison with IkappaBalpha-826 C/C, the genotype frequency of IkappaBalpha-826 C/T was significantly higher in the patients with RA than that of the controls (P = 0.009, OR = 2.0, 95% CI = 1.2-3.4). The allele frequency of IkappaBalpha-826 T was also significantly increased in patients with RA when compared with that of the controls (P = 0.027, OR = 1.6, 95% CI = 1.1-2.4). In comparison with IkappaBalpha-550 A/A, the genotype frequency of IkappaBalpha-550 A/T was significantly decreased in patients with RA when compared with that of the controls (P = 0.02, OR = 0.2, 95% CI = 0.06-0.8). The allele frequency of IkappaBalpha-550 A was significantly increased in patients with RA (P = 0.007, OR = 5.1, 95% = 1.4-18.2). This study also revealed that the IkappaBalpha-826 T -550 A -519 C haplotype was significantly increased in patients with RA in comparison to that of controls (P = 0.01, OR = 1.8, 95% CI = 1.1-2.8). The IkappaBalpha-826 T and -550 A alleles are associated with susceptibility to RA. Moreover, the IkappaBalpha-826 T -550 A -519 C haplotype is associated with susceptibility to RA in Taiwan.

Killer cell immunoglobulin-like receptor gene's repertoire in rheumatoid arthritis.

OBJECTIVE: To investigate the role of the killer cell immunoglobulin-like receptor (KIR) gene's repertoire in the pathogenesis of rheumatoid arthritis (RA) in Taiwan. METHODS: KIR genotypes were determined in 122 patients with RA and 96 healthy controls by the sequence-specific primer polymerase chain reaction (SSP-PCR) method. Human leucocyte antigen (HLA)-C genotyping was also performed simultaneously in 72 patients and 66 controls by the SSP-PCR method. RESULTS: The total carriage frequency of KIR 2DS4 regardless of corresponding HLA-Cw4 was significantly increased in RA patients compared with controls [p<0.001, odds ratio (OR) = 1.9, 95% confidence interval (CI) = 1.1-3.4, Pc<0.01]. The total carriage frequency of KIR 2DL1 regardless of corresponding HLA-C also tended to be increased in RA patients (p<0.02, OR = 2.1, 95% CI = 1.2-3.9, Pc = not significant). The frequency of KIR 2DS4 with corresponding HLA-Cw4 was increased in RA patients in comparison with controls (p = 0.02, OR = 3.2, 95% CI = 1.1-9.4). Moreover, the association of RA with KIR 2DS4 depended on the presence of the corresponding HLA-Cw4. CONCLUSIONS: KIR 2DS4 may be a risk factor for susceptibility to RA in Taiwan.

Sildenafil citrate treatment for erectile dysfunction after kidney transplantation.

OBJECTIVE: Our goal was to analyze the morbidity of organic erectile dysfunction (ED) in kidney-transplant patients and to evaluate the efficacy and reliability of sildenafil citrate treatment. METHOD: Sixty-five ED patients with normal graft function for 3 to 12 months after kidney transplantation were involved in our study. Erectile dysfunction was diagnosed in all the patients by the International Index of Erectile Dysfunction (IIEF). Among them, 10 patients were in light degree; 32 patients in moderate degree, and 23 patients in severe degree according to IIEF score. All of the patients underwent medical history, physical and chemical examinations. In each patient, the IIEF score, blood urea nitrogen, creatinine, and trough concentrations of cyclosporine were compared before and after taking sildenafil citrate at an initial dose of 50 mg every night. RESULTS: Twenty-six patients without ED before transplantation suffered ED after the operation, and 32 patients with ED before transplantation noticed worsening. Taking sildenafil citrate was effective in 53 patients (81.54%). There were no statistical differences in blood urea nitrogen, creatinine, or trough concentrations of cyclosporine in patients before and after sildenafil treatment. CONCLUSIONS: The morbidity of organic erectile dysfunction increased after transplantation. Sildenafil citrate treatment for ED in kidney-transplant patients was effective and safe. Graft function and trough concentrations of cyclosporine were not affected by sildenafil citrate.

Community-based study in Taiwan aborigines concerning renal dysfunction in gout patients.

OBJECTIVE: To reveal the factors associated with renal dysfunction among gout patients in Taiwan aborigines. METHODS: Social demographic data, alcohol consumption data, anthropometric measurements, blood samples, and 24-h urine samples were collected from 128 aboriginals (101 men, 27 women) suffering from gout. RESULTS: The men displayed higher mean creatinine clearance (Ccr) values than women. Twenty-two post-menopausal women had significantly lower Ccr values compared to the five pre-menopausal women [probability (p)<0.001]. The males displayed higher 24-h urinary creatinine value than females (8.60+/-5.39 versus 5.58+/-2.14 mmol/L; p<0.05), and showed a significantly higher positive relationship between 24-h urinary creatinine and uric acid excretion [correlation coefficient (r)=0.7304; p<0.001], whereas the females did not (r=0.1144; p=0.5691). Overall, those who were older members of the Tsou tribe, or had excreted less uric acid from urine in 24 h tended to suffer renal dysfunction. CONCLUSIONS: Gout patients displayed diversity in renal function. An exogenous source of creatinine in men was more likely than in women.

Cytochrome p450 1Al gene polymorphisms in patients with psoriatic arthritis.

OBJECTIVE: To investigate the associations of cytochrome p450 1A1 (CYP1A1) gene polymorphisms with susceptibility to psoriatic arthritis in Taiwan. METHODS: CYP1A1 gene polymorphisms were determined in 52 patients with psoriatic arthritis and in 90 healthy controls by polymerase chain reaction/restriction fragment length polymorphism. RESULTS: The genotype frequency of CYP1A1 4889A/G was significantly increased in patients with psoriatic arthritis in comparison with healthy controls. The phenotype frequency of CYP1A1 4889G was also significantly increased in patients with psoriatic arthritis. The genotype frequency of CYP1A1 4887C/A was significantly higher in patients with psoriatic arthritis than in controls. The allele and phenotype frequencies of 4887A were also significantly increased in patients with psoriatic arthritis. We also found that the association of CYP1A1 4887A with psoriatic arthritis was independent of 4889G but a synergistic effect was present between CYP1A1 4887A and 4889G. The CYP1A1 4889A/G and 4887C/A polymorphisms were not associated with the manifestations and severity of psoriatic arthritis. CONCLUSION: CYP1A1 4887A and 4889G may be precipitating factors for susceptibility to psoriatic arthritis in Taiwan. An additive effect was found between CYP1A1 4887A and 4889G.

Intravenous gamma-globulin therapy in myocarditis complicated with complete heart block: Report of one case.

Myocarditis complicated with complete heart block is rare in childhood. We report a case of 4-year-old child presented with complete heart block which may have been caused by Mycoplasma pneumoniae. Under emergent temporal pacing, patient experienced cardiogenic shock with pulmonary edema eventually. The cardiopulmonary function was improved with atrial rhythm at the 6th hour later after intravenous infusion with high-dose gamma-globulin (IVIG). The IVIG therapy may have immunomodulatory effects and serve as a potential adjunctive therapy for fulminant myocarditis.

Tumor necrosis factor promoter polymorphisms in patients with rheumatoid arthritis in Taiwan.

OBJECTIVE: To investigate the association of tumor necrosis factor (TNF) promoter polymorphisms with rheumatoid arthritis (RA) in Taiwan. METHODS: TNF promoter polymorphisms at positions -238, -244, -308, -376, -857, and -863 were determined in 97 patients with RA and 97 healthy controls using the PCR-RFLP method. RESULTS: The phenotypic frequency of TNF-308A was significantly lower in patients with RA than in healthy controls. This finding can only be found in HLA-DR4 negative patients, not in DR4 positive RA patients and controls. The TNF promoter polymorphisms at positions -238, -244, -308, -376, -857, and -863 were not related to the clinical manifestations of RA patients. CONCLUSION: TNF-308A itself or a neighboring gene may be a protective factor for the development of RA in the HLA-DR4 negative population in Taiwan. TNF promoter polymorphisms were not associated with the clinical manifestations of patients with RA in Taiwan.

HLA-DQA1 genotyping in patients with rheumatoid arthritis in Taiwan.

To investigate the role of HLA-DQA1 genotypes and their interaction with HLA-DRB1 in the pathogenesis of rheumatoid arthritis (RA) in Taiwan, HLA-DQA1 was determined in 71 patients with RA and 108 healthy controls by SSP-PCR method. HLA-DRB1 and HLA-DQA1 were simultaneously detected in 55 RA patients and 101 healthy controls. PCR/SSOP method was used to determine the HLA-DRB1 genotypes, and the subtypes of HLA-DR4 were determined by cloning and sequencing. The phenotypic frequency of HLA-DQA1*0301 was significantly lower in RA than in controls, and, in contrast, the HLA-DQA1*0302 and DQA1*0303 were significantly higher in RA than in controls. The associations of DQA1*0301, *0302, and *0303 with RA were independent of DR4 and DRB1*0405. Moreover, the interactions between HLA-DR4 and HLA-DQA1*0302 or DQA1*0303 could enhance the development of RA. We also found that the prevalence of bone erosion and seropositivity of rheumatoid factor (RF) were significantly higher in HLA-DQA1*0303 positive RA patients than in healthy controls. HLA-DQA1*0302 and DQA1*0303 are the risk factors for susceptibility to RA, while HLA-DQA1*0301 is a protective factor. A synergistic effect for the susceptibility to RA can be found between HLA-DR4 and HLA-DQA1*0302 or DQA1*0303. We also found that the HLA-DQA1*0303 was related to bone erosion and seropositivity of RF in RA patients.

Familial Mediterranean fever in a Taiwanese patient.

Familial Mediterranean fever is a rare disease characterized by cyclic attacks of fever, serositis and strong family background. Here we report a 22-year-old man who suffered from recurrent fever accompanied by chest and abdominal pain for more than 10 years. The attack frequency was about once per 2-3 weeks. Although he consulted many clinics and even received appendectomy at the age of 15, no definite diagnosis was given. During the admission, many laboratory examinations failed to show any abnormality except mild leukocytosis and elevated C-reaction protein. Image studies including chest X ray and abdominal CT scan showed negative result but, interestingly, Gallium-67 scan showed a hot spot in right lower chest and right lower abdomen. After prophylaxis with colchicine 1.0 mg per day, he has enjoyed more than 2 years without the above symptoms.