Chang Gung medical journal最新文献

Background: Varicella-zoster virus (VZV) is the etiologic agent of two diseases, varicella (chicken pox) and zoster (shingles). Varicella is a self- limited infection, while zoster is mainly a disease of adults. The present study was conducted to isolate VZV from clinically diagnosed children using cell cultures and compare the activity of liquorice powder extract, an alternative herbal antiviral agent, with acyclovir and interferon alpha 2a (IFN-α2a) against the isolated virus.

Methods: Forty-eight VZV specimens, 26 from vesicular aspirates and 22 from vesicular swabs, from children clinically diagnosed with varicella were isolated on the Vero cell line. Isolates were propagated and identified with specific antiserum using indirect immunofluorescence and immunodot blotting assays. The growth kinetics of the viral isolates was studied. The antiviral activity of liquorice powder extract, acyclovir (ACV) and IFN-α2a was evaluated against the isolated virus.

Results: VZV was successfully isolated in 4 of the 48 specimens, all from vesicular aspirates. The growth kinetics of the viral isolates was time dependent. The inhibitory activity of liquorice powder extract (containing 125 µg/ml glycyrrhizin) when compared to ACV (250 µg/ml) and IFN-α2a is the lowest.

Conclusions: VZV isolates were successfully isolated and propagated using Vero cells. Isolates were identified using indirect immunofluorescent and immunodot blotting techniques. Growth kinetics of the isolates revealed an increase in the viral infectivity titer relative to time. Glycyrrhizin in the crude form has low antiviral activity against VZV compared with acyclovir and interferon.

The formation and deposition of β-amyloid (Aβ) plaques are the earliest pathological changes in Alzheimer's disease (AD). Molecular imaging of Aβ plaques could serve as a surrogate marker in early diagnosis and neuropathogenesis studies of AD. Several radionuclide labeled ligands have recently been developed for noninvasive visualization of Aβ plaques in the brains of AD patients using single photon emission computed tomography or positron emission tomography (PET). There has been rapid progress in the field of imaging for plaque pathology. AV-45 was the first plaque imaging agent to enter multi-center, investigational new drug clinical trials in the US, and has now been studied in dozens of trials with more than 1,000 subjects ranging from cognitively normal individuals to those with AD dementia. "Imaging to autopsy" phase III studies further confirmed and validated the specific imaging signal correlated to the plaque burden in living subjects. With these promising and confirmed characteristics of AV-45, the Alzheimer's Disease Neuroimaging Initiative (ADNI) under common consensus decided on AV-45 as the emerging standard PET imaging agent for evaluating the progression of plaque pathology in patients with AD or mild cognition impairment, and even healthy controls. With the wide availability of AV-45 for plaque imaging, the ultimate goal of the ADNI is global clinical trials for disease detection and progression. This review presents recent experience with Aβ-targeting radiotracers at Chang Gung University and Chang Gung Memorial Hospital.

In recent years, there has been increasing interest by reconstructive surgeons in improving the aesthetic and functional outcomes of donor sites. As the success rate of free tissue transfers has exceeded more than 95% in most microsurgical centers, more emphasis can be shifted to the donor site. However, morbidities of donor sites can occur not only in free tissue transfers, but in locoregional flaps as well. In reconstructive procedures, the main principle is to mobilize normal tissue and utilize it to reconstruct an area of defect. The donor site, of course has no pathology, but is a previously healthy area. Therefore, it is of paramount importance to not only minimize postoperative complications at recipient sites, but also pay attention to donor sites. Just as in organ transplantation where efforts are made to ensure the safety and a good outcome for a donor patient, outcomes should be improved and morbidity reduced at donor sites in reconstructive surgery.

Background: This study aimed to present experience in treating patients with posterior fossa epidural hematoma (PFEDH) and to discuss the risk factors, clinical features, and outcome in PFEDH patients with acute clinical deterioration (ACD).

Methods: Twenty-seven patients with PFEDH initially treated conservatively were evaluated. A comparison was made between patients with and without ACD during hospitalization.

Results: Eight of the 27 patients subsequently experienced ACD. Local traumatic findings, loss of consciousness due to injury, headache, and vomiting were the four most common clinical features of the 27 cases. Seven of the 8 patients with ACD had good recoveries and 1 died. Eighteen of the 19 patients without ACD had good recoveries, while 1 remained moderately disabled. Stepwise logistic regression demonstrated that the adjusted risk of ACD during hospitalization for patients with vomiting and an occipital fracture across the transverse sinus on computed tomography (CT) had odds ratios of 12.6 (95% confidence interval = 1.03-152.37, p = 0.047) and 8.8 (95% CI = 1.02-75.95, p = 0.048), respectively, compared with those without ACD.

Conclusion: This study demonstrated that an occipital fracture across the transverse sinus on CT and vomiting on presentation are risk factors for ACD during hospitalization. In this study, PFEDH patients including those with ACD had good outcomes. Further studies are necessary to clarify the clinical course and risk factors for the clinical deterioration of PFEDH patients and to establish a treatment strategy.

The left superior laryngeal artery was observed arising from the external carotid artery instead of the superior thyroid artery in the cadaver of an approximately 70 year-old Asian man. In addition, on the same side, the superior thyroid artery arose from the common carotid artery 2 cm before the bifurcation instead of its usual origin from the external carotid artery. From the external carotid artery, the lingual and facial arteries arose from the common linguofacial trunk. The nerves in the carotid triangle were normal in course. No variations were observed on the right side carotid system. The multiple variations in this case have not been previously described. The embryogenesis of this combination of variations is not clear, but the anatomic consequences may have important clinical implications. As angiography has gained popularity in diagnostic approaches in recent years, it is essential to be aware of these variations so that they are not overlooked in differential diagnoses.

Hepatoid differentiation in pancreatic carcinoma is a rare phenomenon. It occurs either as a pure form or as a component with other subtypes. Herein, we report a 52-year-old man with an ampullary large cell neuroendocrine carcinoma presenting with obstructive jaundice for 2 months. A 0.5-cm nodule was found in the pancreatic head. Morphologically, the nodule was composed of exclusively hepatocytic tumor cells and sinusoids with dysplastic cytology and capsular invasion. The patient did not have a hepatic mass or ectopic normal liver tissue. This is the first reported case of ampullary large cell neuroendocrine carcinoma coinciding with a pancreatic hepatoid microcarcinoma. The clinicopathological features of pancreatic hepatoid carcinomas and their histogenesis are discussed.

Type 4 cyclic nucleotide phosphodiesterases (PDE4) are a family of low km 3',5'-cyclic adenosine monophosphate (cAMP)-specific phosphodiesterases including at least 20 isozymes encoded by four genes (PDE4A, PDE4B, PDE4C, and PDE4D) in mammals. Each PDE4 gene plays a special, nonredundant role in the control of cell function even though the four subfamilies share the highly conserved catalytic domain and upstream conserved region (UCR) 1 and UCR2 motifs of the regulatory domain. By their wide tissue distribution as well as differential expression and regulation among various cell types, PDE4s are viewed as critical regulators of intracellular cAMP levels, cAMP signaling, and signal compartmentalization. By increasing cAMP levels, PDE4 inhibitors show a broad spectrum of anti-inflammatory effects in almost all inflammatory cells. Many PDE4 inhibitors have been evaluated in clinical trials for various inflammatory conditions. Developed inhibitors, including the recently approved and marketed roflumilast, have considerable efficacy, but they also have adverse effects such as nausea and emesis which limit their dosing and subsequently their immunomodulatory activity. Thus, the development of PDE4 inhibitors with improved therapeutic indexes has been a major focus of pharmaceutical research for the treatment of chronic inflammatory diseases. Recent PDE4 gene knockout studies strongly suggest that PDE4 inhibitors with PDE4B selectivity may retain the anti-inflammatory effects while limiting side effects. Development of PDE4 inhibitors with different delivery routes, such as topical application and inhalation, is also a promising approach for the treatment of pulmonary inflammatory conditions and dermatitis. This review includes a brief overview of the domain structure and function of PDE4 isozymes, the role of PDE4s in inflammatory cell responses, and the potential therapeutic utility of PDE4 inhibitors in inflammatory diseases.

Background: To investigate the role of radiotherapy (RT) for upper urinary tract urothelial cell carcinoma (UTUC) after surgery.

Methods: Between July 1997 and February 2007, 40 patients who had undergone radical surgery and RT were selected. Twenty patients received RT as adjuvant treatment for advanced disease (PORT). The remainder received RT as salvage treatment (SART). The prescription dose of RT ranged from 32 to 66.6 Gy (median: 50 Gy). Cisplatin-based chemotherapy was given to 34 patients. The median follow-up was 61 months (22-93 months).

Results: At the time of analysis, 10 patients were alive, but two of them had tumor recurrence. Twenty-four patients died from disease recurrence, two died from chemotherapy-related complications, and two from non-cancer comorbidities. Two patients were lost to follow-up but one of them had tumor recurrence. The 3-year overall survival (OS) was 45% for the PORT group, and 16% for the SART group (p = 0.03). The 3-year progression-free survival (PFS) was 41% for the PORT group, and 12% for the SART group (p = 0.02). A prescription dose < 50 Gy (p = 0.02) was another poor prognostic factor. The 3-year OS was 38% for a prescription dose ≥ 50 Gy, and 18% for < 50 Gy (p = 0.06). The 3-year PFS improved from 7% to 41% if the prescribed dose was ≥ 50 Gy (p < 0.05).

Conclusion: According to our analysis, RT combined with chemotherapy is effective in the postoperative treatment of advanced disease and salvage treatment for recurrent UTUC. The prescription dose should be ≥ 50 Gy.

Background: Eccrine angiomatous hamartoma (EAH) comprises a rare nevoid proliferation of normal eccrine glands and small blood vessels and occasionally other elements in the middle and deep dermis with variable clinical manifestations. Case series have rarely been published except for case reports and literature reviews. The aims of this article were to investigate the clinical and pathologic features of patients with EAH in Taiwan and to compare our results with the results of previous studies.

Methods: A retrospective review of medical records and histopathological findings was performed on patients diagnosed with EAH in a medical center in Taiwan between 1994 and 2010.

Results: Fifteen patients with pathologically diagnosed EAH were collected. The mean age at the time of diagnosis was 38.6 years (range, birth to 67 years). The male to female ratio was 3 to 2. In most cases, EAH arose as a single lesion on a lower extremity. The symptoms and signs most commonly associated with EAH were pain (60%), hypertrichosis (13.3%), itching (13.3%) and hyperhidrosis (6.7%). Additional pathological findings included hemangioma (13.3%), verrucous hemangioma (6.7%), arteriovenous malformation (6.7%), and angiokeratoma (6.7%). None of the patients experienced spontaneous regression of the lesions before excision. Excisions were done in one patient under general anesthesia, and ten patients with local anesthesia. Four patients were kept under observation. Tumor recurrences were noted in two out of the eleven patients whose lesions were excised.

Conclusion: Compared with cases in the literature, we found additional histopathological findings and an increased tumor recurrence risk in our cohort. EAH remains a benign and uncommon hamartomatous condition. Further multi-center, retrospective studies with larger case numbers are needed to better characterize the disease presentation in Asian populations.

Background: Ganoderma lucidum (G. lucidum) has been used in traditional Chinese medicine for thousands of years because of its immunomodulatory properties. It is believed that G. lucidum enhances the human immune response by improving the function of human polymorphonuclear neutrophils (PMNs); nevertheless, the actual mechanism by which G. lucidum acts on human PMNs remains unknown. In this study, we investigated the molecular pathways through which G. lucidum activates human PMNs.

Methods: The phagocytic activity of PMNs was evaluated with and without treatment with the extract of sporoderm-broken germinating spores of G. lucidum. The same activity was measured after G. lucidum treatment with or without p38 mitogen-activated protein kinase (p38 MAPK) inhibitor. The activation of p38 MAPK was also evaluated with or without treatment with the extract of sporoderm-broken germinating spores of G. lucidum.

Results: In this study, we found that the extract of G. lucidum enhanced the phagocytic activity of PMNs in a dose-dependent manner, but this response was attenuated by treatment with SB203580, a p38 MAPK inhibitor. The extract of G. lucidum also enhanced activation of p38 MAPK in a dose-dependent manner.

Conclusion: These results clearly show that the extract of G. lucidum can modulate human immunity by activating human PMNs via the p38 MAPK pathway. These results may be of clinical importance to doctors of traditional Chinese medicine.