Administration, Sublingual ; Bacterial Vaccines ; administration & dosage ; immunology ; Child ; Child, Preschool ; Double-Blind Method ; Female ; Humans ; Immunoglobulin A ; blood ; Immunoglobulin A, Secretory ; analysis ; Male ; Pseudomonas Vaccines ; Recurrence ; Respiratory Tract Infections ; immunology ; prevention & control ; Treatment Outcome

The cases of lymphoma accompanied or preceded by Coombs' test positive autoimmune hemolytic anemia (AIHA) have been reported. However, Coombs' test negative AIHA prior to the diagnosis of lymphoma was rarely described. Herein, this article reports a case of non-Hodgkin's lymphoma (NHL) preceded about 1.5 years by Coombs test negative AIHA. A woman aged 69 was diagnosed with HA based on the history and laboratory tests. Further studies revealed that this patient was negative with Coombs' test for IgG, IgM, IgA and C3. After all possible causes of HA, especially malignancies were ruled out, the patient was diagnosed with Coombs' test negative AIHA and treated with prednisolone. The patient responded well initially to steroid treatment. Two recurrences of acute HA were presented at time of 10 months post steroid cessation, and immediately after an attempt to withdraw steroid, respectively, but the hemolysis was effectively controlled by reinstitution of prednisolone. At third recurrence, however, the patient was no longer responding to steroid, and was found with cervical lymphadenopathy. Coombs' test for IgG, IgM, IgA and C3 remained negative. B cell NHL was diagnosed by pathology. After receiving 6 cycles of CHOP chemotherapy, the patient was lymphoma free, but the hemolysis was not improved, however, which was effectively controlled by the following low dose-rituximab (RTX) therapy. The patient was still kept in a remission of lymphoma free of anemia. In conclusion, this report presented a very rare case of NHL with Coombs' test negative AIHA as initial major clinical manifestation.
Aged ; Anemia, Hemolytic, Autoimmune ; diagnosis ; etiology ; therapy ; Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Coombs Test ; Female ; Humans ; Lymphoma, Non-Hodgkin ; complications ; diagnosis ; Rituximab

OBJECTIVETo investigate the expression and amplification of steroid receptor coactivator- 3(SRC- 3) gene in colorectal carcinoma (CRC) and its clinicopathological significance.

METHODSImmunohistochemistry and fluorescence in situ hybridization (FISH) were used to detect the expression and amplification of SRC- 3 gene in CRC, and its association with patient's clinical pathological features was analyzed.

RESULTSA total of 60 patients with CRC were studied. SAR- 3 proteins were overexpressed in 23 cases (38% ). There was a significant association between SAR- 3 overexpression and neoplasm staging (P< 0.01). SRC- 3 protein was overexpressed in 62% of patients with Dukes C or D stage, whereas SRC- 3 protein was normally expressed in 74% of patients with Dukes A or B stage. As for FISH study, 47 cases were informative. High- level amplification of SRC- 3 gene was detected in 6 cases(13% ) and all showed overexpression of SRC- 3 protein. Low- level amplification of SRC- 3 was observed in 9 cases (19% ). Overexpression of SRC- 3 was detected in 6 cases. The remaining 9 of 32 patients(28% ) without amplification of SRC- 3 gene were observed with overexpression of SRC- 3 protein. In addition, 91% patients with CRC were found overexpression of SRC- 3 as well as overexpression of P53.

CONCLUSIONThe abnormal expression of SRC- 3 gene might impact on the function of P53 and development of CRC. There might exist some unknown mechanisms other than gene amplification of SRC- 3 to regulate its encoded protein expression in CRC.

Biomarkers, Tumor ; genetics ; Colorectal Neoplasms ; genetics ; pathology ; Female ; Gene Expression ; Histone Acetyltransferases ; genetics ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Nuclear Receptor Coactivator 3 ; Trans-Activators ; genetics

OBJECTIVE: The malignant transformation (MT) of ovarian mature cystic teratoma (MCT) to squamous cell carcinoma (SCC) is very rare. This study analyzed cases from multiple medical centers in Taiwan to investigate the clinicopathologic characteristics, treatment, and prognostic factors of this disease and reviewed related literature. METHODS: Pathological reports of 16,001 patients with primary ovarian cancer who were treated at Taiwan medical centers from 1990 to 2011 were reviewed. In total, 52 patients with MT of MCT to SCC were identified. RESULTS: Among all ovarian MCTs, the incidence of MT to SCC is 0.2%. The median age of patients was 52 years (range, 29–89 years), and the mean tumor size was 10.5 cm (range, 1–40 cm). We analyzed the patients in our study and those in the literature and determined that early identification and complete surgical resection of the tumor are essential for long-term survival. In addition, adjuvant chemotherapy or concurrent chemoradiotherapy can be used to treat this malignancy. Old age, large tumor size (≥15.0 cm), and solid components in MCTs are suitable indicators predicting the risk of MT of MCT to SCC. CONCLUSION: Similar to general epithelial ovarian cancers, the early detection of MT of MCT to SCC is critical to long-term survival. Therefore, older patients with a large tumor or those with a tumor containing a solid component in a clinically diagnosed MCT should be evaluated to exclude potential MT to SCC.
Carcinoma, Squamous Cell* ; Cell Transformation, Neoplastic ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Epithelial Cells* ; Humans ; Incidence ; Ovarian Neoplasms ; Taiwan ; Teratoma*

Objective An improved method for obtaining pseudo-computed tomography (CT ps) based on ultrasound deformation field.Methods The three-dimensional image data of computed tomography and ultrasound for three postoperative cervical cancer patients were selected,including the CT (CTsim) and ultrasound (USsim) images obtained during the simulated positioning stage,and the cone beam CT (CBCT) and ultrasound images obtained during the positioning verification stage of the treatment one week later.Binary masks of the OROI and OROW were created and applied in ultrasound image registration;thus,the deformation field was obtained.The deformation field was applied to CTsim images and different pseudo-CT images were obtained.Similarities between these pseudo-CT images and those of CBCT were compared,and registration accuracies between pseudo-CT images under different binary masks and CTsim were discussed.Results The averages of the correlation coefficient between pseudo-CT based on OROI,OROW,no binary mask and CBCT were 0.95,0.82 and 0.64 respectively.The average of the normalized mean square Error were 0.12,0.42 and 0.57 respectively.Conclusion The pseudo-CT based on OROI binary mask matches the best with CTsim and achieves the highest similarity with CBCT.

OBJECTIVETo assess the value of PET in the identification of cervical nodal metastases of tongue cancer in comparison with CT/MRI and clinical palpation.

METHODSThirty-eight patients with tongue cancer underwent PET and CT/MRI within 2 weeks before surgery. The results of PET, CT/MRI, and clinical palpation were interpreted separately to assess the regional lymph node status, using histopathological analysis as the golden standard. The differences in the sensitivity, specificity and accuracy among the imaging modalities and clinical palpation were analyzed.

RESULTSThe sensitivity of PET for nodal metastasis identification was 11.1% higher than that of CT/MRI (83.3% vs 72.2%, P=0.423) and 16.6% higher than that of clinical palpation (83.3% vs 66.7%, P=0.248). The specificity of PET was 5% higher than that of CT/MRI (80% vs 75%, P=0.703) and 15% higher than that of clinical palpation (80% vs 65%, P=0.288). The accuracy of PET, CT/MRI, and clinical palpation in identifying cervical nodal metastases was 81.6%, 73.7% and 65.8%, respectively.

CONCLUSIONThe sensitivity, specificity and accuracy of PET for detecting cervical nodal metastases are greater than those of CT/MRI and clinical palpation. Although the results failed to show statistically significant differences, we still recommend that PET be used as a supplementary modality for identifying nodal metastases of tongue cancer.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymphatic Metastasis ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Tongue Neoplasms ; diagnostic imaging ; pathology

Objective To compare the dose difference between the 12-bit and 16-bit CT images containing metallic implants calculated by different algorithms. Methods The titanium alloy rod was inserted into the phantom and subject to CT scan and then the 12-bit and 16-bit CT images were reconstructed. The CT images were online transmitted to the Monaco planning system and a 0° of single field was designed. The dose distribution was calculated by PB (Pencil Beam), CC (Collapsed Cone) and MC (Monte Carlo) algorithms, respectively. The CT-ED curve was expanded and the dose was recalculated. The depth dose curve through the center of the metallic implants along with the direction of the field was obtained by using the Matlab 8. 3 statistical software. The dose distribution curves between 12-bit and 16-bit CT images calculated by different algorithms and the dose difference of varying distances between the incident and the exit surfaces of metallic implants were statistically compared. The dose was measured by thimble chamber. Results The 16-bit CT images accurately read the CT values of the metallic implants. After the CT-ED curve was expanded, the dose on the incident surface of metallic implant was reduced by 5. 43% and that on the exit surface was increased by 25. 56% calculated by PB algorithm compared with MC algorithm. The dose on the posterior exit surface was higher than that of MC algorithm. The dose on the incident surface of metallic surface was decreased by 4. 5%, whereas that on the exit surface was reduced by 4. 31% using CC algorithm. The dose on the posterior exit surface was more significantly reduced. The calculated values by MC algorithm were the most close to the measured values. Conclusions Application of 16-bit CT image, CT-ED curve expansion of the treatment planning system combined with MC algorithm can enhance the accuracy of dose calculation for the patients containing metallic implants during radiotherapy.

INTRODUCTION: Nontraumatic acute abdomen (NTAA) in dialysis patients is a challenging issue. The aetiologies of NTAA vary considerably depending on the renal replacement therapy (RRT) modality. Although haematological parameters and contributing factors have been reported to be associated with outcomes for dialysis patients, their clinical effect on the length of hospital stay (LOS) remains unknown. METHODS: We retrospectively analysed 52 dialysis patients (peritoneal dialysis [PD], n = 33; haemodialysis [HD], n = 19) and 30 non-dialysis patients (as controls) between January 2011 and December 2014. To attenuate the selection bias, non-dialysis patients with NTAA were matched to cases at a ratio of 1:1 by age, gender and comorbidities (diabetes mellitus and hypertension). Their demographic characteristics, laboratory data, clinical assessment scores and LOS were analysed. RESULTS: The PD group exhibited a significantly higher neutrophil percentage, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR); longer LOS; and lower lymphocyte percentage and absolute lymphocyte count than the control group. After multivariate analysis adjustment, female gender, longer RRT duration and higher intact parathyroid hormone (iPTH) levels were associated with a lower probability of being discharged home. In the dialysis group, a higher iPTH level (> 313 μg/mL) was positively correlated with longer LOS. iPTH level combined with NLR can be used as a surrogate marker for predicting longer LOS (p < 0.001). CONCLUSION NTAA dialysis patients with female gender, longer RRT duration and higher iPTH levels are prone to experiencing longer LOS. In addition, the combination of iPTH and NLR is a significant determinant for LOS in NTAA dialysis patients.

Oxidative Phosphorylation ; Acetylglucosamine ; Uridine Diphosphate N-Acetylglucosamine/metabolism*