Convcntional Kaposi's sarcorna is distinguished frorn AIDS-associated Kaposi's sarcorna.. The authors report a case of 65 year-old male who presented with a nodular type of conventional Kaposi's sarcoma. The result of the serum antibody test against HTLV-3 in this patient was negative. Trial with b-interferon administered systemically and by local injection showed favorable results. Following 4 weeks of treatment, the tumor masses had markedly decreased in size. The authors suggest that b-interferon treatment for this patient was effectivc.
Aged ; Human T-lymphotropic virus 3 ; Humans ; Male ; Sarcoma* ; Sarcoma, Kaposi

The recent development of molecular diagnostic assays like as polymerase chain reaction (PCR) has provided powerful tools for the diagnosis of viral infection in the clinical fields. To ensure optimal therapeutic and prognostic value, it is important to establish whether viral load measurements are affected by repeated freeze-thaw (FT) cycles since the freezing of clinical samples is a universal method of specimen storage. This study was done to determine the effect of freezing and thawing of various samples on the quantitation and positivity of viral DNA. For this study, three different types of samples being used frequently in clinical fields were selected. Those samples contained ovine herpesvirus-2 (OvHV-2), a member of the gamma herpesviruses (genus Rhadinovirus). Two OvHV-2 DNA positive plasma samples, two peripheral blood mononuclear cell (PBMC) samples, and two nasal swab samples were randomly selected. They were carefully aliquated into 8 tubes for each sample. The aliquoted samples were frozen and thawed 0, 3, 6, 9, 12, 15, 18, and 21 times for each aliquot and then analyzed for changes on DNA levels and positivity. OvHV-2 DNA positivity and quantitation were tested by using nested PCR and real-time PCR, respectively. Twenty-one cycles of freezing and thawing did not significantly change this herpesviral DNA positivity in any of the samples tested. However, the decreases of viral DNA copies were observed in all samples by the increasing of FT cycles. In conclusion, the integrity of herpesviral DNAs in clinical specimens may be degraded by the increasing FT cycles. These results implicate that there is a need to aliquot specimen when it is first collected in order to reduce FT cycles during its analysis.
Diagnosis ; DNA* ; DNA, Viral ; Freezing ; Herpesviridae ; Pathology, Molecular ; Plasma ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; Viral Load

INTRODUCTIONInstitutional febrile neutropenia (FN) management protocols were changed following the finding of a high prevalence of ceftazidime-resistant Gram-negative bacteraemia (CR-GNB) among haematology patients with FN. Piperacillin/tazobactam replaced ceftazidime as the initial empirical antibiotic of choice, whereas carbapenems were prescribed empirically for patients with recent extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae colonisation/infection. An audit was conducted to determine the impact of these changes.

METHODSData from all FN episodes between October 2008 and December 2010 were collected prospectively, with mid-November 2009 demarking the transition between pre-intervention and intervention periods. Outcomes measured included 30-day mortality post-development of FN and the presence of CR-GNB.

RESULTSThere were 427 FN episodes (200 in the pre-intervention period) from 225 patients. The prevalence of CRGNB was 10.3%, while the 30-day mortality was 4.7%, with no difference between pre-intervention and intervention periods. Independent risk factors for 30-day mortality included the presence of active haematological disease, vancomycin prescription and older age. Independent factors associated with initial CR-GNB were profound neutropenia, the presence of severe sepsis and active haematological disease. Recent ESBL-producing Enterobacteriaceae colonisation/infection was not predictive of subsequent CR-GNB (positive predictive value 17.3%), whereas a model based on independent risk factors had better negative predictive value (95.4%) but similarly poor positive predictive value (21.4%), despite higher sensitivity.

CONCLUSIONA change in the FN protocol did not result in improved outcomes. Nonetheless, the audit highlighted that empirical carbapenem prescription may be unnecessary in FN episodes without evidence of severe sepsis or septic shock, regardless of previous microbiology results.

Academic Medical Centers ; Adult ; Bacteremia ; complications ; drug therapy ; Carbapenems ; therapeutic use ; Ceftazidime ; pharmacology ; Drug Resistance, Multiple ; Febrile Neutropenia ; complications ; drug therapy ; Female ; Gram-Negative Bacteria ; Humans ; Male ; Middle Aged ; Penicillanic Acid ; administration & dosage ; analogs & derivatives ; Piperacillin ; administration & dosage ; Prevalence ; Prospective Studies ; Risk Factors ; Sepsis ; Singapore ; Treatment Outcome ; Universities

Input signals originating from baroreceptors and vestibular receptors are integrated in the rostral ventrolateral medulla (RVLM) to maintain blood pressure during postural movement. The contribution of baroreceptors and vestibular receptors in the maintenance of blood pressure following hypotension were quantitatively analyzed by measuring phosphorylated extracellular regulated protein kinase (pERK) expression and glutamate release in the RVLM. The expression of pERK and glutamate release in the RVLM were measured in conscious rats that had undergone bilateral labyrinthectomy (BL) and/or sinoaortic denervation (SAD) following hypotension induced by a sodium nitroprusside (SNP) infusion. The expression of pERK was significantly increased in the RVLM in the control group following SNP infusion, and expression peaked 10 min after SNP infusion. The number of pERK positive neurons increased following SNP infusion in BL, SAD, and BL+SAD groups, although the increase was smaller than seen in the control group. The SAD group showed a relatively higher reduction in pERK expression when compared with the BL group. The level of glutamate release was significantly increased in the RVLM in control, BL, SAD groups following SNP infusion, and this peaked 10 min after SNP infusion. The SAD group showed a relatively higher reduction in glutamate release when compared with the BL group. These results suggest that the baroreceptors are more powerful in pERK expression and glutamate release in the RVLM following hypotension than the vestibular receptors, but the vestibular receptors still have an important role in the RVLM.
Animals ; Blood Pressure ; Denervation ; Glutamic Acid ; Hypotension* ; Neurons ; Nitroprusside ; Pressoreceptors* ; Protein Kinases ; Rats*

PURPOSE: We recently reported that rosiglitazone (RGTZ), a peroxisome proliferator-activated receptor gamma (PPARgamma) agonist, has a protective effect against cyclosporine (CsA)- induced renal injury. Here we report the effect of RGTZ on peroxisome proliferator-activated receptor gamma (PPARgamma) expression in an experimental model of chronic cyclosporine (CsA) nephropathy. MATERIALS AND METHODS: Chronic CsA nephropathy was induced in Sprague-Dawley rats by administering CsA (15mg/kg per day) for 28 days, and control rats were treated with vehicle (VH group, olive oil 1mL/kg per day) for 28 days. RGTZ (3mg/kg) was concurrently administered via gavage to the CsA and VH groups. Expression of PPARgamma mRNA and protein was evaluated with RT-PCR, immunohistochemistry, and immunoblotting. RESULTS: PPARgamma mRNA expression was similar to the level of PPARgamma protein constitutively expressed in the kidneys of the VH treated rats, with expression in the glomerular epithelial, distal tubular cells, and collecting tubular cells. PPARgamma protein expression in CsA-treated rat kidneys was significantly less than in the VH group. However, concomitant administration of RGTZ restored PPARgamma protein expression in the kidneys of the CsA- reated rats. CONCLUSION: Exogenous administration of RGTZ treatment upregulates PPARgamma expression and that this mechanism may play a role in protecting against CsA-induced renal injury.
Transcription, Genetic/*drug effects ; Thiazolidinediones/*pharmacology ; Rats, Sprague-Dawley ; Rats ; RNA, Messenger/*genetics ; Protein Biosynthesis/*drug effects ; PPAR gamma/*genetics ; Male ; Kidney Diseases/genetics/pathology/*prevention & control ; Gene Expression Regulation/*drug effects ; Disease Models, Animal ; Cyclosporine/*toxicity ; Animals

PURPOSE: To evaluate the accuracy of Pentacam(R) built-in 5 intraocular pressure (IOP) correction programs used to measure the IOP of patients who received corneal refractive surgery. METHODS: IOP of 124 eyes from 62 patients who underwent epipolis laser in situ keratomileusis was measured with Goldmann applanation tonometry (GAT) at 6 months pre- and post-operatively. The collected data was input into Pentacam(R), calculated by 5 correction programs, Ehlers, Shah, Dresden, Orssengo / Pye, Kohlhaas, and compared. RESULTS: The GAT-based pre- and post-operative IOP was 15.75 +/- 2.24 mm Hg, and 10.72 +/- 2.31 mm Hg, respectively, revealing the post-operative IOP to be significantly lower than the pre-operative IOP (p < 0.001). Among the 5 correction programs within Pentacam(R), Ehlers program showed little difference between pre- and post-operative IOP values (p = 0.228) and the post-operative correction value showed no significant difference with the pre-operative GAT value (p = 0.413). CONCLUSIONS: The Ehlers program is the most accurate among the 5 Pentacam(R) correction programs evaluated in the present study, and can be a useful tool for correcting the true IOP of patients which tends to be higher after corneal refractive surgery.
Humans ; Intraocular Pressure* ; Keratomileusis, Laser In Situ ; Manometry ; Refractive Surgical Procedures*

The use of nonsteroidal antiinflammatory drugs (NSAIDs) can be complicated by severe forms of renal dysfunction. These include fluid and electrolyte abnormalities, acute renal insufficiency due to alteration in renal hemodynamics, or interstitial nephritis and proteinuria secondary to glomerular pathology, which has the histologic characteristics of minimal change glomerulopathy (MCG). While NSAID-induced nephrotic syndrome characteristically consists of MCG with interstitial nephritis, which is the most common clinical manifestation, it rarely consists of MCG without interstitial nephritis, which has been reported in a handful of patients who took fenoprofen, ibuprofen, sulindac, diclofenac, or zomepirac. We experienced a 66-year-old female patient who presented with low serum albumin, proteinuria and generalized edema and received Geworin for about 2 year before developing symptoms. She histologically had MCG without interstitial nephritis and achieved a complete remission thirty-fifth days after discontinuing the drug. A cause-and-effect relationship of this disease to Geworin administration is strongly suggested by the resolution of the proteinuria after the drug was stopped and by no evidence of any impairment in renal function after twenty eight months of follow-up.
Acute Kidney Injury ; Aged ; Analgesics* ; Anti-Inflammatory Agents ; Antipyrine ; Diclofenac ; Edema ; Female ; Fenoprofen ; Follow-Up Studies ; Hand ; Hemodynamics ; Humans ; Ibuprofen ; Nephritis ; Nephritis, Interstitial* ; Nephrosis, Lipoid* ; Nephrotic Syndrome ; Pathology ; Proteinuria ; Serum Albumin ; Sulindac

To investigate the effect of fluoxetine, one of selective serotonin reuptake inhibitors (SSRIs), on the immune system, human peripheral blood mononuclear cells (PBMC) were treated with fluoxetine (10 7 M) for 24 h, and immune-related genes were analyzed by cDNA microarray. Expression of the immune- related genes such as CD107b (LAMP-2), CD47 receptor (thrombospondin receptor), CD5 antigen-like (scavenger receptor cysteine rich family), copine III (CPNE3), interleukin (IL) -18 (interferon-gamma- inducing factor), integrin alpha 4 (CD49d), integrin alpha L subunit (CD11a), IL-3 receptor alpha subunit, L apoferritin, and small inducible cytokine subfamily A (Cys-Cys) member 13 (SCYA13) was induced by fluoxetine. This result suggests that fluoxetine may affect the immune system, and provides fundamental data for the involvement of SSRIs on immunoregulation.
Apoferritins ; Cysteine ; DNA, Complementary* ; Fluoxetine ; Humans* ; Immune System ; Interleukins ; Oligonucleotide Array Sequence Analysis* ; Receptors, Interleukin-3 ; Serotonin Uptake Inhibitors

This study demonstrates the ability of magnolol, a hydroxylated biphenyl compound isolated from Magnolia officinalis, to inhibit LPS-induced expression of iNOS gene and activation of NF-kappaB/Rel in RAW 264.7 cells. Immunohisto-chemical staining of iNOS and Western blot analysis showed magnolol to inhibit iNOS gene expression. Reporter gene assay and electrophoretic mobility shift assay showed that magnolol inhibited NF-kappaB/Rel transcriptional activation and DNA binding, respectively. Since p38 is important in the regulation of iNOS gene expression, we investigated the possibility that magnolol to target p38 for its anti-inflammatory effects. A molecular modeling study proposed a binding position for magnolol that targets the ATP binding site of p38 kinase (3GC7). Direct interaction of magnolol and p38 was further confirmed by pull down assay using magnolol conjugated to Sepharose 4B beads. The specific p38 inhibitor SB203580 abrogated the LPS-induced NF-kappaB/Rel activation, whereas the selective MEK-1 inhibitor PD98059 did not affect the NF-kappaB/Rel. Collectively, the results of the series of experiments indicate that magnolol inhibits iNOS gene expression by blocking NF-kappaB/Rel and p38 kinase signaling.
Adenosine Triphosphate ; Binding Sites ; Biphenyl Compounds ; Blotting, Western ; DNA ; Electrophoretic Mobility Shift Assay ; Flavonoids ; Gene Expression ; Genes, Reporter ; Imidazoles ; Lignans ; Macrophages ; Magnolia ; Models, Molecular ; Phosphotransferases ; Pyridines ; Sepharose ; Transcriptional Activation

BACKGROUND AND OBJECTIVES: The state of the coronary microcirculation is an important determinant of the myocardial viability and clinical outcomes for patients suffering with acute myocardial infarction (AMI). However, there are scant comparative studies on the most reliable invasive, on-site measurement for assessing the microvascular integrity and myocardial viability in AMI patients. The aim of this study is to evaluate the usefulness of a novel index of microcirculatory resistance (IMR) and the coronary physiologic parameters for predicting the myocardial viability after primary percutaneous coronary intervention (PCI) in AMI patients. SUBJECTS AND METHODS: Twenty-four patients (21 males, mean age: 55+/-11 years) underwent primary PCI for AMI (LAD: 17, RCA: 6, LCX: 1) were enrolled. After successful PCI, using a pressure-temperature sensor-tipped coronary wire, the thermodilution-derived CFR (CFRthermo) and coronary wedge pressure (Pcw) were measured and the ratio of the Pcw and the mean aortic pressure (Pcw/Pa) was calculated, along with the IMR, which was defined as the distal coronary pressure divided by the inverse of the hyperemic mean transit time. 18F-fluorodeoxyglucose (FDG) PET was performed after primary PCI at 7 days post-AMI to evaluate the myocardial viability by the regional percentage of FDG uptake in the infarct-related segments. RESULTS: There were good correlations between all the coronary pressure measurements and the regional FDG uptake (CFRthermo, r=0.454, p=0.026; Pcw, r=-0.407, p=0.048; Pcw/Pa, r=-0.480, p=0.018; IMR, r=-0.696, p<0.001, respectively). Multiple logistic regression analysis demonstrated that the IMR was an adjusted predictor for myocardial viability as defined by the 50% FDG-PET threshold value among all the coronary pressure measurements (OR=0.884, p=0.021). The cut-off value of IMR for predicting myocardial viability was 22 U (a sensitivity of 82%, a specificity of 85% and an accuracy of 85%). CONCLUSIONS: Intracoronary pressure wire-based indexes are useful for on-site assessment of myocardial viability after primary PCI. IMR is a novel index that represents the microvascular integrity, and it is a better predictor of myocardial damage than the current techniques for evaluating the microvasculature after primary PCI.
Angioplasty* ; Arterial Pressure ; Humans ; Logistic Models ; Male ; Microcirculation ; Microvessels ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Pulmonary Wedge Pressure ; Sensitivity and Specificity