Initial cyclic-di-GMP upregulation triggers sporadic cellular expansion leading to improved cellular survival

Bacterial second messenger c-di-GMP upregulation is associated with the transition from planktonic to sessile microbial lifestyle, inhibiting cellular motility, and virulence. However, in-depth elucidation of the cellular processes resulting from c-di-GMP upregulation has not been fully explored. Here, we report the role of upregulated cellular c-di-GMP in promoting planktonic cell growth of Escherichia coli K12 and Pseudomonas aeruginosa PAO1. We found a rapid expansion of cellular growth during initial cellular c-di-GMP upregulation, resulting in a larger planktonic bacterial population. The initial increase in c-di-GMP levels promotes bacterial swarming motility during the growth phase, which is subsequently inhibited by the continuous increase of c-di-GMP, and ultimately facilitates the formation of biofilms. We demonstrated that c-di-GMP upregulation triggers key bacterial genes linked to bacterial growth, swarming motility, and biofilm formation. These genes are mainly controlled by the master regulatory genes csgD and csrA. This study provides us a glimpse of the bacterial behavior of evading potential threats through adapting lifestyle changes via c-di-GMP regulation.

Targeted EpCAM-binding for the development of potent and effective anticancer proteins

Protein-based cancer therapies are considered an alternative to conventional anticancer regimens, providing multifunctional properties while showing low toxicity. However, its widespread use is limited by absorption and instability issues, resulting in higher dosage requirements and a prolonged onset of bioactivity to elicit the desired response. Here, we developed a non-invasive antitumor treatment using designed ankyrin repeat protein (DARPin)-anticancer protein-conjugate that specifically targets the cancer biomarker, epithelial cell adhesion molecule (EpCAM). The DARPin-anticancer proteins bind to EpCAM-positive cancer cells and improve the in vitro anticancer efficacy by over 100-folds within 24 h, where the DARPin-tagged human lactoferrin fragment (drtHLF4) IC50 value is within the nanomolar range. Orally administered drtHLF4 was readily absorbed into the systemic flow of the HT-29 cancer murine model, exerting its anticancer effect on other tumors in the host body. Orally administered drtHFL4 cleared HT29-colorectal tumors using a single dose, whereas intratumoral injection cleared HT29-subcutaneous tumors within three doses. This approach addresses the limitations of other protein-based anticancer treatments by providing a non-invasive anticancer therapy with improved potency and tumor-specificity.

Engineered Spore-Forming Bacillus as a Microbial Vessel for Long-Term DNA Data Storage

DNA data storage technology may supersede conventional chip or magnetic data storage medium, providing long-term stability, high density, and sustainable storage. Due to its error-correcting capability, DNA data stored in living organisms exhibits high fidelity in information replication. Here we report the development of a Bacillus chassis integrated with an inducible artificially assembled bacterial chromosome to facilitate random data access. We generated three sets of data in the form of DNA sequences using a rudimentary coding system accessible by the regulatory promoter. Sporulated Bacillus harboring the genes were used for long-term storage, where viability assays of spores were subjected to harsh environmental stresses to evaluate the data storage stability. The data accuracy remained above 99% after high temperature and oxidative stress treatment, whereas UV irradiation treatment provided above 96% accuracy. The developed Bacillus chassis and artificial chromosome facilitate the long-term storage of larger datum volume by using other DNA digital encoding and decoding programs.

Elucidation of Iron(III) Bioleaching Properties of Gram-Positive Bacteria

Microbial-based iron reduction is an emerging technology used as an alternative to conventional chemical-based iron reduction. The iron reduction in kaolin refinement is vital for enhancing its commercial value. Extensive studies on microbial-based iron reduction mainly focus on Gram-negative bacteria, whereas little is understood about Gram-positive bacteria's mechanism and potential application. This study aims to investigate the iron-reducing mechanism of two Gram-positive bacterial isolates, Bacillus cereus (B. cereus) and Staphylococcus aureus (S. aureus). By varying the growth environment of bacteria and monitoring the biochemical changes during the process of iron reduction, the results show that Gram-positive bacterial iron reduction performance depends on the medium composition, differing from Gram-negative bacteria-based reduction processes. Nitrogen-rich medium facilitates the microbial basification of the medium, where the alkaline conditions impact the microbial iron reduction process by altering the gene expression involved in intracellular pH homeostasis and microbial growth. This discovery will contribute to the mineral refining processes and promote the development of microbial-based bioprocesses for ore purification, while also laying the foundation for investigating other Gram-positive bacterial iron-reducing ability.

CRISPR/Cas-Based Genome Editing for Human Gut Commensal Bacteroides Species

Bacteroides is the most abundant genus in the human gut microbiome and has been increasingly used as model organisms for studying the function and ecology of the gut microbiome. However, genome editing tools for such commensal gut microbes are still lacking. Here we developed a versatile, highly efficient CRISPR/Cas-based genome editing tool that allows markerless gene deletion and insertion in human gut Bacteroides species. We constructed multiple CRISPR/Cas systems in all-in-one Bacteroides-E. coli shuttle plasmids and systematically evaluated the genome editing efficiency in Bacteroides thetaiotaomicron, including the mode of Cas protein expression (constitutive, inducible), different Cas proteins (FnCas12a, SpRY, SpCas9), and sgRNAs. Using the anhydrotetracycline (aTc)-inducible CRISPR/FnCas12a system, we successfully deleted large genomic fragments up to 50 kb to study the function of metabolic gene clusters. Furthermore, we demonstrated that CRISPR/FnCas12a can be broadly applied to engineer multiple human gut Bacteroides species, including Bacteroides fragilis, Bacteroides ovatus, Bacteroides uniformis, and Bacteroides vulgatus. We envision that CRISPR/Cas-based genome editing tools for Bacteroides will greatly facilitate mechanistic studies of the gut commensal and the development of engineered live biotherapeutics.

Recent Development of Probiotic Bifidobacteria for Treating Human Diseases

Bifidobacterium is a non-spore-forming, Gram-positive, anaerobic probiotic actinobacterium and commonly found in the gut of infants and the uterine region of pregnant mothers. Like all probiotics, Bifidobacteria confer health benefits on the host when administered in adequate amounts, showing multifaceted probiotic effects. Examples include B. bifidum, B. breve, and B. longum, common Bifidobacterium strains employed to prevent and treat gastrointestinal disorders, including intestinal infections and cancers. Herein, we review the latest development in probiotic Bifidobacteria research, including studies on the therapeutic impact of Bifidobacterial species on human health and recent efforts in engineering Bifidobacterium. This review article would provide readers with a wholesome understanding of Bifidobacteria and its potentials to improve human health.

Evaluation of the Anti-Inflammatory and Anti-Oxidative Effects of Therapeutic Human Lactoferrin Fragments

Chronic inflammation is considered a pressing health issue that needs resolving. Inflammatory disease such as inflammatory bowel disease requires a long-term medical regimen to prevent disease progression. Conventionally, lactoferrin is used to treat mild gastrointestinal tract and skin inflammation. Protease-digested lactoferrin fragments often exhibit improved therapeutic properties compared to full-length lactoferrin (flHLF). However, there are no studies on the use of protease-digested lactoferrin fragments to treat inflammation. Herein, we assess the anti-inflammatory properties of engineered recombinant lactoferrin fragments (rtHLF4, rteHLF1, and rpHLF2) on non-malignant colonic fibroblast cells and colorectal cancer cells. We found that rtHLF4 is 10 times more effective to prevent inflammation compared to flHLF. These results were investigated by looking into the reactive oxygen species (ROS) production, angiogenesis activity, and cellular proliferation of the treated cells. We have demonstrated in this study the anti-inflammatory properties of the flHLF and the various lactoferrin fragments. These results complement the anti-cancer properties of these proteins that were demonstrated in an earlier study.

Engineering of Human Lactoferrin for Improved Anticancer Activity

Protease-digested lactoferrin fragments often exhibit improved therapeutic properties. However, there are limited studies investigating the anticancer properties of these fragments. The fragment with improved anticancer activities is an attractive alternative to chemotherapeutic drugs-presenting severe side effects. Herein, we report the isolation and characterization of recombinant engineered-lactoferrin (rtHLF4), exhibiting up to 100-fold improved anticancer activity compared to the full-length lactoferrin (flHLF). Further, rtHLF4 exerts its anticancer effect in a shorter duration. Through transcriptomic analysis of various cancer biomarkers, rtHLF4 was found to upregulate various pro-apoptotic markers and downregulate signaling proteins involved in angiogenesis and metastasis. We further determined that rtHLF4 showed no hemolytic activity at high concentrations. We believe that this anticancer protein can be further developed as a cancer treatment.

Impact of the Host-Microbiome on Osteomyelitis Pathogenesis

The microbiome is a collection of genomes from microbiota, including all microorganisms in a niche, through direct and indirect interactions with the host. Certain microorganisms can exist in areas conventionally considered to be sterile, such as the bone matrix. Osseous microbiota dysbiosis caused by host-microbiome perturbation or external infections may ultimately lead to osteomyelitis, a bone inflammatory disorder. Our review covers the current discoveries on the impact of host-microbiome on osteomyelitis and some common osseous diseases. Some studies suggest that the microbiotas from both osseous and non-osseous tissues (e.g., blood or gut) impact the pathogenicity of osteomyelitis and other osseous diseases (e.g., rheumatoid arthritis). We believe that this review will provide readers with a better understanding on the role of the microbiome to the host’s bone health.

Advances in Bacterial Biofilm Management for Maintaining Microbiome Homeostasis

Certain microbial biofilm in the human-microbiota community can negatively impact the host microbiome. This gives rise to various methods to prevent the formation of biofilms or to facilitate biofilm dispersal from surfaces and tissues in the host. Despite all these efforts, these persistent microbial biofilms on surfaces and in the host tissue can result in health problems to the host and its microbiome. It is the adaptive behavior of microbes within the biofilm that confers on these tenacious microbes the resistance to harsh environments, antibiotic treatments, and the ability to evade the host immune system. In this review, the approaches to combat microbial biofilm in the last decade are discussed. The biochemical pathway regulating biofilm formation is first discussed, followed by the discussion of the three approaches to combat biofilm formation: physical, chemical, and biological approaches. The advances in these approaches have given rise to methods of effectively dispersing the microbial biofilm and preventing the adherence of these microbial communities altogether. As there are numerous approaches to target biofilm, in this review the attempt is to provide insights on how these approaches have been used to modulate the host-microbiome by looking at the individual strengths and weaknesses.

Author Correction: Engineered commensal microbes for diet-mediated colorectal-cancer chemoprevention

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Reprogramming Probiotic Lactobacillus reuteri as a Biosensor for Staphylococcus aureus Derived AIP-I Detection

Gram-positive Staphylococcus aureus infection that results in pneumonia, urinary tract infection, and in severe cases, sepsis, has recently been classified as a serious threat to public health. Rapid and cost-effective detection of these infections are costly and time-consuming. Here, we present probiotic lactic acid bacteria engineered to detect autoinducer peptide-I (AIP-I), a quorum sensing molecule produced by Staphylococcus sp. during pathogenesis. We achieved this by adapting the well-characterized agr quorum sensing ( agrQS) from Staphylococcus aureus into Lactobacillus reuteri. The engineered biosensor is able to detect AIP-I levels in the nanomolar to micromolar range. We further investigated the function of the biosensor to detect real-time changes in AIP-I levels to understand the dynamics of Staphylococcus aureus under various strenuous conditions. The developed sensors would be useful for detection of Staphylococcus contamination in hospital settings and for high-throughput drug screening.

Engineered commensal microbes for diet-mediated colorectal-cancer chemoprevention

Chemoprevention-the use of medication to prevent cancer-can be augmented by the consumption of produce enriched with natural metabolites. However, chemopreventive metabolites are typically inactive and have low bioavailability and poor host absorption. Here, we show that engineered commensal microbes can prevent carcinogenesis and promote the regression of colorectal cancer through a cruciferous vegetable diet. The engineered commensal Escherichia coli bound specifically to the heparan sulphate proteoglycan on colorectal cancer cells and secreted the enzyme myrosinase to transform host-ingested glucosinolates-natural components of cruciferous vegetables-to sulphoraphane, an organic small molecule with known anticancer activity. The engineered microbes coupled with glucosinolates resulted in >95% proliferation inhibition of murine, human and colorectal adenocarcinoma cell lines in vitro. We also show that murine models of colorectal carcinoma fed with the engineered microbes and the cruciferous vegetable diet displayed significant tumour regression and reduced tumour occurrence.

Matrix-immobilized yeast for large-scale production of recombinant human lactoferrin

An improved method of recombinant human lactoferrin (hLF) expression in rich culture medium is demonstrated using macroporous microencapsulation.

Investigation of availability and accessibility of community automated external defibrillators in a territory in Hong Kong

OBJECTIVE

To evaluate the availability and accessibility of community automated external defibrillators in a territory in Hong Kong.

DESIGN

Cross-sectional study.

SETTING

Two public hospitals in New Territories West Cluster in Hong Kong.

PARTICIPANTS

Information about the locations of community automated external defibrillators was obtained from automated external defibrillator suppliers and through community search. Data on locations of out-of-hospital cardiac arrests from August 2010 to September 2013 were obtained from the local cardiac arrest registry of the emergency departments of two hospitals. Sites of both automated external defibrillators and out-of-hospital cardiac arrests were geographically coded and mapped. The number of out-of-hospital cardiac arrests within 100 m of automated external defibrillators per year and the proportion of out-of-hospital cardiac arrests with accessible automated external defibrillators (100 m) were calculated. The number of community automated external defibrillators per 10,000 population and public access defibrillation rate were also calculated and compared with those in other countries.

RESULTS

There were a total of 207 community automated external defibrillators in the territory. The number of automated external defibrillators per 10,000 population was 1.942. All facilities with automated external defibrillators in this territory had more than 0.2 out-of-hospital cardiac arrests per automated external defibrillator per year within 100 m. Among all out-of-hospital cardiac arrests, 25.2% could have an automated external defibrillator reachable within 100 m. The public access defibrillation rate was 0.168%.

CONCLUSIONS

The number and accessibility of community automated external defibrillators in this territory are comparable to those in other developed countries. The placement site of community automated external defibrillators is cost-effective. However, the public access defibrillation rate is low.

Reprogramming microbes to be pathogen-seeking killers

Recent examples of new genetic circuits that enable cells to acquire biosynthetic capabilities, such as specific pathogen killing, present an attractive therapeutic application of synthetic biology. Herein, we demonstrate a novel genetic circuit that reprograms Escherichia coli to specifically recognize, migrate toward, and eradicate both dispersed and biofilm-encased pathogenic Pseudomonas aeruginosa cells. The reprogrammed E. coli degraded the mature biofilm matrix and killed the latent cells encapsulated within by expressing and secreting the antimicrobial peptide microcin S and the nuclease DNaseI upon the detection of quorum sensing molecules naturally secreted by P. aeruginosa. Furthermore, the reprogrammed E. coli exhibited directed motility toward the pathogen through regulated expression of CheZ in response to the quorum sensing molecules. By integrating the pathogen-directed motility with the dual antimicrobial activity in E. coli, we achieved signifincantly improved killing activity against planktonic and mature biofilm cells due to target localization, thus creating an active pathogen seeking killer E. coli.

Visualizing the perturbation of cellular cyclic di-GMP levels in bacterial cells

Cyclic di-GMP (c-di-GMP) has emerged as a prominent intracellular messenger that coordinates biofilm formation and pathogenicity in many bacterial species. Developing genetically encoded biosensors for c-di-GMP will help us understand how bacterial cells respond to environmental changes via the modulation of cellular c-di-GMP levels. Here we report the design of two genetically encoded c-di-GMP fluorescent biosensors with complementary dynamic ranges. By using the biosensors, we found that several compounds known to promote biofilm dispersal trigger a decline in c-di-GMP levels in Escherichia coli cells. In contrast, cellular c-di-GMP levels were elevated when the bacterial cells were treated with subinhibitory concentrations of biofilm-promoting antibiotics. The biosensors also revealed that E. coli cells engulfed by macrophages exhibit lower c-di-GMP levels, most likely as a response to the enormous pressures of survival during phagocytosis.

Rational design of fluorescent biosensor for cyclic di-GMP

Messenger bagged: The design of a fluorophore-labeled protein biosensor for the bacterial messenger cyclic di-GMP is described. The biosensor responds to c-di-GMP with sub-micromolar sensitivity in a real-time fashion. The biosensor can be used for enzyme assays for diguanylate cyclases and c-di-GMP phosphodiesterases as well as the high-throughput screening of inhibitors.

One-Stage Reconstruction of the Penis with Free Skin Flap: Report of Three Cases

Three cases of penile defect of varying extent were reconstructed with free skin flaps from the forearm based on the radial artery. In two cases, part of the forearm flap was used to reconstruct the urethra, and the rest of the flap to reconstruct the corpus penis. A piece of autogenous cartilage was then inserted between the two layers. All procedures were completed in a one-stage operation. In the third case, a free skin graft was used for urethral reconstruction. Surgery in all three cases was successful, providing a penis of acceptable appearance as well as excellent urinary function.

CNS aspergillosis with mycotic aneurysm, cerebral granuloma and infarction

We are reporting a case of an immunocompromised patient with invasive aspergillosis (IA) who developed aspergillotic granulomas and a mycotic aneurysm of the superior cerebellar artery. The route of infection of the central nervous system (CNS) was hematogenous spread from a pulmonary focus. IA was detected with the Galactomannan (GM) technique. However, despite treatment with amphotericin B, progressive involvement of the vessel wall occurred causing fatal subarachnoid hemorrhage and massive brainstem and cerebellar infarction. This case provides pathologic-imaging correlation of one of the most devastating types of fungal involvement affecting the CNS with a fungal aneurysm. Finally the literature regarding the pathogenetic, and diagnostic investigations and the management of CNS aspergillosis is reviewed.

Idiopathic segmental infarction of right sided greater omentum. Case report and review of the literature

Idiopathic right segmental infarction of the greater omentum is an uncommon cause of acute abdomen. The aetiology is still unclear and the symptoms mimick acute appendicitis. We present a case of a 77-year old man with unsignificant medical history, admitted with an acute abdomen, in whom the clinical diagnosis was unknown until an infarcted segment of right side of the greater omentum was found at laparoscopy, and successfully resected. As the aetiology is unknown, we highlighted some of the possible theories, and emphasize the importance of considering omental infarction in the differential diagnosis of right iliac fossa syndrome in cases of acute abdomen.

Clinical PET imaging--an Asian perspective

Positron emission tomography (PET) has entered a new phase of development since a major technological breakthrough in 2000. Combined with computed tomography (CT), the second-generation PET-CT scanner is now able to obtain both functional and anatomical information of the whole body from a single study. Its application in oncology has become one of the standard imaging modalities in diagnosis, staging and monitoring therapeutic efficacy. It is well known that the Asian and Western populations have their own characteristic disease spectrum and cancer incidence. Although changes in diet and life-style have narrowed the differences in the last decade, there remains moderate divergence and disparities in cancer pattern and priority of resource allocation in different countries. It is known that F-18 fluorodeoxyglucose (FDG) is the most widely used radiopharmaceutical in PET imaging and it has been confirmed valuable in a variety of cancer types such as lung, colorectum, oesophagus, head and neck (including nasopharyngeal carcinoma), breast, pancreas, lymphoma, melanoma, cholangiocarcinoma and many types of sarcoma. Some cancer types, however, are less sensitive to FDG-PET detection and these include hepatocellular carcinoma, urological carcinoma, gastric malignancy, mucinous and clear-cell gastrointestinal tumours, neuroendocrine tumours and well-differentiated thyroid cancers. Some of these less sensitive cancer types are more prevalent in the Asian population than the Euro-American population and are, therefore, more frequently encountered as false negative cases in FDG-PET imaging. On the other hand, Asian countries are more prevalent in diseases such as tuberculosis and the chance of having false positive FDG-PET cases is higher than the Euro-American countries in the evaluation of lung and other cancers. From the Asian perspective, we are more susceptible to having a higher chance of both false negative and false positive FDG-PET cases. Thus, there is a stronger emphasis of research on new drugs to overcome the limitations of FDG. The use of PET imaging as a diagnostic tool has gained wide acceptance in Asia during the past few years and its clinical utility is expected to continue to rise. More research on other PET radiopharmaceuticals should therefore be given a higher priority along side with the maturation of scanning technology.

Suppurative salmonella thyroiditis in a patient with chronic lymphocytic leukemia

We describe an 82-year-old man with undiagnosed chronic lymphocytic leukemia (CLL) who presented with acute swelling of the thyroid goiter. Subsequent thyroid aspirate and blood culture yielded group B Salmonella thyroid abscess with septicemia. Infectious complications are the major cause of morbidity and mortality in patients with CLL since most of them can be timely detected and few can arise from innocent-looking lesions.

Rhegmatogenous retinal detachment in morning glory syndrome pathogenesis and treatment

We report a case of morning glory syndrome with retinal detachment. A slit-like retinal break at the edge of the excavated disc anomaly provided a direct communication between the subretinal space and the vitreous cavity. Retinal reattachment and useful vision was achieved after a single procedure of vitrectomy and gas tamponade. We believe that identification of the retinal break, removal of epipapillary fibroglial tissue and its traction force, the avoidance of perfluorocarbon liquid and the appropriate use of long-acting gas as endotamponade, all contributed to the favorable outcome. This is more evidence supporting the rhegmatogenous theory of retinal detachment in morning glory syndrome. A literature review of the clinical presentations and treatments of similar cases is included.

Intravitreous tissue plasminogen activator injection and pneumatic displacement in the management of submacular hemorrhage complicating scleral buckling procedures

PURPOSE

To evaluate the efficacy of recombinant tissue plasminogen activator (rTPA) and sulfur hexafluoride (SF6) in displacing submacular hemorrhage in patients who had scleral buckling procedures complicated by the development of submacular hemorrhage. Final visual acuity and complications of the procedures were evaluated.

METHODS

Sequential intravitreal injections of 50 microg rTPA in 0.1 mL and 0.4 cc SF6 were performed in eight patients who showed submacular hemorrhage 1 day after a scleral buckling procedure. The fundus was checked daily for 3 days after the injection of TPA and gas, and then was followed every week for 1 month and then every 2 months. Patients were observed for at least 6 months. Visual acuity and the status of complications were evaluated.

RESULTS

Submacular hemorrhage was totally or partially displaced extramacularly in all patients on the day after rTPA and SF6 injection. Vitreous hemorrhage was present in all patients. The retina was attached in all patients and no recurrent retinal detachment was noted. Visual acuity was improved at 6 months after treatment in all seven of the patients with macula-off retinal detachments compared to the preoperative visual acuity. The last patient who had a macula-sparing retinal detachment had decreased vision (20/25) at 6 months compared to preoperatively.

CONCLUSIONS

Recombinant tissue plasminogen activator and SF6 injection is an easy procedure that is less complicated than and as effective as internal drainage in patients with submacular hemorrhage developing as a complication of scleral buckling procedures.

Reduction of subretinal fluid after preoperative immobilization of the eyes with rhegmatogenous retinal detachment

BACKGROUND

Bullous retinal detachment may be difficult to handle with higher operative complications. Preoperative immobilization of the eyes might reduce subretinal fluid and facilitate surgical procedures. Factors influencing subretinal fluid absorption were analyzed.

METHODS

Twenty-eight eyes with primary rhegmatogenous retinal detachment with preoperative binocular patching and complete bed rest for at least 12 hours were enrolled. Ultrasonography was performed before and after immobilization to estimate the reduction in subretinal fluid.

RESULTS

The amount of reduction diverged in cases with an average of a 17.1% decrease in the maximal height of detachment. Retinal detachments in patients with smaller breaks and without vitreal traction or chronicity showed more significant reduction of subretinal fluid than did those patients with larger breaks and with vitreal traction or chronicity. On the other hand, break shape, height of retinal detachment, age, and gender had no obvious effect on subretinal fluid change.

CONCLUSIONS

Preoperative immobilization of the eyes reduces the subretinal fluid in selected cases, which can decrease operative complications. Break size, vitreal traction, and chronicity are important factors affecting the absorption of subretinal fluid.

Adult lymphoblastic lymphoma in Taiwan: an analysis of treatment results of 26 patients

Lymphoblastic lymphoma (LBL) frequently affects young adults and usually presents with a mediastinal mass as well as bone marrow involvement. Although the frequency of LBL in the Far East is higher than that of Western countries, no reports regarding treatment of this disease have as yet been reported. We herein report our treatment experience and verify the efficacy of the Stanford/Northern California Oncology Group (NCOG) protocol for this disease and recommend treatment strategies for LBL patients. We retrospectively reviewed the medical records of adult LBL patients treated in our hospital from 1986 to 1996. Twenty-seven patients were diagnosed to have LBL. These patients' ages ranged from 17 to 73 years old with a median of 23. Nineteen patients had an initial stage IV disease. Of the 23 cases in which immunological studies were performed, 20 proved to be of T cell lineage, 1 of B cell type, and the other 2 lacked both T and B markers. Three major chemotherapeutic regimens including prednisone, methotrexate, doxorubicin, cyclophosphamide, etoposide-mechlorethamine, vincristine, procarbazine, prednisone (ProMACE-MOPP), cyclophosphamide, hydroxydaunomycin, vincristine, prednisone (CHOP), and the Stanford/NCOG protocol were used to treat 3, 6, and 15 patients, respectively. Two other patients were treated with two different chemotherapeutic regimens, respectively. One patient was excluded for analysis because of initial treatment by surgery. The complete response (CR) rates with ProMACE-MOPP, CHOP, and the Stanford/NCOG regimens were 0%, 17%, 80% and median overall survival 9, 8.5, and 15 months, respectively. Five patients with stage II-III diseases achieved long-term disease-free survival of 11-36 months with the Stanford/NCOG protocol with a median follow-up of 24 months. Four patients in late stage or relapse received allogeneic bone marrow transplantation (BMT). Two of them obtained long-term disease-free survival. Two other patients in CR were treated with high-dose chemotherapy (HDCT) supported with autologous BMT and peripheral blood stem cell transplantation (PBSCT), respectively. The patient receiving HDCT with autologous PBSCT died of LBL relapse 6 months after transplantation. The other patient undergoing HDCT with autologous BMT died of fulminant hepatitis 5.5 months after transplantation. The median overall survival of all these 26 patients was 12 months. B symptoms and treatment without the Stanford/NCOG protocol were found to have significantly negative impacts on both patients' overall and progression-free survivals. Our results suggest that the Stanford/NCOG protocol may be an effective chemotherapy for adult LBL and may provide long-term remission for patients in an early stage of disease. For those patients with LBL in an advanced stage or in relapse, HDCT with allogeneic or autologous BMT is probably the treatment of choice.

Impact of open lung biopsy for undiagnosed pulmonary infiltrates in patients with hematological malignancies

Pulmonary complications are frequently encountered in patients with hematological malignancy. The optimal therapeutic decision including open lung biopsy (OLB) for such patients is uncertain. We herein examine the clinical impact of OLB on these patients. Seven patients with progressively diffuse pulmonary infiltrates despite aggressive medical treatment were examined. The underlying diseases, prior treatment for presumptive pneumonia, the change in therapeutic approach after operation, and clinical outcome were reviewed retrospectively. Diffuse pulmonary infiltrates were caused by infection in two patients and by noninfectious etiology such as alveolar proteinosis, idiopathic interstitial pneumonitis, leukemic involvement, and drug-induced alveolar damage in the others. Four patients who had serious underlying hematologic diseases such as myelodysplastic syndrome, acute and chronic myeloid leukemia, and T cell lymphoma died. Three patients with acute lymphoid leukemia survived. In two of these three, change of therapeutic strategies after OLB was created for the survival. OLB in patients with hematological malignancy may be useful in selected patients with a treatable hematologic disease who have treatable underlying causes of the pulmonary infiltrate.

Enhancing the hypotensive effect and diminishing the cytolytic activity of hornet mastoparan B by D-amino acid substitution

Mastoparan B (MP-B) is a cationic tetradecapeptide (LKLKSIVSWAKKVL-CONH(2)) isolated from the venom of the Taiwan hornet Vespa basalis. Unlike other vespid mastoparans, the peptide is capable of inducing short-term hypotension and causes hemolysis in animals. This study was aimed to find out MP-B analogs that possess higher hypotensive potency with the least lytic action by D-amino acid substitution, especially at lysine (Lys) residues. The synthetic MP-B isomer in which Lys(2) was replaced by D-Lys showed a significant decrease in both hemolytic and hypotensive activities. Substitution of Lys(4) by D-Lys in MP-B also caused a marked reduction of hemolytic activity, but its hypotensive action was only slightly affected. However, when Lys(11,12) were replaced by D-Lys, the resulting isomer ([D-Lys(11,12)]MP-B) exhibited a higher hypotensive activity with negligible hemolytic activity as compared with the native peptide. The D-antipot of MP-B in which all amino acid residues were replaced by D-isomers showed the highest hypotensive activity with a hemolytic activity about 1/5 that of MP-B. The results reveal that D-Lys substitution at the N-terminus of MP-B (Lys(2,4)) causes decreases in both hypotensive and hemolytic activities, while D-Lys substitution at the C-terminus (Lys(11,12)) leads to a significant increase in hypotensive activity of MP-B with a remarkable decrease in hemolytic activity. The hypotensive effect of [D-Lys(11,12)]MP-B was more prominent on spontaneously hypertensive rats. At a proper dose (0.3mg/kg) the peptide could reduce the high blood pressure (approximately 180 mmHg) of the rat to a normal level (approximately 120 mmHg) for more than 3h. [D-Lys(11,12)]MP-B which possesses a potent hypotensive action with the least cytolytic side effect is the best MP-B analog for studying the mechanism of cardiovascular inhibition by MP-B and could be useful as a hypotensive agent in hypertension crisis.

Ocular ischemic syndrome

BACKGROUND

The purpose of this study was to investigate the clinical features and management of ocular ischemic syndrome (OIS) and factors influencing its development.

METHODS

Ten patients (12 eyes) with OIS underwent detailed medical and ocular histories, complete ophthalmic evaluation including fluorescein angiography, internal carotid artery evaluation by duplex ultrasonography, and management. The following outcome measures were considered: visual acuity, anterior segment neovascularization, lens status, retinal and choroidal changes, and carotid artery stenosis or occlusion.

RESULTS

The mean age of the patients was 63 +/- 8 years. Presenting visual symptoms included gradual (82.5%) or sudden (17.5%) onset of vision loss. At initial visit, eyes with OIS had visual acuity less than or equal to counting fingers in 50%, iris neovascularization in 58%, and neovascular glaucoma in 42%. Initially associated systemic diseases in these patients included arterial hypertension (60%), diabetes mellitus (40%), coronary artery disease (20%), previous stroke (30%) and hemodialysis (10%). Complete occlusion or severe occlusion (70-99%) of the internal carotid artery was seen in 75% on the side of OIS. Panretinal photocoagulation did not prevent OIS from progressing but vitreous hemorrhage and rubeosis iris regressed. Carotid endarterectomy had some benefit in stabilizing or improving vision in patients with OIS.

CONCLUSION

OIS has a poor visual prognosis. It is imperative that the clinician be aware of the signs and symptoms of carotid disease in order to facilitate prompt diagnosis and appropriate referral, because OIS may be the presenting sign of serious ischemic cerebrovascular and ischemic heart disease.

Expression profiles of ErbB family receptors and prognosis in primary transitional cell carcinoma of the urinary bladder

In vitro experiments have demonstrated that epidermal growth factor (EGF)-related peptides activate distinct subsets of ErbB receptors and differ in their biological activities. The implications of cross-talk among ErbB family receptors in human cancer, however, remain to be clarified. This cohort study was performed to examine the expression patterns of ErbB receptors by immunohistochemistry in primary human bladder cancer (n = 245) and compared with conventional biological indicators for their prognostic significance. Expression of individual EGF receptor (EGFR) and ErbB2, ErbB3, or ErbB4 receptors was detected in 72.2, 44.5, 56.3, and 29.8% of bladder cancer cases, respectively. Expression of two of the receptors varied from 14.7 to 42.4%, of three of the receptors between 11.0 and 22.0%, and of all four of the ErbB receptors by 8.6%. Important indicators in association with patient survival were tumor staging (P = 0.017), ErbB2 (P = 0.018), EGFR-ErbB2 (P = 0.023), and ErbB2-ErbB3 (P = 0.042). In the subset of grade-2 tumors, EGFR-ErbB2-ErbB3 and EGFR-ErbB2 predicted the development of second recurrence (P = 0.026 and 0.039, respectively), and ErbB2-ErbB3 tended to correlate with patient survival (P = 0.09). The results indicate that a combination of EGFR, ErbB2, and ErbB3 expression profile may be a better prognostic indicator than any family member alone. Given that ErbB2 is the preferred coexpression partner of ErbB family members, expression of other ErbB receptors may significantly affect the prognostic implication of ErbB2 for bladder cancer patients.

Autologous peripheral blood stem cell transplantation for patients with malignancies: the Tri-Service General Hospital experience

BACKGROUND

High-dose chemotherapy/radiotherapy followed by autologous peripheral blood stem cells transplantation (APBSCT) can be used to treat chemosensitive malignant diseases. We retrospectively studied the APBSCT treatment efficacy and safety of patients at Tri-Service General Hospital (TSGH).

METHODS

From January 1994 to March 2000, 11 patients were treated with high doses of chemotherapy/radiotherapy followed by APBSCT. Nine patients were male and 2 were female. The median age was 26 years, with a range of 21 to 51. There were 7 acute myeloid leukemia (AML), 3 non-Hodgkin's lymphoma (NHL) and 1 ovarian cancer. All patients received both chemotherapy and granulocyte-colony stimulating factor to mobilize hematopoietic stem cells, and the most commonly used conditioning regimen was combined chemotherapy with Busulfan and Cyclophosphamide.

RESULTS

The median numbers of infused mononuclear and CD34+ cells were 3.19 x 10(8)/kg and 9.2 x 10(6)/kg, respectively. Nine of the 11 patients engrafted successfully, but 2 patients with AML failed to engraft. The median times of WBC recovery (ANC > or = 500/uL) and platelet recovery (> or = 20 x 10(3)/uL) were 13 and 16 days, respectively. Four patients with AML survived after APBSCT and two of them were alive and disease-free for 36 and 51 months, respectively. One patient with AML and 3 patients with NHL died of relapse, and one patient with ovarian cancer was alive but with disease at 50 months.

CONCLUSIONS

For patients with AML, APBSCT may be an alternative, safe and useful treatment modality. Further strategies for reducing relapse in lymphoma patients merit further investigation.

Acute angle-closure glaucoma resulting from spontaneous hemorrhagic retinal detachment in age-related macular degeneration: case reports and literature review

PURPOSE

Acute angle-closure glaucoma resulting from massive subretinal hemorrhage is a rare and catastrophic complication in age-related macular degeneration. Anticoagulant usage had been strongly correlated with this complication in previously reported cases.

METHODS

Four patients (4 eyes), 3 men and 1 woman, developed angle-closure glaucoma with diffuse subretinal hemorrhage and total hemorrhagic retinal detachment.

RESULTS

Serial funduscopic examinations and echographic studies in 2 eyes showed that the blood gradually accumulated in the subretinal space. It took more than 10 days for the bleeding to build up to bullous hemorrhagic retinal detachment and secondary glaucoma. Anti-glaucomatous agents were given and sclerotomy was performed in 3 of the 4 patients. Phthisical changes were observed subsequently in these 3 eyes. The eye that received early drainage of blood was an exception, and a small degree of residual acuity was retained. Three of the 4 patients had diabetes mellitus, and hypertension and vascular diseases were also present in the same 3 patients.

CONCLUSIONS

Diabetes mellitus might be a predisposing factor for the impaired hemostasis. Anti-glaucomatous agents were of no effect in the management of intraocular pressure. Sclerotomy and drainage of blood help control intraocular pressure and relieve ocular pain. Poor final visual acuity is inevitable. However, phthisical changes might be prevented with early sclerotomy and drainage of blood.

Progression of hydroxychloroquine retinopathy after discontinuation of therapy: case report

Chloroquine and its derivative, hydroxychloroquine sulfate, have been used in treating malaria, dermatitides of systemic lupus erythematosus and rheumatoid arthritis. Hydroxychloroquine retinopathy is uncommon in Taiwan. Here we report a patient with hydroxychloroquine retinopathy which progressed even after discontinuation of hydroxychloroquine. A 42-year-old woman had systemic lupus erythematosus for twenty years. She had been treated with 200 to 400 mg of hydroxychloroquine per day (4 to 8 mg/kg of body weight/day) with a cumulative dose of 657 g. After bull's-eye maculopathy was found, hydroxychloroquine was discontinued. Her medical history revealed no chloroquine administration and no other systemic disease. Five years after cessation of the therapy, her visual acuity and visual fields continued to deteriorate. Ophthalmoscopic examination revealed the hydroxychloroquine retinopathy had advanced. To the best of our knowledge, the progression of hydroxychloroquine retinopathy after discontinuation of medications is a rare phenomenon. Regular ophthalmologic examinations should be performed for patients on hydroxychloroquine regimens because there is no satisfactory treatment for hydroxychloroquine retinal toxicity. Ophthalmologists, dermatologists and rheumatologists should monitor for ocular toxicity of hydroxychloroquine carefully.