Definitive Chemoradiation Treatment Response Evaluation Using NI-RADS and ctHPVDNA for HPV-Associated Oropharyngeal Squamous Cell Carcinoma

PURPOSE/OBJECTIVE(S)

To compare the evaluation of treatment response among patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive (chemo)radiotherapy (CRT).

MATERIALS/METHODS

Patients with locally advanced HPV-associated OPSCC treated with definitive radiotherapy (RT) or CRT from 2019 to 2022 at a single institution were reviewed. Patients underwent standard 3-month post-CRT positron emission tomography/computed tomography (PET/CT) scan with or without contrast enhanced CT (CECT) of the head and neck. Plasma circulating tumor HPV DNA (ctHPVDNA) was collected from 2-8 months post-CRT. Equivocal findings on post-CRT imaging prompted repeat evaluation. Imaging response was assessed via NI-RADS (Neck Imaging Reporting and Data System) risk classification and independently reviewed by two board certified radiologists, both blinded to outcomes and ctHPVDNA values.

RESULTS

Our cohort of 52 patients included: 87% males; median age 61.5; 63% never smokers, 31% former smokers, 6% current smokers; 44% tonsil primary, 46% base of tongue; 4% T0, 25% T1, 40% T2, 12% T3, 17% T4; 6% N0, 15% N1, 2% N2a, 44% N2b, 25% N2c, 8% N3 (AJCC 7th edition). Concurrent systemic therapy was received in 90%. During this period 71 PET/CTs and 15 CECTs were reviewed for treatment response evaluation; 44% (23/52) patients required additional imaging for equivocal findings; 62 ctHPVDNA blood samples were co-analyzed for treatment evaluation. The highest risk classification score between mucosa, primary, and/or neck site was: 42% NI-RADS 1, 48% NI-RADS 2, and 10% NI-RADS 3. Only patients with locoregional disease recurrence/progression were included for evaluation comparison between imaging and circulating biomarkers. No cancer events occurred without imaging and/or ctHPVDNA detection. Patients with NI-RADS score ≥2 during first post-CRT imaging evaluation more frequently underwent additional imaging (70% vs 30%, p<0.001). NI-RADS risk classification suggested 5 locoregional events (2 true positives, 3 false positives) resulting in 100% sensitivity, 94% specificity, 40% positive predictive value (PPV), and 100% negative predictive value (NPV). Circulating tumor HPV-DNA identified 2 locoregional events (2 true positives, 0 false positives) resulting in 100% sensitivity, 100% specificity, 100% PPV, and 100% NPV. Salvage operations were performed in 2 of 3 patients with false positive disease by NI-RADS classification without any evidence of cancer on final pathology.

CONCLUSION

While limited by the small number of recurrence events in this cohort, ctHPVDNA for HPV-associated OPSCC in conjunction with post-treatment imaging evaluation may limit the need for repeat imaging and unwarranted salvage operations that increase patient worry, morbidity, and financial toxicity. Additional prospective study is warranted.

[Immunogenicity and safety of a booster vaccination with an inactivated severe acute respiratory syndrome coronavirus 2 vaccine in adults aged 18 to 59 years]

Objective: To assess the immunogenicity and safety of a booster vaccination with an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Methods: The phase Ⅱ trial of an inactivated SARS-CoV-2 vaccine was conducted by Jiangsu Provincial Center for Disease Control and Prevention (CDC) since October 2020. The subjects were healthy adults aged 18-59 years, excluding pregnant, and not breastfeeding women. The primary vaccination schedule groups were 0-14 d 5 μg, 0-14 d 10 μg, 0-28 d 5 μg and 0-28 d 10 μg, respectively. And 50 participants in each group, a total of 200, who have received 2-doses primary vaccination were selected in ascending order of the study number and vaccinated with a booster dose (same dosage as primary vaccination) at the 6th months after post the primary vaccination (30-day window period). Blood samples were collected before and after boosting and tested for the geometric mean titers (GMT) and seroconversion of live virus neutralizing antibody, pseudovirus neutralizing antibody and receptor-binding-domain (RBD) IgG antibody. Adverse events (AE) were collected and assessed within 28 days after boosting. Results: The ages of subjects in group 0-14 d 5 μg, 0-14 d 10 μg, 0-28 d 5 μg and 0-28 d 10 μg were (43.98±9.58), (43.46±9.34), (42.56±9.08) and (43.94±11.05) years old, respectively (P=0.877). Sex ratios were balanced among the 4 groups (P=0.331). The live virus neutralizing antibody GMT (95%CI) in group 0-14 d 5 μg, 0-14 d 10 μg, 0-28 d 5 μg and 0-28 d 10 μg increased from 4.07 (3.30-5.04), 3.75 (3.08-4.55), 8.33 (7.01-11.11) and 7.69 (6.19-9.57) before the booster vaccination to 284.84 (215.28-376.86), 233.05 (178.61-304.08), 274.81 (223.64-337.68) and 280.77 (234.59-336.04) in 28 days after the booster vaccination, respectively. The rates of live virus neutralizing antibody seroconversion were all 100% in the 4 groups. The AE incidences following booster vaccination were 18.0% (9 cases), 4.0% (2 cases), 12% (6 cases), and 12% (6 cases) in the 4 groups(P=0.182). No AE was graded as level 3 or worse. No serious AE was reported. Conclusion: One booster vaccination of an inactivated SARS-CoV-2 vaccine administered 6 months after primary vaccination showed good immunogenicity and safety.

Molecular Modeling for Structural Insights Concerning the Activation Mechanisms of F1174L and R1275Q Mutations on Anaplastic Lymphoma Kinase

Anaplastic lymphoma kinase (ALK) is a receptor tyrosine kinase involved in various cancers. In its basal state, the structure of ALK is in an autoinhibitory form stabilized by its A-loop, which runs from the N-lobe to the C-lobe of the kinase. Specifically, the A-loop adopts an inhibitory pose with its proximal A-loop helix (αAL-helix) to anchor the αC-helix orientation in an inactive form in the N-lobe; the distal portion of the A-loop is packed against the C-lobe to block the peptide substrate from binding. Upon phosphorylation of the first A-loop tyrosine (Y1278), the αAL-helix unfolds; the distal A-loop detaches from the C-lobe and reveals the P+1 pocket that accommodates the residues immediately after their phosphorylation, and ALK is activated accordingly. Recently, two neuroblastoma mutants, F1174L and R1275Q, have been determined to cause ALK activation without phosphorylation on Y1278. Notably, F1174 is located on the C-terminus of the αC-helix and away from the A-loop, whereas R1275 sits on the αAL-helix. In this molecular modeling study, we investigated the structural impacts of F1174L and R1275Q that lead to the gain-of-function event. Wild-type ALK and ALK with phosphorylated Y1278 were also modeled for comparison. Our modeling suggests that the replacement of F1174 with a smaller residue, namely leucine, moves the αC-helix and αAL-helix into closer contact and further distorts the distal portion of the A-loop. In wild-type ALK, R1275 assumes the dual role of maintaining the αAL-helix–αC-helix interaction in an inactive form and securing αAL-helix conformation through the D1276–R1275 interaction. Accordingly, mutating R1275 to a glutamine reorients the αC-helix to an active form and deforms the entire A-loop. In both F1174L and R1275Q mutants, the A-loop rearranges itself to expose the P+1 pocket, and kinase activity resumes.

[Pathogenesis of immunoglobulin G4-related hepatobiliary disease]

IgG4-relaed hepatobiliary diseases (IgG4-HBD) are the hepatobiliary manifestations of IgG4-related disease, a multisystem fibro-inflammatory disorder. Previous studies on the pathogenesis of genetics and immunology have provided significant assistance in understanding the disease, rational diagnosis and treatment, but there are still many unknowns and challenges. The current research progress summarizes several factors influencing fibrosis and inflammation in the pathogenesis of disease.

Correction: Surface modification of carbon cloth anodes for microbial fuel cells using atmospheric-pressure plasma jet processed reduced graphene oxides

Correction for ‘Surface modification of carbon cloth anodes for microbial fuel cells using atmospheric-pressure plasma jet processed reduced graphene oxides’ by Shih-Hang Chang et al., RSC Adv., 2017, 7, 56433–56439.

Molecular modeling on HIF-2α-ARNT dimer destabilization caused by R171A and/or V192D mutations in HIF-2α

Oxygen homeostasis in normal and tumor cells is mediated by hypoxia-inducible factors (HIFs), which are active as heterodimer complexes, such as HIF-2α-aryl hydrocarbon receptor nuclear translocator (ARNT) and HIF-1α-ARNT. A series of mutations on the interfaces between HIF-2α and ARNT and on the domain-domain interface within HIF-2α has been reported to exert varying effects on HIF-2α-ARNT dimerization. In the present study, molecular dynamic simulations were conducted to evaluate HIF-2α mutations, namely R171A, V192D, and R171A/V192D, which are not involved in the interaction with ARNT but impede HIF-2α-ARNT dimerization. Our results indicate that these mutations induct local conformation leading to a shortened (by V192D) or widened (by R171A and R171A/V192D) Y91-E346 separation distance, where E346 and Y91 are located on the HIF-2α and interact with ARNT according to electrostatic and geometrical shape complementarity, respectively.

Surface modification of carbon cloth anodes for microbial fuel cells using atmospheric-pressure plasma jet processed reduced graphene oxides

Surface modification of a carbon cloth anode by screen-printing rGO and APPJ is promising for manufacturing large-scale MFC stacks.

Clinical presentations of thyroid cancer patients with multiple primary cancers

BACKGROUND

In thyroid cancer patients with multiple primary cancers, primary cancers tend to be more aggressive.

AIMS

We analyzed multiple primary cancers in thyroid cancer patients and determined the differences between the incidence and the characteristics of primary cancers.

MATERIALS AND METHODS

A total of 3070 patients with thyroid cancer underwent a thyroidectomy and follow-up examination at a single medical center. The times of diagnosis of the primary cancers were categorized as antecedent, synchronous, or subsequent to the diagnosis of thyroid cancer.

RESULTS

After a mean follow-up period of 8.8 ± 0.5 yr, the presence of multiple primary cancers was histopathologically confirmed in 163 patients (5.3%). Patients with multiple primary cancers had a lower female-to-male ratio, an older mean age, advanced tumor-node-metastasis (TNM) stage, higher total mortality, and higher therapeutic radioactive iodide (131I) doses than patients without multiple primary cancers. Hematological malignancy and renal cell carcinoma, neither of which are among the 10 most common cancers observed in the general population of Taiwan, were the most common multiple cancers among women and men with thyroid cancer. Patient age, thyroid cancer tumor size, and thyroid cancer mortality in the antecedent, synchronous, and subsequent groups were not significantly different.

CONCLUSIONS

Patients with multiple primary cancers in advanced stages had shorter disease-free survival period after treatment. Thyroid cancer patients with multiple primary cancers should be closely followed up for the occurrence of other secondary cancers in order to improve total mortality.

Pediatric sensorineural hearing loss, part 2: syndromic and acquired causes

This article is the second in a 2-part series reviewing neuroimaging in childhood SNHL. Previously, we discussed the clinical work-up of children with hearing impairment, the classification of inner ear malformations, and congenital nonsyndromic causes of hearing loss. Here, we review and illustrate the most common syndromic hereditary and acquired causes of childhood SNHL, with an emphasis on entities that demonstrate inner ear abnormalities on cross-sectional imaging. Syndromes discussed include BOR syndrome, CHARGE syndrome, Pendred syndrome, Waardenburg syndrome, and X-linked hearing loss with stapes gusher. We conclude the article with a review of acquired causes of childhood SNHL, including infections, trauma, and neoplasms.

Pediatric sensorineural hearing loss, part 1: Practical aspects for neuroradiologists

SNHL is a major cause of childhood disability worldwide, affecting 6 in 1000 children. For children with prelingual hearing loss, early diagnosis and treatment is critical to optimizing speech and language development, academic achievement, and social and emotional development. Cross-sectional imaging has come to play an important role in the evaluation of children with SNHL because otolaryngologists routinely order either CT or MR imaging to assess the anatomy of the inner ears, to identify causes of hearing loss, and to provide prognostic information related to potential treatments. In this article, which is the first in a 2-part series, we describe the basic clinical approach to imaging of children with SNHL, including the utility of CT and MR imaging of the temporal bones; we review the most recent proposed classification of inner ear malformations; and we discuss nonsyndromic congenital causes of childhood SNHL.

Green fabrication of agar-conjugated Fe3O4 magnetic nanoparticles

Magnetic nanoparticles are of great interest both for fundamental research and emerging applications. In the biomedical field, magnetite (Fe(3)O(4)) has shown promise as a hyperthermia-based tumor therapeutic. However, preparing suitable solubilized magnetite nanoparticles is challenging, primarily due to aggregation and poor biocompatibility. Thus methods for coating Fe(3)O(4) NPs with biocompatible stabilizers are required. We report a new method for preparing Fe(3)O(4) nanoparticles by co-precipitation within the pores of agar gel samples. Permeated agar gels were then dried and ground into a powder, yielding agar-conjugated Fe(3)O(4) nanoparticles. Samples were characterized using XRD, FTIR, TGA, TEM and SQUID. This method for preparing agar-coated Fe(3)O(4) nanoparticles is environmentally friendly, inexpensive and scalable.

The effect of glucagon-like peptide 2 injection on performance, small intestinal morphology, and nutrient transporter expression of stressed broiler chickens

An experiment was conducted to determine the effect of injecting glucagon-like peptide 2 (GLP-2) on the small intestinal weight, morphology, and nutrient transporter expression in pharmacologically stressed broiler chickens. A total of 144 seven-day-old birds were fed either a basal diet (CTRL) or a basal diet plus 30 mg of corticosterone (CORT)/kg of diet for a total of 14 d. Half of the birds from each group were injected daily with GLP-2 (6.7 nmol/kg of BW) or saline for 14 d. The average final BW, ADG, ADFI, and the ratio of feed intake to weight gain (F:G) was recorded over 21 d for the 4 groups of 36 birds, namely CTRL + saline, CTRL + GLP-2, CORT + saline, and CORT + GLP-2. In addition, the absolute and relative small intestinal weight, villus height (VH), and crypt depth (CD) of the duodenum and jejunum, as well as the abundance of sodium and glucose co-transporter 1 (SGLT-1), vitamin D-dependent calcium-binding protein-28,000 molecular weight (CaBP-D28k), and peptide transporter 1 (PepT-1) mRNA in the duodenum and of liver fatty acid-binding protein (L-FABP) mRNA in the jejunum. The total DNA, RNA, and protein content in small intestinal mucosa were also determined. The results showed that CORT administration significantly lowered average final BW, ADG, ADFI, absolute small intestinal weight, VH, and CD of duodenum and jejunum (P < 0.05) while increasing the relative small intestinal weight, F:G, relative abundance of SGLT-1, CaBP-D28k, PepT-1, and L-FABP mRNA (P < 0.05). Glucagon-like peptide 2 injection increased the average final BW, ADG, VH, and CD in duodenum and jejunum and relative abundance of SGLT-1, CaBP-28k, PepT1, and PepT1 mRNA of broiler chickens, respectively (P < 0.05), and decreased F:G (P < 0.05). In chickens fed basal diet plus CORT, injecting GLP-2 decreased F:G (P < 0.05); increased VH and CD of duodenum and CD of jejunum; and increased relative abundance of SGLT-1, CaBP-D28k, PepT-1, and L-FABP mRNA, RNA, and total protein content in small intestine compared with the injection of saline (P < 0.05). In birds fed the basal diet, GLP-2 injection decreased F:G (P < 0.05) and increased final BW, ADG, small bowel weight, CD of jejunum, and relative abundance of CaBP-D28k and PepT-1 mRNA compared with injecting saline (P < 0.05). In conclusion, GLP-2 injection reversed the negative effect of stress on the weight and morphology and the absorptive function of small bowel of broiler chickens. Glucagon-like peptide 2 injection also had a positive effect on the growth performance of healthy broiler chickens.

Association of choline levels and tumor perfusion in brain metastases assessed with proton MR spectroscopy and dynamic susceptibility contrast-enhanced perfusion weighted MRI

While malignant brain tumors typically show high choline concentrations and neovascularity, we have anecdotally noted that a substantial number of brain metastases from lung cancer demonstrate only mildly elevated choline resonances on proton MR spectroscopy ((1)H-MRS). The goals of this study were to determine whether lung cancer metastases are more likely to demonstrate low choline than other metastases and, in addition, to assess the relationship between choline and tissue perfusion in brain metastases. We performed a retrospective analysis of 66 patients with untreated brain metastases (40 NSCLC; 17 breast cancer; 9 melanoma) who underwent multivoxel 2D-CSI (1)H-MRS. Cho/Cr was compared between histologies using Mann-Whitney U tests. Lesions were dichotomized into low and high Cho/Cr groups, and differences in relative Cho/Cr between groups were assessed with Fisher's exact tests. 21 patients also underwent dynamic susceptibility MR perfusion weighted imaging (PWI). Normalized relative cerebral blood volume ratios (rCBV(norm)) were calculated, and strength of correlation between Cho/Cr and rCBV(norm) was assessed. Cho/Cr was significantly lower in lung cancer metastases compared to breast cancer metastases. Cho/Cr < 2.0 was observed in 37.5% of lung cancer metastases, 23.5% of breast cancer metastases, and 0% of melanoma metastases. Lung cancer metastases were significantly more likely to demonstrate low Cho/Cr than melanoma metastases (p = 0.04). There was a strong correlation between Cho/Cr and rCBV(norm) (p = 0.847, p < 0.001), and metastases in the high Cho/Cr group showed significantly higher rCBV(norm). These findings suggest that choline metabolism and tumor perfusion in brain metastases are interrelated, and we posit that this relationship may be due to the influence of the transcription factor HIF-1.

Brain stem and inner ear abnormalities in children with auditory neuropathy spectrum disorder and cochlear nerve deficiency

BACKGROUND AND PURPOSE

Cranial abnormalities, including CND, are common in children with ANSD. The purpose of this study was to assess whether CND is associated with brain or inner ear abnormalities in a cohort of children with ANSD.

MATERIALS AND METHODS

Two neuroradiologists retrospectively reviewed cranial MR imaging examinations in 103 children with ANSD. Brain, cochlear nerve, and temporal bone abnormalities were described and tabulated. Findings were stratified on the basis of the presence and laterality of CND, and differences in the presence of associated inner ear or intracranial abnormalities were assessed by using 2-tailed Fisher exact tests.

RESULTS

CND was identified in 33.0% of children and 26.9% of ears with ANSD. Significantly more patients with bilateral CND had intracranial abnormalities than those with unilateral CND (60.0% versus 15.8%; P = .012). Forty percent of patients with bilateral CND, 0% of patients with unilateral CND, and 10.1% of those without CND demonstrated hindbrain malformations. Patients with bilateral CND were more likely to demonstrate hindbrain malformations than patients with normal nerves (P = .01) or unilateral CND (P = .004). Labyrinthine abnormalities were significantly more common in patients with bilateral CND than in those without CND (P ≤ .001). Cochlear anomalies were more common in patients with bilateral versus unilateral CND (P = .01). IAC and cochlear aperture stenosis were more common in those with unilateral and bilateral CND than those without CND (both P < .001).

CONCLUSIONS

Cochlear and hindbrain abnormalities are significantly more common among patients with ANSD with bilateral CND compared with those with at least 1 intact cochlear nerve.

A pilot study on low power pulse rate detection based on compressive sampling

Low power consumption is one of the key design challenges for various pervasive healthcare systems. Compressive Sampling (CS) is an emerging technique for reconstructing signals from data sampled under the Nyquist rate. CS has great potentials for low power pulse rate detection based on photoplethysmograph (PPG) signals, since by reducing the PPG data sampling rate the LEDs could be turned off for a prolonged period of time. Obviously the higher CS rate, the lower power consumption and lower pulse rate measurement accuracies. In this paper, a feasibility study of using CS for low power pulse rate detection was conducted. A miniature PPG measurement device based on our body sensor networks platform was employed for signal acquisition. Experiments for evaluation the pulse rate estimation and the power consumption were completed. Results suggested that the Gradient Projection for Sparse Reconstruction (GPSR) algorithm is a highly efficient for retrieving pulse rate from PPG signals. It was suggested that the CS rate should be approximate 3 for low power pulse rate detections with averaging estimation mean-square error being less than 5.

Clear lens phacoemulsification with continuous curvilinear capsulorhexis and foldable intraocular lens implantation for the treatment of a patient with bilateral anterior lenticonus due to Alport syndrome

The case of a 29-year-old man is reported who presented with a gradually progressive, painless decrease in vision over 10 years. Anterior segment examination with a slit lamp revealed anterior lenticonus in both eyes. The patient had previously been diagnosed with bilateral sensorineural deafness, however investigations revealed microscopic haematuria and renal insufficiency that subsequently led to a diagnosis of classical Alport syndrome. Since the patient's quality of vision was severely affected by the bulging anterior lens capsule, surgical treatment was required. Clear lens phacoemulsification with continuous curvilinear capsulorhexis and foldable intraocular lens implantation were performed in each eye 2 days apart. One week after surgery, visual acuity was excellent in both eyes. Clear lens phacoemulsification with continuous curvilinear capsulorhexis and foldable intraocular lens implantation was a safe and effective therapeutic choice in this patient for the management of anterior lenticonus due to Alport syndrome.

Catalytic growth of metallic tungsten whiskers based on the vapor-solid-solid mechanism

Metallic W whiskers with tip diameters of 50-250 nm and lengths of 2-4 µm have been successfully synthesized in large quantities using Co-Ni alloyed catalysts. The relatively low growth temperature of 850 °C and the large catalyst size (over 100 nm) suggest that the growth of the W whiskers must be governed by the vapor-solid-solid mechanism. Our results show that the vapor-solid-solid model is suitable not only for the growth of nano-scaled whiskers with diameters below 100 nm, but also for submicro-scaled whiskers with diameters well above 100 nm. This technique has great potential to synthesize well controlled metallic whiskers.

Posterior fossa dermoid cysts in association with Klippel-Feil syndrome: report of three cases

Although the association of spinal lumbosacral dysraphism and congenital spinal dermoid tumors is well known, the association of craniocervical spinal anomalies and posterior fossa dermoids has only been recognized recently. Advances in imaging technology and awareness of the association likely contribute to an increase in recently reported cases.

A working-side change to lateral tooth guidance increases lateral pterygoid muscle activity

The inferior head of lateral pterygoid (IHLP) is thought to play a critical role in the generation and control of lateral jaw movements.

AIM

The aim was to test the hypothesis that a change to the lateral tooth guidance (working-side occlusal alteration, OA) results in a significant change in the electromyographic (EMG) activity of the IHLP during standardised lateral jaw movements (laterotrusion) tracked by a jaw-tracking system.

METHODS

Ten trials of right laterotrusion were repeated under: control 1 (before occlusal alteration), OA (after occlusal alteration placement), and control 2 (after occlusal alteration removal) conditions in 14 subjects while recording left IHLP, bilateral anterior and posterior temporalis, masseter and submandibular muscles.

RESULTS

IHLP activity was significantly (p<0.05) increased with the occlusal alteration during the outgoing (movement from intercuspal position to approximately 5mm right) and return phases of laterotrusion. The other muscles demonstrated no change or a significant decrease in activity.

CONCLUSIONS

These findings suggest that a change to the occlusion on the working-side in the form of a steeper guidance necessitates an increase in IHLP activity to move the mandible down the steeper guidance. It must be emphasised that these data cannot be used as justification for occlusal therapy.

Activity of inferior head of human lateral pterygoid muscle during standardized lateral jaw movements

OBJECTIVE

(a) To describe the changes in electromyographic (EMG) activity from selected jaw muscles during a standardized lateral jaw movement with the teeth together, and (b) to investigate the effects on jaw muscle activity of changes in both the rate of lateral jaw movement and the relative magnitude of jaw-closing force.

DESIGN

In 16 healthy volunteers, recordings were made using a jaw-tracking system, of mid-incisor point (MIPT) movements, as well as EMG activity from the contralateral inferior head of the lateral pterygoid muscle (IHLP), and bilateral anterior and posterior temporalis, masseter and submandibular muscles, during lateral jaw movement tasks at two speeds and two closing force levels with the teeth together.

RESULTS

The IHLP was the only muscle to show a consistent increase in activity in association with the outgoing phase of the task and a decrease during the return phase. Under high closing force at slow speed, the EMG activities of the IHLP and bilateral anterior temporalis and masseter muscles were significantly (p < 0.05) higher than those under a low closing force, while there was no significant change (p > 0.05) in bilateral posterior temporalis and submandibular muscles. The change from slow to fast lateral movement at low force did not significantly (p > 0.05) alter the mean activity except for the IHLP (increase in activity) and the contralateral anterior temporalis (decrease in activity).

CONCLUSIONS

The data suggest that the IHLP is one of the principal jaw muscles involved in a lateral jaw movement with the teeth together while the other jaw muscles may play a contributory or facilitatory role.

The differential effects of tamoxifen and ICI 182,780 on the reduction of Na+/K+ ATPase activity and spontaneous oscillations by 17beta-estradiol

A prolonged treatment with 17beta-estradiol reduces the frequency of spontaneous oscillations and the Na+/K+ ATPase activity in rat uteri. Acute inhibition of Na+/K+ ATPase activity by a Na+/K+ ATPase inhibitor, ouabain, decreases the frequency of oxytocin-induced oscillations in uteri. Therefore, the purpose of this study was to examine whether the prolonged inhibition of Na+/K+ ATPase activity by 17beta-estradiol was estrogen receptor (ER)-dependent. The uterine explants from ovariectomized rats were cultured in vitro as our experimental model to compare the effect of two antiestrogenic compounds (ICI 182,780 and tamoxifen) on the Na+/K+ ATPase activity and the frequency of spontaneous oscillations. ATPase assay and a standard muscle bath apparatus were to measure the activity and the contraction. When compared with the control, a 2-day treatment with 17beta-estradiol in vivo or in vitro decreased the activity and the frequency. ICI 182,780 lowered the activity but tamoxifen did not. ICI 182,780 did not decrease the frequency but tamoxifen did. Even the reversal effects of these antiestrogenic compounds on the reduced activity and the frequency by 17beta-estradiol were different. Tamoxifen elicited a greater reversal effect on the reduced activity but ICI 182,780 did not. In contrast, ICI 182,780 elicited a greater reversal effect on the reduced frequency but tamoxifen did not. Prolonged inhibition of Na+/K+ ATPase activity by K+-free solution suppressed the frequency with the elevation of basal tension. Addition of KCl at lower concentrations (0.3-1.2 mM) induced oscillatory contraction after reducing the basal tension. As our data suggest, the prolonged effect of 17beta-estradiol may decrease uterine the activity through ER dependent and independent pathways. The reduction of uterine Na+/K+ ATPase activity by estrogens may increase the basal tension after each oscillatory cycle, which, in part, contributes to the reduced frequency of spontaneous oscillations.

The status of diabetes control in Asia--a cross-sectional survey of 24 317 patients with diabetes mellitus in 1998

AIMS

To establish the status of diabetes control in Asia, the Diabcare-Asia 198 study collected data from 230 diabetes centres in Bangladesh, People's Republic of China, India, Indonesia, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand and Vietnam from March to December 1998.

METHODS

Data were obtained either by patient interview during the enrolment visit or by reviewing medical records for the most recent laboratory assessment and clinical examinations. Blood samples were also collected during patients'. visits for central assessments of HbA1c (normal range 4.7-6.4%).

RESULTS

The mean of centrally measured HbA1c was 8.6 +/- 2.0% for 18 211 patients (82% of the analysis population). Of the patients with central HbA1c measurements, the majority (55%) had values exceeding 8%, indicative of poor glycaemic control. The prevalence of retinopathy, microalbuminuria and neuropathy was also higher in the group of patients with higher HbA1c. Based on the findings from central HbA1c measurements and reported local HbA1c assessments, it also appears that more patients with poor glycaemic control did not have access to glycated haemoglobin measurements. Mean HbA1c of thediabetic populations in Bangladesh, Indonesia, Korea, Malaysia and Taiwan were significantly lower (all P = 0.0001, except P = 0.0007 for Malaysia), while that of China, India, Philippines and Vietnam was significantly higher (all P = 0.0001) than the grand mean.

CONCLUSIONS

In our study population of the Asian diabetes patients treated at diabetes centres, more than half were not well controlled. The prevalence of diabetic microvascular complications was higher in the group of patients with higher HbA1c. Further therapeutic actions to improve glycaemic control are required to prevent chronic diabetic complications.

A method of indirect registration of the coordinates of condylar points with a six-degree-of-freedom jaw tracker

Previous studies have indicated that the location of a condylar point can significantly influence its trajectory. The aim of this investigation was to develop a method of registering the location of radiographically defined condylar points in the coordinate system of a six-degree-of-freedom jaw-tracking device and to determine the accuracy of this method by using a perspex model in one experiment and a dry skull in another. A direct measurement ('the gold standard') of condylar point coordinates in the coordinate system of JAWS3D was done using a three-dimensional (3D) digitizer (MicroScribe-3DX). The indirect measurement used a distributed fiducial marker as the interface between the coordinate system of MicroScribe-3DX (which was used to register the fiducial marker and the JAWS3D coordinate system) and the coordinate system of the CT scans (used to define condyle anatomy and the relation with the fiducial marker). The coordinates of condylar points could then be calculated in the coordinate system of JAWS3D. The results showed that the indirect method could register condylar point coordinates on either side to an accuracy of approximately 0.5 mm.

The current state of diabetes management in Taiwan

The aim of this study was to provide an overview of diabetes management and complication status in Taiwan. A cohort of 2446 patients (from 25 diabetic centers) with more than 12 months of diabetes management participated and data were collected by interviews and reviewing the medical records. Overall, 97% were diagnosed as type 2 diabetes, with a mean age (+/-S.D.) of 61.6+/-11.3 years, duration of diabetes of 10.3+/-7.3 years and age at onset of diabetes of 51.5+/-11.8 years. Mean BMI was 25.1+/-3.6 kg/m(2) and about 50% had BMI>25 kg/m(2). Majority (75%) were treated with oral hypoglycemic agents (OHAs), 14% with insulin and 10% with combination of insulin and OHA. Mean HbA(1c) was 8.1+/-1.6% and 59% had HbA(1c) >7.4% (1% above the upper limit of normal range, 4.7-6.4%). Mean FBG was 9.0+/-3.3 mmol/l and 59% had FBG>7.8 mmol/l. Of all the patients who had screening for complications, cataract (38%), neuropathy (30%), proteinuria (17%) and stroke (6%) were the most frequently reported eye, feet, kidney and late complications. We conclude that the majority of patients involved in this study had unsatisfactory glycaemic control which may lead to diabetes complications.

The accuracy with which the human condyle can be expressed in the coordinate system of JAWS3D using a unilateral fiducial marker

Previous studies have indicated that the selection of condylar referencing points can significantly influence condylar point trajectories, and the use of radiographically determined condylar points is essential for accurate representation of condylar movement. The aim of this investigation was to determine the accuracy with which the three-dimensional locations of condylar points could be determined in the coordinate system of the JAWS3D tracking device when an ipsilateral fiducial marker is used. A perspex mandible containing condylar radiographic markers was constructed. A JAWS3D target frame and a fiducial marker, supporting radiographic markers, were secured to the perspex mandible. The image data from computer tomography scans of the condyles and fiducial marker, together with photographs of the fiducial marker and the JAWS3D target frame were used to calculate condylar point coordinates in the JAWS3D coordinate system. These data were then compared with the data obtained by direct measurement of the condylar radiographic markers in the JAWS3D coordinates. The results suggest that a unilateral fiducial marker is sufficient to allow the registration of ipsilateral condylar point coordinates to an accuracy of approximately 1.0 mm.

[Characteristics of an established cervical carcinoma cell line HCE1]

This paper deals with a new cell line established from 5 carcinoma specimens of hysterectomy and designated as HCE1. This cell line has been passaged more than 80 times(more than 18 months). It has the characteristics: 1. The pathological features of the tumor transplanted in nude mice were similar to that of the original inoculated lesion; 2. Electromicroscopically, there were rich microvilli on the surface of the cells. Abundant ribosomes were also observed; 3. The growth curves of the 25th passage were determined, the population doubline time calculated in the log phase of growth was 45.8 h; 4. The cloning efficiency in soft agar averaged 14.8% after counting 6 plates; 5. Karyo-type analysis showed aneuploidy with the modal chromosomal number 64-97.

Impact of depressive symptoms on hospitalization risk in community-dwelling older persons

OBJECTIVE

To determine whether depressive symptoms in older adults are associated with an increased risk for hospitalization.

DESIGN

A 6 month cohort study.

SETTING

Five counties in the northern Piedmont of North Carolina from the Duke University site of the Established Populations for Epidemiological Studies of the Elderly project.

PARTICIPANTS

The sample included 3486 community-dwelling adults, aged 65 and older.

MEASUREMENTS

Crude risk ratios for the effect of depressive symptoms on 6 month risk for hospitalization were calculated, followed by a multivariable analysis controlling for demographics and health status.

RESULTS

Three hundred participants were hospitalized during the 6 month follow-up period. The crude risk ratio for the effect of depressive symptoms on hospitalization was 1.95 (95% CI = 1.47-2.58). Subgroup analysis showed significant positive risk ratios for men aged 65 to 74 and > or =75, and women aged 65 to 74. After a multivariable analysis, however, these associations remained significant only among men > or =75 (RR = 3.43; 95% CI = 1.33-8.86).

CONCLUSIONS

Depressive symptoms were independently associated with a more than threefold increased risk for hospitalization among men aged > or =75. This result reflects differences in the effects of depressive symptoms across age and gender groups, and emphasizes that symptoms of depression influence overall health and medical utilization among, at the very least, the oldest subset of men.

Factors related to the survival of papillary and follicular thyroid carcinoma patients with distant metastases

There is limited clinical information comparing presentations and results of treatment of papillary and follicular thyroid carcinoma patients with distant metastases. We retrospectively analyzed data of 1,257 thyroid cancer patients who received their treatment and follow-up at Chang Gung Memorial Hospital. We found 992 patients with papillary carcinoma and 205 patients with follicular thyroid carcinoma. Of these, 68 patients with papillary thyroid carcinoma (6.9%) had distant metastases at the time of diagnosis or during the follow-up period. Of the follicular thyroid carcinoma patients, 69 (33.7%) had distant metastases. Of the 68 patients with papillary carcinoma, only 33 were categorized as stage IV at the time of diagnosis. Nine of the patients were categorized as clinical stage I carcinoma, 10 as stage II, and 16 as stage III. Sixteen patients (23.5%) died during the study period, all but 2 of thyroid cancer. Twelve of the 68 patients were disease-free after treatment. Of the 69 patients with follicular thyroid carcinoma, 58 were categorized as stage IV at the time of diagnosis. Six of the patients were categorized as clinical stage I carcinoma, 2 as stage II, and 3 as stage III at the time of diagnosis; all of these patients deteriorated to stage IV during the follow-up period. Of the 42 patients with follicular thyroid carcinoma involving bone, 24 presented with bone metastases during the initial diagnosis. After treatment, 25 of 69 patients with follicular carcinoma died of follicular carcinoma. Only 3 patients were disease-free after the treatment. In patients with follicular carcinoma, only tumor size was an important prognostic factor. In this study, 8 patients categorized as clinical stages I to III at the time of operation had thyroglobulin (Tg) levels less than 5 ng/mL and developed distant metastases during the follow-up period. In conclusion, at diagnosis a large group of Asian patients with metastatic well-differentiated thyroid cancer was more likely to have follicular than papillary histology, and that, as expected, metastases from follicular cancer were present earlier and more frequently, were more likely to involve bone, were more likely to be associated with mortality, and were linked to tumor size but not gender. Also unlike some other reports, treatment producing a low Tg did not always produce a good outcome. More aggressive surgical procedures may be able to improve outcomes.

Diagnosis and management of 34 Hürthle cell tumors

BACKGROUND

Controversies still exist around the diagnosis and management of Hürthle cell tumors. The aim of this study is to reexamine our experience to improve our methods in the future.

METHODS

We treated 34 patients with verified Hürthle cell carcinoma and adenoma at Chang Gung Memorial Hospital, Linkou from 1990 through 1996. Clinical characteristics, thyroid ultrasonogram, 131I, 201Tl, 99mTc-methoxy-isobutyl-isonitrile (MIBI) and 99mTc-thyroid scan, fine needle aspiration cytology (FNAC) and histology results were analyzed.

RESULTS

Female predominance (82.4%) was noticed among our Hürthle cell tumors. Nine (26.5%) patients had carcinoma. The median size of carcinoma was 4.0 cm, which was significantly larger than the median 3.0 cm for adenoma. No significant differences were found between gender, age, multiplicity or echogenicity between two groups. All 12 adenoma and 3 carcinoma patients who received pre-operative 99mTc and/or 131I thyroid scan showed cold nodules. The sensitivity and specificity of detection Hürthle cell carcinoma as indeterminate and malignant using FNAC was 78% and 18% respectively. These improved to 100% and 86% using frozen sections. One carcinoma patient developed neck lymph node metastasis, with normal serum thyroglobulin, negative 131I but positive 201Tl and 99mTc-MIBI whole body scans. Another one showed mediastinum metastasis with elevated serum thyroglobulin, detected using 131I scan, revealed successful regression after 131I therapeutic scan.

CONCLUSION

Tumor size of carcinoma is significantly larger than adenoma. All patients with FNAC suggestive of Hürthle cell tumors should receive surgery for histological diagnosis to differentiate carcinoma from adenoma. Therapeutic radioiodine ablation is indicated whenever there is 131I uptake by tumor cells.

Melioidosis with adrenal gland abscess

We report a case of melioidosis with left adrenal gland abscess in a 51-year-old man from Taiwan who traveled to Rangoon, Burma for a four-day tour on July 15, 1997. The patient developed fever and left upper abdominal pain upon returning to Taiwan on July 19, 1997. Ten days after returning to Taiwan, he was admitted to Chang Gung Memorial Hospital in Keelung, Taiwan and blood culture on admission was positive for Burkholderia pseudomallei. Computerized tomography of the abdomen revealed left adrenal gland swelling and suppuration. Treatment with parenteral ceftazidime and cotrimoxazole for three weeks followed by two months of oral cotrimoxazole cured the infection. The patient remained asymptomatic at 12 months follow-up.

Prevalence and significance of thyroid autoantibodies in patients with chronic hepatitis C virus infection: a prospective controlled study

OBJECTIVE

To clarify controversies on the prevalence and clinical significance of thyroid autoimmunity in hepatitis C virus (HCV) infection.

DESIGN

A prospective controlled and follow-up study.

PATIENTS AND MEASUREMENTS

Serum thyroid microsomal antibody (TMA) and thyroid stimulating hormone were assayed and compared in a consecutive, unselected series of 130 patients with chronic HCV infection, 130 sex/age (+/- 2 years)-matched patients with chronic hepatitis B virus (HBV) infection and 260 matched normal controls.

RESULTS

The prevalence of thyroid autoantibodies in male patients with chronic HCV was < 2%. The prevalence of TMA (< 1:400) in female patients with chronic HCV infection was significantly higher than that of HBV controls (22.1 vs. 1.6%; P < 0.001), and higher but not significant compared with normal controls (13.5%). However, the trend of increasing prevalence with age in normal controls was not observed in HCV patients. TMA seropositive female HCV patients were not different from seronegative counterparts in age, duration of infection, HLA haplotype, associated autoantibodies and liver histology but had a significantly higher prevalence of genotype 1b/2b mixed infection (P < 0.01) and anti-GOR (P < 0.05). Of the 23 HCV patients seropositive for thyroid autoantibodies, seven had Hashimoto's thyroiditis, two had Graves' disease and three had received subtotal thyroidectomy. During follow-up, four of 15 female patients showed a 14-16-fold increase in TMA titre and one developed hyperthyroidism. Patients with thyroid autoantibodies did not show a propensity to develop thyroid dysfunction during interferon therapy.

CONCLUSIONS

These results suggest a weak association between HCV and thyroid autoimmunity in females. As in the ordinary population with thyroid autoantibodies, they should be evaluated for thyroid status and be followed-up if thyroid autoimmunity is evident. However, seropositivity of thyroid autoantibodies is not a contraindication to interferon therapy.

Comparison of the results of diagnosis and treatment between solid and cystic well-differentiated thyroid carcinomas

We assessed the accuracy of ultrasonography and fine-needle aspiration cytology (FNAC) in diagnosing cystic thyroid cancer and compared the results with solid thyroid cancer patients. We also compared the results of treatment between these patient groups. We retrospectively reviewed 1013 thyroid cancer patients who received treatment at Chang Gung Memorial Hospital. For this study, 910 cases of papillary or follicular thyroid carcinomas were considered eligible. Of these, 682 patients received preoperative high-resolution ultrasonographic and FNAC examinations. The nodules of 583 (85.5%) patients were diagnosed as solid masses, 80 (11.7%) as mixed masses, and 19 (2.8%) as cystic masses. Of the 19 patients with cystic thyroid carcinoma, only 4 papillary thyroid carcinomas were diagnosed by ultrasonography with FNAC as malignant before operation. Six patients presented as occult thyroid carcinomas with the tumor size less than 1 cm. Despite the low rate of accurate diagnosis for the cystic malignancy, clinical staging and the survival rates were not statistically different when they were compared with the other groups. In conclusion, low diagnostic rates were observed in well-differentiated thyroid cancer with prospective ultrasound-guided FNA when lesions were cystic or in mixed lesions. If the solid portion of the cystic masses is aspirated under ultrasound-guided FNA and cytology is performed after the centrifugation of the aspirated fluid, diagnostic accuracy may be improved.

Correlation of fine needle aspiration cytology and frozen section biopsies in the diagnosis of thyroid nodules

AIMS

To evaluate the correlation of fine needle aspiration (FNA) cytology and frozen section biopsy in the diagnosis of thyroid nodules.

METHODS

The medical records of 662 patients who underwent FNA cytology of the thyroid and thyroid surgery were analysed. Frozen section biopsies were taken from 586 of the 662 patients. The diagnostic correlations of FNA cytology, frozen section, and both FNA cytology and frozen section with definitive histological assessment were evaluated.

RESULTS

Among the 662 patients who received FNA cytology, there were 356 cases (53.8%) diagnosed as benign, 114 cases (17.2%) as malignant, 148 cases (22.4%) as indeterminate, and 44 cases (6.6%) as unsatisfactory. The positive predictive value for the detection of malignancy by FNA cytology was 92.1% and the negative predictive value was 95.2%. The incidence of malignancy in the indeterminate cytological diagnosis was 23%. The diagnosis from frozen sections was benign in 445 cases (75.9%), malignant in 134 cases (22.9%), and deferred in 7 cases (1.2%). By frozen section, the positive and negative predictive values were 97% and 95.5%, respectively. Diagnostic accuracy up to 98% was achieved when FNA cytology and frozen section diagnoses were in agreement. No false positives were observed when FNA cytology and frozen sections were both positive for malignancy. When FNA cytology and frozen section diagnoses were discordant, frozen section showed a higher accuracy (78.9%) than FNA cytology (21.1%). In the face of an indeterminate or unsatisfactory cytological diagnosis, the diagnostic accuracy of frozen sections reached 92.6%.

CONCLUSIONS

The results confirm that FNA cytology is a useful tool in the initial evaluation of thyroid nodules. Intraoperative frozen section is a valuable procedure to confirm the cytological diagnosis and identify malignancy in patients with indeterminate or unsatisfactory cytological diagnosis. With reliance on frozen sections as an intraoperative guide of thyroid surgery, the possibility of unnecessary extensive surgery and the need for the second operation are considerably lower.

Diagnosis of occult thyroid carcinoma by thyroid ultrasonography with fine needle aspiration cytology

OBJECTIVE

To assess the role of ultrasonography and fine needle aspiration cytology (FNAC) in preoperative diagnosis of patients with occult thyroid carcinoma (OTC).

STUDY DESIGN

Data on 768 thyroid carcinoma patients receiving primary treatment at Chang Gung Medical Center were retrospectively reviewed. Of these patients, 97 had OTC. To detect small thyroid nodules early and define the characteristics of clinically palpable nodules, thyroid ultrasonography with FNAC were performed on 67 histopathologically proven OTC patients. Analysis for diagnostic value was done for ultrasonography and FNAC.

RESULTS

In the 67 patients receiving ultrasonography with FNAC, 23 were preoperatively diagnosed as having papillary thyroid carcinoma and 1 as having follicular carcinoma. The tumor size of these 24 preoperative FNAC-proven OTC was 0.81 +/- 0.23 cm (mean +/- SD). In the remaining patients, 10 presented pictures suspicious for malignancy, with a mean tumor size 0.63 +/- 0.24 cm, and 33 (49.3%) were diagnosed as having benign thyroid lesions in preoperative FNAC. The tumor size in these 33 lesions was 0.58 +/- 0.24 cm. Fifty-seven of the 67 OTC patients received frozen sections. Thirty-eight papillary thyroid carcinomas and four follicular carcinomas were correctly diagnosed on frozen sections.

CONCLUSION

Although the rate is not high, high-resolution ultrasonography and FNAC is the best approach to preoperative diagnosis for OTC patients today.

Thyroid follicular neoplasms diagnosed by high-resolution ultrasonography with fine needle aspiration cytology

OBJECTIVE

To investigate the final results of cases with preoperative diagnoses of thyroid follicular neoplasms by fine needle aspiration cytology (FNAC).

STUDY DESIGN

A retrospective review of 6,499 patients who received thyroid ultrasonography with FNAC at Chang Gung Memorial Hospital. Among 6,499 patients, 209 (3.2%) were diagnosed by FNAC as having follicular neoplasms, of which 84 received surgical treatment. Eighty-two of the 84 cases had a frozen section prepared during the operation.

RESULTS

Thyroid malignancy was confirmed histopathologically in 164 cases. Among 84 thyroid follicular neoplasm patients, 21 cases were diagnosed as malignant tumors, including papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma and Hürthle's cell carcinoma. Ultrasonography on these 21 patients revealed that 16 cases (76.2%) had low echo density in the thyroid nodule. The percentage was statistically significantly different from that in benign cases, 23.8% (P < .05). A higher incidence of malignancy was found in males, but the data did not reach statistical significance (P = .0586).

CONCLUSION

Most of the follicular neoplasms revealed by FNAC were benign lesions. Low echo density on ultrasonography and male sex carried a higher risk of malignancy.

Thyroid ultrasonography with fine-needle aspiration cytology for the diagnosis of thyroid cancer

This series retrospectively reviewed 3657 patients who received thyroid ultrasonography with fine-needle aspiration cytological (FNAC) examinations at Chang Gung Memorial Hospital during the period from January 1, 1993 to December 31, 1993. Thyroid ultrasonography studies were performed using a real-time ultrasonographic machine with a 10 MHz transducer. The aspirates were air dried and stained by the Romanowsky-based Liu method. Three hundred seventy-eight cases (10.3%) received surgical treatment after the ultrasonographic and FNAC examinations. Benign lesions were diagnosed in 269 patients. Thyroid malignancy was confirmed histopathologically in 109 cases including 76 papillary thyroid carcinomas, 17 follicular carcinomas, 5 medullary thyroid carcinomas, 3 anaplastic carcinomas, 3 Hürthle cell carcinomas, and 3 lymphomas. Another 2 cases were metastatic cancer to thyroid. The results demonstrated that 28.8% of the surgically treated patients had histopathologically proven malignancies. The incidence of thyroid malignancy was 2.98% in this study. The sensitivity of the cytological diagnosis was 79.80% and the specificity was 98.66%. The positive predictive value was 96.34%. Negative predictive value was 91.70%. The false negative index was 20.20%. The diagnostic accuracy was 92.89%. Thyroid ultrasonography with the FNAC can provide high specificity and sensitivity in differentiating malignant lesions from benign.

The accuracy of ultrasonography and 201Tl-99mTc subtraction scan in localization of parathyroid lesions

We reviewed 27 patients who received preoperative localization using both parathyroid ultrasonography and parathyroid 201Tl-99mTc subtraction (TTS) scan from March 1986 to July 1993 in Chang Gung Memorial Hospital, Linkou. These 27 patients were diagnosed hyperparathyroidism by the pathological reports. There were 16 patients with primary hyperparathyroidism [PHPT; 9 males, 7 females; (mean age: 56.3 +/- 4.6 yrs)] and 11 patients with secondary hyperparathyroidism [SHPT; 8 males, 3 females; (mean age: 38.3 +/- 2.5 yrs)] due to end stage renal disease. The diagnostic accuracy was compared, and the results were as follow: (1) in localization of PHPT, the sensitivity and specificity of ultrasonography were 75.0% and 95.8% respectively, whereas the sensitivity and specificity of TTS were 87.5% and 100.0% respectively. The differences were not statistically significant; (2) the sensitivity and specificity of ultrasonography and TTS for patients with SHPT were 32.4% and 85.7% vs. 32.4% and 100.0%; and (3) higher sensitivity and specificity were achieved when both methods were chosen for localizing either PHPT or SHPT.

Clinical experience of medullary thyroid carcinoma in Chang Gung Memorial Hospital

Total 19 cases of medullary thyroid carcinoma (MTC) diagnosed at Chang Gung Memorial Hospital from Jan. 1979 to Dec. 1994 were studied retrospectively. All of them were pathologically proved. All cases except one were thought as sporadic MTC. The gender distribution showed a female preference with female : male (F:M) ratio of 3.8:1. The mean age at diagnosis was 44.9 +/- 13.7 years. The most common clinical presentation was thyroid mass in all (100%). The staging of MTC in our cases demonstrated: 12 (63%) stage I, 1 (5%) stage II, 3 (16%) stage III, and 3 (16%) stage IV. Thyroid ultrasonography with fine-needle aspiration cytology (FNAC) were performed in 15 patients. Eleven cases were diagnosed as malignancy, including 5 cases diagnosed as MTC preoperatively. Neck nodal metastases were noted in 7 cases and all occurred in tumors larger than 3 cm. All cases received operation according to clinical stage. Six of 7 patients who had preoperative calcitonin data showed abnormal high values. After operation, there were 8 patients with persistent hypercalcitoninemia. Of these, 5 received 131I therapy which induced undetectable calcitonin level in 2 stage I patients. Three cases received external beam radiotherapy but all failed. During a period of 0.5 to 9.4 years follow-up (mean +/- SE: 3.6 +/- 0.7 years), 3 patients died of pulmonary infection, 1 lost follow-up and 15 patients are alive and well. In conclusion, the preliminary data suggests that the medullary thyroid carcinoma in Taiwan has following characteristics: (1) gender distribution showed a female preference; (2) accuracy of preoperative FNAC was 42%; (3) most of the diagnoses of MTC were made postoperatively.

Identification of malnutrition-related diabetes mellitus among hospitalized patients in Taiwan

A retrospective review of 1,089 diabetes mellitus admitted to the metabolic ward of Chang Gung Memorial Hospital was performed to screen for malnutrition-related diabetes mellitus (MRDM). None of the patients fulfilled the MRDM criteria, although 20 patients with a body mass index < or = 15 kg/m2 were further analyzed. These patients presented with poor glycemic control and most had associated chronic diseases. C-peptide levels were < 0.8 ng/mL in 17 patients and undetectable in six patients. Two patients experienced diabetic ketoacidosis (DKA). Insulin treatment was required by 18 patients with a mean (+/- SD) dosage of 30 +/- 9 U/day. During follow-up of 14 of the patients for 9.8 +/- 4.3 months, HbA1c decreased significantly. Their mean body weight and body mass index increased significantly from 36.6 +/- 4.6 kg to 47.2 +/- 6.2 kg and 13.9 +/- 0.9 to 18.0 +/- 1.9 kg/m2, respectively. Careful attention should be paid to diabetic control and associated chronic illness in patients with severe undernutrition.

Comparison of the outcome between the calculated dosimetry and the estimated dosimetry of 131I in the treatment of hyperthyroidism

To compare the outcomes of different methods in prescribing the optimal dose of radioactive iodine (131I) for the treatment of hyperthyroidism, we retrospectively analyzed 52 patients with toxic diffuse goiter. They received single dose of 131I for the treatment of hyperthyroidism. In addition, all of them met the following criteria: 1) symptoms and signs of hyperthyroidism; 2) elevated blood triiodothyronine (T3) and thyroxin (T4) by radioimmunoassay (RIA) method; 3) diffuse goiter with increase of uptake proved by thyroid scintiscan; 4) only one dose of 131I was given during the follow-up period; 5) well-documented thyroid function test in the medical chart during the follow-up period (6 months, 1 year, 2 years and 5 years after 131I therapy). The enrolled patients were divided into estimated and calculated group. The dose of 131I in the calculated group was obtained from the measurement of size and 131I uptake of thyroid gland. The dose of 131I in the estimated group was prescribed according to the size of thyroid gland by physical examination, and the association with cardiac arrhythmia, congestive heart failure, or ischemic heart disease. The mean doses of 131I were 4.8 +/- 1.4 mCi and 7.0 +/- 1.1 mCi in the calculated and estimated group respectively. In this study, there were no significant difference in the incidence of euthyroidism, hyperthyroidism, and hypothyroidism between these two groups in thefollow-up period after 131I therapy. In view of simplicity and time-saving, it is a practical choice to prescribe the dose of 131I therapy for toxic diffuse goiter according to the size of thyroid gland and the associated cardiac condition.

Thyroid cancer treated in Chang Gung Memorial Hospital (northern Taiwan) during the period 1979-1992: clinical presentation, pathological finding, analysis of prognostic variables, and results of treatment

This study is a retrospective analysis of 248 thyroid cancer patients who received their primary treatment in the Chang Gung Memorial Hospital during the period January 1979 to December 1992. Among these cases, there were 173 papillary thyroid cancers (69.8%), 52 cases of follicular thyroid cancer (21%), 7 cases of medullary thyroid cancer (2.8%), and 16 cases of anaplastic thyroid cancer (6.5%). The subjects included 184 female patients with a mean age of 40.7 +/- 14.3 years and 64 males patients with a mean age of 49.2 +/- 14.3 years. Most of the cases had a nearly total thyroidectomy after the diagnosis was confirmed by frozen section during the operation. During the follow-up period, 19 (8.2%) patients diagnosed with well-differentiated thyroid cancer died of thyroid cancer in contrast to 12 patients (75%) with anaplastic thyroid cancer. The 1-year Greenwood survival probabilities after the disease is diagnosed in papillary, follicular, and anaplastic thyroid cancer are 0.98, 0.86, and 0.25, respectively. For the analysis of prognostic variables in well-differentiated thyroid cancer patients, 16 factors were entered for univariate and multivariate analysis. Using a log-rank univariate analysis, survival was significantly associated with the cell type of the primary tumor, age, clinical staging, postoperative 131I pattern, tumor size, postoperative thyroglobulin (Tg) level and postoperative x-ray results. In the Cox multivariate regression analysis the combination factors that gave the best prognostic value were the association of x-ray finding (P = .004), age (P = .017), and Tg level (P = 0.19). In conclusion, thyroid cancer is not an unusual disease in Taiwan. As previously reported anaplastic thyroid cancer has a poor prognosis. In this limited period of follow-up study, the patients' age with postoperative first positive x-ray finding and Tg level may provide the prognostic factors for patients with well-differentiated thyroid cancer.

Insulinoma--clinical experience in ten cases

During the period between January 1981 and December 1992, a total of ten patients with pathologically confirmed insulinoma were studied. All patients presented with variable degrees of neuroglycopenic symptoms and Whipple's triad. The ratio of insulin to glucose after an overnight fast was greater than 0.3 in 90% (9/10) of patients. Eight patients who received supervised fasting developed neuroglycopenia with relative hyperinsulinemia within 48 hours of fasting. Four of 8 patients developed hypoglycemia during a 5-hour oral glucose tolerance test (OGTT). Calcium infusion test was more sensitive in patients with an initially higher plasma glucose. The detection rates of various localization studies were 12.5% (1/8) by abdominal ultrasonography, 37.5% (3/8) by abdominal CT scan, 50% (5/10) by selective superior mesenteric and celiac arteriography. Transhepatic portal venous sampling (THPVS) detected insulinomas in 4 of 4 cases. Endoscopic ultrasonography and intraoperative ultrasonography were performed on 1 and 2 cases respectively, and were able to localize the lesions successfully. All patients received surgical treatment including enucleation (n = 2), subtotal pancreatectomy (n = 3) and distal pancreatectomy (n = 5). All patients had single tumors which were all benign islet cell adenomas. The mean size of the tumors was 15.5 +/- 2.0 mm in diameter (range: 8 to 30 mm) and mainly located in the body (50%) and tail (40%), only 1 in the pancreatic head. All symptoms of hypoglycemia subsided after operation. Hyperglycemia was observed in all patients immediately after operation, and most of them resumed normoglycemia within 8 days. However, the 2 patients who had impaired OGTT preoperatively had persistent hyperglycemia after operation and therefore were diagnosed as having diabetes (NIDDM).

Value of serum alkaline phosphatase in evaluating hyperplasia of parathyroid glands in chronic hemodialysis patients

To investigate the value of serum alkaline phosphatase in evaluating hyperplasia of parathyroid glands in hemodialysis patients, 28 hemodialysis patients who had parathyroid sonography examinations for secondary hyperparathyroidism were studied retrospectively. There were significant elevations of serum alkaline phosphatase, parathyroid hormone (PTH), serum total calcium, and dialysis duration in patients with sonography-detectable parathyroid (N = 17) as compared with those of sonography-undetectable (N = 11) parathyroid. Hemodialysis patients who have both higher serum alkaline phosphatase (> 94 IU/L) and considerably elevated serum PTH (9 x or higher) are likely to have sonography-detectable parathyroids (positive predictive value of 93%). Patients with mildly or moderately elevated serum PTH but normal serum alkaline phosphatase are less likely to have sonography-detectable parathyroids (negative predictive value is 100%). These findings suggest that the elevation of serum alkaline phosphatase could be a valuable parameter in addition to the high serum PTH level in predicting hyperplasia of parathyroid glands in chronic hemodialysis patients.

Effect of gliclazide on plasma lipids and pancreatic beta cell function in non-insulin-dependent diabetes mellitus

Eighteen patients with non-insulin-dependent diabetes mellitus (NIDDM), who were newly diagnosed or had their oral hypoglycemic agents discontinued for more than 3 months, were studied to evaluate the effect of gliclazide on glycemic control, plasma lipids and beta cell function. The mean fasting plasma glucose (249 +/- 11 vs 170 +/- 10 mg/dl, p < 0.001), postprandial plasma glucose (353 +/- 16 vs 237 +/- 16 mg/dl, p < 0.001) and HbA1C (9.6 +/- 0.4 vs 6.5 +/- 0.3% p < 0.001) decreased significantly after 3-months of gliclazide treatment. The beta cell function showed a significant increase in fasting serum C-peptide (1.8 +/- 0.2 vs 2.1 +/- 0.3 ng/ml, p < 0.05) and an insignificant increment in serum C-peptide after glucagon stimulation (2.2 +/- 0.3 vs 2.2 +/- 0.4 ng/ml, p < 0.1). In 8 cases with an initial serum cholesterol above 200 mg/dl, the serum cholesterol decreased significantly (236 +/- 8 vs 200 +/- 12 mg/dl, p < 0.05). However, LDL-cholesterol (164 +/- 8 vs 145 +/- 13 mg, p > 0.05) and HDL-cholesterol (66 +/- 5 vs 54 +/- 9 mg, p > 0.05) showed insignificant decrease after gliclazide therapy. In 4 patients with hypertriglyceridemia, the serum triglyceride decreased (441 +/- 161 vs 239 +/- 73 mg/dl, p > 0.1), but this was not statistically significant. These findings suggest that hyperglycemia, fasting serum C-peptide levels and hypercholesteremia are significantly improved after a 3-month period of gliclazide therapy in NIDDM patients.

The skin, tongue, and brain as favorable organs for hog cholera diagnosis by immunofluorescence

Hog cholera virus antigens were found densely distributed in skin and tongue of pigs experimentally infected with hog cholera virus. The finding described here warrants the usage of ear biopsies for hog cholera diagnosis on a herd basis.

Ultrasonography and fine needle aspiration cytology of acute suppurative thyroiditis

Although acute suppurative thyroiditis is a rare disorder, from January. 1985 to December 1991, we observed 11 cases of acute suppurative thyroiditis in our hospital. All patients underwent thyroid ultrasonography and fine needle aspiration biopsy and cytologic evaluation of the specimens. In eight cases, pus cultures were positive, four of them grew Gram negative bacteria. Ultrasonographic finding showed either local or diffuse low to a very low echo density on both lobes. However, a cystic lesion was also found. Polymorphonuclear cells were the main elements in the smears from the thyroid aspirates. In conclusion, thyroid ultrasound with fine needle aspiration and cytology can assist in confirming the early diagnosis of acute suppurative thyroiditis.

[Pituitary apoplexy: a study of eighteen cases]

Pituitary Apoplexy is a rare but sometimes life threatening condition which requires prompt recognition and timely medical intervention to avoid catastrophic consequences. From January 1979 to June 1989 and total of one hundred and ninety eight pituitary tumor patients were operated on our hospital. Eighteen cases (9.1%) were diagnosed "pituitary apoplexy" according to histopathological findings. The group consisted of twelve men and six women ranging in age from twenty two to sixty one years with a mean of forty. There were three cases of prolactin-secreting adenomas (16.7%), four growth-hormone secreting adenomas (22.2%), and eleven nonfunctional adenomas (61.1%) with an incidence of 6.1%, 8.3%, and 11.4% respectively (P > 0.05). Clinical manifestation occurred acutely in 66.7% and nonacutely in 33.3%. The patients presented with headaches (100%), visual impairment (83.3%), visual field defects (66%), disturbed consciousness (22%), fever and meningismus (11%). Radiological examinations able to demonstrate abnormalities included plain skull films (84%), computed tomography (84.6%), and angiography (93.8%). Various investigations of endocrine function pre and post operatively showed a deficient gonad axis (53%, 62.5%), adrenal axis (26.7%, 56.2%), and thyroid axis (20%, 43.8%). Sixteen cases received a transsphenoid operation and three cases underwent a transfrontal craniotomy. No case of mortality was reported. Postoperative radiotherapy was given to nine cases and nine cases were followed up on a regular basis. Therefore, our retrospective study suggests that pituitary apoplexy is not uncommon and has an acute clinical presentation. No particular tumor type was prone to occur. Various radiological examinations could define perisellar abnormalities. With a decreasing order of hormone deficiency, gonad, adrenal and thyroid axis were observed during the course of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Low dose radioiodine treatment of papillary thyroid carcinoma in a child--a case report]

The thyroid carcinoma is rare in children and the optimal management is rather controversial. We report a case of a 7-year-old boy who had right neck masses and proved to be papillary thyroid carcinoma after near-total thyroidectomy. Post-operative 20 mCi radioiodine-131 (I-131) ablation scan, lung metastasis was suspected but the chest X ray was normal. After being lost to follow up for 4 years, the patient returned with the complaints of cough; the chest X ray was still normal. He then received 5 treatment with low dose (30 mCi) I-131 therapy and continued thyroxine replacement. Progressive decrease both of the thyroglobulin level and the intensity of radioactivity of lung were noted. After a total doses of 193 mCi I-131 therapy, neither pulmonary fibrosis nor bone marrow suppression was seen. Although the low dose (< or = 30 mCi) I-131 therapy was recommended, it was limited for the ablation therapy of the remnant thyroid tissue. Upon consideration of economics and the convenience of not being admitted to the isolation room, the low dose I-131 therapy seems feasible for children with thyroid carcinoma with systemic disease. However, the long term efficacy needs further evaluation.

Apolipoprotein levels in normolipidemic non-insulin-dependent diabetes mellitus

The purpose of this study was to examine the change in apolipoprotein and lipoprotein levels in patients with normolipidemic untreated non-insulin-dependent diabetes mellitus (NIDDM). Fifteen untreated, non-obese male NIDDM patients without hyperlipidemia were chosen, and 15 healthy subjects, matched for age, sex, body weight, alcohol consumption and cigarette smoking served as the control group. We observed that the concentrations of plasma total cholesterol (TC), triacylglycerol (TG) and very low density lipoprotein cholesterol (VLDL-C) were identical in both NIDDM and control groups. The levels of low-density lipoprotein cholesterol (LDL-C) were slightly increased in the diabetic group, but the difference did not reach statistical significance in our study. High-density lipoprotein cholesterol (HDL-C) was lower in the NIDDM group than in the controls. Significantly increased TC/HDL-C and LDL-C/HDL-C ratios were found in NIDDM patients compared with controls. The apolipoprotein A-I (apo A-I) and apolipoprotein A-II (apo A-II) levels were decreased in NIDDM patients, while the apolipoprotein B (apo B) level remained similar to that of the control subjects. The ratio of apo A-I/apo B was decreased significantly in the NIDDM group. Our results suggest that NIDDM patients are at higher risk of coronary heart disease, even if they remain normolipidemic.