Large magnetoresistance and quantum oscillations in Sn0.05Pb0.95Te

We have synthesized high-quality single crystals of Sn_xPb_1-xTe and carried out detailed studies of the magnetotransport properties of one of the samples, Sn_0.05Pb_0.95Te. Longitudinal magnetoresistance increases almost linearly with increasing applied field (H) and reaches ∼310% atH= 13 T. At higher fields, both longitudinal and Hall resistance show clear Shubnikov de Haas oscillations. The oscillations are smooth and periodic, and there exists only one frequency,f_α∼ 57 T. However, an additional frequency,f_β∼ 69 T, appears as the angle between the field direction and the normal to the sample surface (θ) is increased. Bothf_αandf_βexhibitθ-dependence;f_αdecreases whereasf_βincreases gradually with increasingθ. The presence of two frequencies in Sn_0.05Pb_0.95Te indicates that there exist two Fermi surface pockets (αandβpockets). We have constructed the Landau-level fan plot and determined the Berry phase (δ) for theαpocket to beδ∼ 0.1. Thisδvalue is very close to the expected value of 0 for a topologically trivial system.

Low-temperature microstructural studies on superconducting CaFe2As2

Undoped CaFe₂As₂ (Ca122) can be stabilized in two slightly different non-superconducting tetragonal phases, PI and PII, through thermal treatments. Upon proper annealing, superconductivity with a T_c up to 25 K emerges in the samples with an admixture of PI and PII phases. Systematic low-temperature X-ray diffraction studies were conducted on undoped Ca122 samples annealed at 350 °C over different time periods. In addition to the diffraction peaks associated with the single-phase aggregation of PI and PII, a broad intermediate peak that shifts with annealing time was observed in the superconducting samples only. Our simulation of phase distribution suggests that the extra peak is associated with the admixture of PI and PII on the nanometer scale. High-resolution transmission electron microscopy confirms the existence of these nano-scale phase admixtures in the superconducting samples. These experimental results and simulation analyses lend further support for our conclusion that interfacial inducement is the most reasonable explanation for the emergence of superconductivity in undoped Ca122 single crystals.

Thioridazine Enhances P62-Mediated Autophagy and Apoptosis Through Wnt/β-Catenin Signaling Pathway in Glioma Cells

Thioridazine (THD) is a common phenothiazine antipsychotic drug reported to suppress growth in several types of cancer cells. We previously showed that THD acts as an antiglioblastoma and anticancer stem-like cell agent. However, the signaling pathway underlying autophagy and apoptosis induction remains unclear. THD treatment significantly induced autophagy with upregulated AMPK activity and engendered cell death with increased sub-G1 in glioblastoma multiform (GBM) cell lines. Notably, through whole gene expression screening with THD treatment, frizzled (Fzd) proteins, a family of G-protein-coupled receptors, were found, suggesting the participation of Wnt/β-catenin signaling. After THD treatment, Fzd-1 and GSK3β-S9 phosphorylation (inactivated form) was reduced to promote β-catenin degradation, which attenuated P62 inhibition. The autophagy marker LC3-II markedly increased when P62 was released from β-catenin inhibition. Additionally, the P62-dependent caspase-8 activation that induced P53-independent apoptosis was confirmed by inhibiting T-cell factor/β-catenin and autophagy flux. Moreover, treatment with THD combined with temozolomide (TMZ) engendered increased LC3-II expression and caspase-3 activity, indicating promising drug synergism. In conclusion, THD induces autophagy in GBM cells by not only upregulating AMPK activity, but also enhancing P62-mediated autophagy and apoptosis through Wnt/β-catenin signaling. Therefore, THD is a potential alternative therapeutic agent for drug repositioning in GBM.

GSK3β‑mediated Ser156 phosphorylation modulates a BH3‑like domain in BCL2L12 during TMZ‑induced apoptosis and autophagy in glioma cells

BH3 domains, classified initially as BCL2 homology domains, participate in both apoptosis and autophagy. Beclin-1 contains a BH3 domain, which is required for binding to antiapoptotic BCL2 homologs and BCL2-mediated inhibition of autophagy. BCL2-like 12 (BCL2L12) also harbors a BH3-like domain, which is 12 residues long and contains a LXXXAE/D motif. In a yeast two-hybrid system performed in the present study, BCL2L12 shared similar binding partnerships to antiapoptotic BCL2 homologs, such as Beclin-1. In addition, this BH3-like domain was involved in antiapoptosis and drug-induced autophagy in glioma cell lines. Mutations in S156 and hydrophobic L213 to alanine counteracted the antiapoptotic properties of BCL2L12 and downregulated the activation of microtubule associated protein 1 light chain 3B (LC3B), autophagy-related (ATG)12-ATG5 conjugates and Beclin-1, compared with a BCL2L12 wild-type group. Molecular dynamics simulations revealed that phosphorylation at Ser156 of BCL2L12 (within α-6 and α-7 helices) influenced the BH3-like domain conformation (α-9 helix), indicating that glycogen synthase kinase (GSK) 3β-mediated Ser156 phosphorylation modulated a BH3-like domain in BCL2L12. Altogether, the present findings indicated that BCL2L12 may participate in anti-apoptosis and autophagy via a BH3-like domain and GSK3β-mediated phosphorylation at Ser156. Furthermore, blockade of temozolomide (TMZ)-induced autophagy by 3-methyladenine (3-MA) resulted in enhanced activation of apoptotic markers, as well as tumor suppresor protein p53 (p53) expression in U87MG cells. The present results suggested that p53 and O6-methylguanine DNA methyltransferase activation, and BCL2, BCL-extra large, Beclin-1 and BCL2L12 expression may be used as a detection panel to determine which patients can benefit from TMZ and ABT-737 combination treatment.

Pancreas Transplantation After Liver Transplantation: A Case Report

Our aim was to describe the clinical indications, surgical technique, and clinical outcomes of a pancreas transplantation, performed 4 years after liver transplantation, as treatment for new-onset, uncontrolled diabetes mellitus in a 53-year-old man. Liver transplantation was performed for end-stage liver disease secondary to hepatitis B virus infection and hepatocellular carcinoma. The patient had no history of diabetes prior to the liver transplantation. The decision to proceed with a pancreas transplantation was made when the patient's blood sugar levels could not be normalized despite insulin doses >100 IU/d. A modified cadaveric transplantation technique was used, with the recipient's inferior vena cava dissected for anastomosis with the portal vein of the graft, using a diamond-shaped patch procedure. Moreover, the right common iliac artery was anastomosed with a Y-graft in the pancreas graft, and the duodenum remnant of the graft was anastomosed to the recipient's duodenum using a side-to-side procedure. The 6-month postoperative follow-up included repeated endoscopic biopsy of the graft duodenum, with no evidence of thrombosis or rejection of the graft, with glucose level within normal limits without requirement for diabetic drugs. To our knowledge, this is the first reported case of pancreas transplantation after liver transplantation.

Inferior Vena Cava-Duodenal Drainage in Pancreas Alone Transplantation for Chronic Pancreatitis: A Case Report

Enteric drainage has been the main trend in solitary pancreas transplantation. Compared with bladder drainage, it does not cause metabolic or urologic complications, but there is no way to perform immunologic monitoring, except by graft pancreas biopsy. Additionally, although portal drainage of the graft vein is considered physiological drainage, it has more of a risk for surgical complications. To overcome these disadvantages, we successfully performed inferior vena cava (IVC)-duodenal drainage in pancreas alone transplantation. A 44-year-old man underwent pancreas alone transplantation. He had insulin-dependent diabetes because of chronic pancreatitis, thus he had taken a pancreatic enzyme. After right-sided medial visceral rotation, the IVC was dissected for anastomosis with a graft portal vein. The right common iliac artery was anastomosed with a Y-graft in the pancreas graft. The graft duodenum was anastomosed with recipient duodenum using the side-to-side manner. Postoperatively, he underwent protocol biopsies of the graft duodenum through endoscopy two times. There was no evidence of graft thrombosis or rejection. He had a normal glucose level without any diabetic drugs, and he required no pancreatic enzyme for digestion. The IVC-duodenum drainage procedure was a feasible method for preventing thrombosis and providing an opportunity for direct graft monitoring through endoscopy.

Complete Regression of Recurrent Advanced Hepatocellular Carcinoma After Liver Transplantation in Response to Sorafenib Treatment: A Case Report

Liver transplantation is a potentially curative treatment for hepatocellular carcinoma. However, patients with recurrent hepatocellular carcinoma after liver transplantation have few treatment options and local treatment may not be feasible. Sorafenib, an orally active multikinase inhibitor approved for the treatment of advanced hepatocellular carcinoma, significantly improves progression-free and overall survival. However, only a few studies have evaluated the efficacy of sorafenib in patients with recurrent hepatocellular carcinoma following liver transplantation. Here, we report a case of a patient with recurrent advanced hepatocellular carcinoma after living donor liver transplantation who achieved complete remission in response to sorafenib treatment. The patient has survived for more than 4 years post-transplantation.

Evaluation of nasal patency by visual analogue scale/nasal obstruction symptom evaluation questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study

OBJECTIVE

To assess the efficacy of septoplasty and the correlation between the subjective evaluations of a visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and active anterior rhinomanometry of the nasal airway after septoplasty.

DESIGN

A retrospective, individual cohort study.

SETTING

Ear, Nose and Throat Department, Taipei City Hospital, Taipei, Taiwan.

PARTICIPANTS

Fifty patients with chronic nasal obstruction were enrolled in the study. All 50 patients underwent septoplasty because of nasal septal deviation. Another 28 patients without nasal symptoms served as controls.

MAIN OUTCOME MEASURES

VAS, NOSE and active anterior rhinomanometry were used to measure the sensation of nasal obstruction. All measurements were performed in both groups preoperatively and then repeated on three postoperative visits (3, 6 and 12 months).

RESULTS

The mean VAS score, NOSE score and the nasal resistance in the narrow side of the nose in the study group showed reduced symptoms at 3, 6 and 12 months postoperatively compared with the respective preoperative measurements (P < 0.001, all). The VAS and NOSE scores did not significantly correlate with total nasal resistance preoperatively or postoperatively. The VAS and nasal resistance in the obstructed nasal cavity correlated significantly preoperatively (P < 0.05), but not postoperatively.

CONCLUSIONS

The subjective and objective symptoms of nasal obstruction had improved 1 year after septoplasty. A significant correlation between VAS scores and nasal resistance in the narrow side of the nose was found before surgery. The subjective and objective measurements of nasal obstruction lacked significant correlation postoperatively.

Observation of universal strong orbital-dependent correlation effects in iron chalcogenides

Establishing the appropriate theoretical framework for unconventional superconductivity in the iron-based materials requires correct understanding of both the electron correlation strength and the role of Fermi surfaces. This fundamental issue becomes especially relevant with the discovery of the iron chalcogenide superconductors. Here, we use angle-resolved photoemission spectroscopy to measure three representative iron chalcogenides, FeTe_0.56Se_0.44, monolayer FeSe grown on SrTiO₃ and K_0.76Fe_1.72Se₂. We show that these superconductors are all strongly correlated, with an orbital-selective strong renormalization in the d_xy bands despite having drastically different Fermi surface topologies. Furthermore, raising temperature brings all three compounds from a metallic state to a phase where the d_xy orbital loses all spectral weight while other orbitals remain itinerant. These observations establish that iron chalcogenides display universal orbital-selective strong correlations that are insensitive to the Fermi surface topology, and are close to an orbital-selective Mott phase, hence placing strong constraints for theoretical understanding of iron-based superconductors.

A proper theoretical description for unconventional superconductivity in iron-based compounds remains elusive. Here, the authors, to capture the electron correlation strength and the role of Fermi surfaces, report ARPES measurements of three iron chalcogenide superconductors to establish universal features.

Magnetic and structural relationship of RFe2Si2 and R(Fe(1-x)M(x))2Si2(x = 0-1) systems (R = La, Y and Lu, M = Ni, Mn and Cu)

Due to the similarity between AFe(2)As(2) (A = Ba, Sr) and RFe(2)Si(2) (R = La, Y and Lu), the RFe(2)Si(2) system has been proposed as a potential candidate for a new high TC superconducting family containing Fe-Si (instead of Fe-As) layers as a structural unit. Various R (Fe(1-x)M(x))2 Si(2) (M = Ni and Cu) materials were synthesized and measured for their magnetic properties. None of these materials is superconducting down to 1.8 K. A pronounced peak at 232 K was observed in the magnetization curve of YFe(2)Si(2). (57)Fe Mössbauer studies confirm the absence of any long-range magnetic ordering below 232 K. Similar peaks at various temperatures also appear in R (Fe(1-x)M(x))2 Si2 samples. For Y (Fe(1-x)Mn(x))2 Si(2) the peak position is dramatically affected by the magnetic Mn dopants. Four independent factors affect the peak position and shift it to lower temperatures: (i) the lattice parameters, (ii) the concentration of x (iii) the applied magnetic field and (iv) the magnetic nature of M. It is proposed that the magnetic peaks observed in RFe(2)Si(2) and in R (Fe(1-x)M(x))2 Si(2) represent a new nearly ferromagnetic Fermi liquid system, its nature is yet to be determined.

Observation of temperature-induced crossover to an orbital-selective Mott phase in A(x)Fe(2-y)Se2 (A=K, Rb) superconductors

Using angle-resolved photoemission spectroscopy, we observe the low-temperature state of the A(x)Fe(2-y)Se(2) (A=K, Rb) superconductors to exhibit an orbital-dependent renormalization of the bands near the Fermi level-the d(xy) bands heavily renormalized compared to the d(xz)/d(yz) bands. Upon raising the temperature to above 150 K, the system evolves into a state in which the d(xy) bands have depleted spectral weight while the d(xz)/d(yz) bands remain metallic. Combined with theoretical calculations, our observations can be consistently understood as a temperature-induced crossover from a metallic state at low temperatures to an orbital-selective Mott phase at high temperatures. Moreover, the fact that the superconducting state of A(x)Fe(2-y)Se(2) is near the boundary of such an orbital-selective Mott phase constrains the system to have sufficiently strong on-site Coulomb interactions and Hund's coupling, highlighting the nontrivial role of electron correlation in this family of iron-based superconductors.

Superconductivity at 52.5 k in the lanthanum-barium-copper-oxide system

A superconducting transition with an onset temperature of 52.5 K has been observed under hydrostatic pressure in compounds with nominal compositions given by (La(0.9)Ba(0.1))(2) CuO4-Y. Possible causes for the high-temperature superconductivity are discussed.

Ferromagnetism and superconductivity in uranium compounds

The intimate correlation between the mechanisms causing magnetism and superconductivity in uranium compounds has been verified again-in novel systems.

Design and fabrication of white light emitting diodes with an omnidirectional reflector

This study investigates white light emitting diodes (LEDs), packaged with an omnidirectional reflector (ODR) and UV LED of 378 nm. The current work designs an ODR to solve the problems of UV leak and low phosphors conversion efficiency with a thin film structure of S/(HLH)n/air modified from a quarter-wave stack. Since an ODR is a perfect dielectric mirror for UV light, the UV leak can be eliminated and recycled to enhance phosphors conversion efficiency. By measuring the emission spectrum of a white LED with an ODR, the orientation distribution of the color properties, and the radiation power, the current study did not detect any UV leak. The average luminous intensity enhancement is 15%.

Low-grade astrocytoma associated with abscess formation: case report and literature review

A rare case of low-grade astrocytoma associated with abscess formation occurred in a 52-year-old man presenting with Broca's aphasia. He underwent craniotomy and tumor removal under the impression of brain tumor with necrotic cystic change. Abscess accumulation within the intra-axial tumor was found intraoperatively. Literature related to brain abscess with brain tumor is reviewed, with an emphasis on abscesses with astrocytoma. We discuss the common brain tumors that are associated with abscess, pathogens that coexist with brain tumor, and the pathogeneses of coexisting brain abscess and tumor. It is very important to know how to differentiate between and diagnose a brain abscess and tumor, or brain abscess with tumor, preoperatively from clinical presentation and through the use of computed tomography, conventional magnetic resonance imaging, diffusion-weighted imaging or magnetic resonance spectroscopy.

Organic Donor-Acceptor System Exhibiting Electrical Bistability for Use in Memory Devices

An all-organic electrically bistable device and its application in non-volatile memory is reported. The switching mechanism is attributed to electric-field-induced charge transfer from an organic electron donor to an acceptor, so that the device switches from a low- to a high-conductivity state. This device provides a new direction for data-storage technology based on organic composites.

Changes in magnetocardiogram patterns of infarcted-reperfused myocardium after injection of superparamagnetic contrast media

The changes in spatio-temporal patterns of magnetocardiograms were investigated following injection of superparamagnetic iron-oxide (SPIO) nanoparticles using a dog model of ischemia/reperfusion. Acute myocardial infarction was induced by ligation of the left anterior descending coronary in two anesthetized open-chest dogs. Following 60 min coronary occlusion and 30 min reperfusion, dogs were subjected to injections of SPIO at a dose of 0.56 mg Fe/kg using a catheter inserted into the left atrium. Magnetocardiograms were measured before coronary occlusion, 15 min after reperfusion and immediately after administration of the SPIO. Magnetic field maps of early reperfused myocardium showed spatio-temporal field distributions consistent with anterior myocardial infarction. Magnetic field distribution measured after injection of SPIO revealed additional spatio-temporal features most prominent during ventricular repolarization due to augmentation/fragmentation of the ST-segment detected at several sensor locations. No significant differences in MCG patterns were noted following contrast agent injections in a dog without coronary occlusion. In conclusion, preliminary experimental evidence appears to support the notion that superparamagnetic contrast agents increase the sensitivity of standard MCG and may have an important implication for magnetocardiography in the assessment of regional myocardial ischemia, infarction and perfusion.

Thrombocytosis: A paraneoplastic syndrome in patients with hepatocellular carcinoma

AIM: Hepatocellular carcinoma (HCC) patients manifest a variety of paraneoplastic syndromes. Thrombocytosis was reported in children with hepatoblastoma. The aims of this study were to evaluate the prevalence and clinical significance of thrombocytosis in HCC patients and its relationships with serum thrombopoietin (TPO).

METHODS: We retrospectively reviewed clinical, biochemical and image data of 1154 HCC patients. In addition, we measured platelet count and serum TPO in HCC patients with and without thrombocytosis, in patients with cirrhosis, chronic hepatitis and healthy subjects in a cross-sectional study.

RESULTS: Thirty-one (2.7%) of 1154 HCC patients had thrombocytosis (platelet count ≥ 400 K/mm³). HCC patients with thrombocytosis were significantly younger, had a higher serum α-fetoprotein, higher rate of main portal vein thrombosis, larger tumor volume, shorter survival, and were less likely to receive therapy than HCC patients without thrombocytosis. Multivariate logistic regression analyses showed that tumor volumes ≥ 30% and serum α-fetoprotein ≥ 140000 ng/mL could significantly predict thrombocytosis. HCC patients with thrombocytosis had a significantly higher mean serum TPO than those without, as well as patients with cirrhosis, chronic hepatitis and healthy subjects. Platelet count and serum TPO dropped significantly after tumor resection in HCC patients with thrombocytosis and re-elevated after tumor recurred. Furthermore, the expression of TPO mRNA was found to be more in tumor tissues than in non-tumor tissues of liver in an HCC patient with thrombocytosis.

CONCLUSION: Thrombocytosis is a paraneoplastic syndrome of HCC patients due to the overproduction of TPO by HCC. It is frequently associated with a large tumor volume and high serum α-fetoprotein.

Field-induced reentrant novel phase and a ferroelectric-magnetic order coupling in HoMnO3

A reentrant novel phase is observed in the hexagonal ferroelectric HoMnO3 in the presence of magnetic fields in the temperature range defined by a plateau of the dielectric constant anomaly. The plateau evolves with fields from a narrow dielectric peak at the Mn-spin rotation transition at 32.8 K in zero field. The anomaly appears both as a function of temperature and as a function of magnetic field without detectable hysteresis. This is attributed to the indirect coupling between the ferroelectric (FE) and antiferromagnetic (AFM) orders, arising from an FE-AFM domain wall effect.

Unconventional superconductivity and electron correlations in the cobalt oxyhydrate Na0.35CoO2.yH2O from nuclear quadrupole resonance

We report a careful 59Co nuclear quadrupolar resonance measurement on the recently discovered cobalt oxyhydrate Na0.35CoO2.yH(2)O superconductor from T=40 K down to 0.2 K. We find that in the normal state the spin-lattice relaxation rate 1/T(1) follows a Curie-Weiss type temperature (T) variation, 1/T(1)T=C/(T-theta), with theta=-42 K, suggesting two-dimensional antiferromagnetic spin correlations. Below T(c)=3.9 K, 1/T(1) decreases with no coherence peak and follows a T(n) dependence with n approximately 2.2 down to approximately 2.0 K but crosses over to a 1/T(1) proportional to T variation below T=1.4 K, which suggests non-s-wave superconductivity. The data in the superconducting state are most consistent with the existence of line nodes in the gap function.

Adult-to-adult living donor liver transplantation at the Asan Medical Center, Korea

Between February 1997 and December 2001, 311 adult-to-adult living donor liver transplants (A-A LDLTs) were performed at the Asan Medical Center for patients above 20 years of age. Indications for A-A LDLT were: chronic hepatitis B (203), chronic hepatitis C (5), hepatocellular carcinoma (64), alcoholic cirrhosis (9), cryptogenic cirrhosis (4), secondary biliary cirrhosis (5), primary biliary cirrhosis (1), Wilson' s disease (2), autoimmune hepatitis (1), hepatic tuberculosis (1), cholangiocarcinoma (1), fulminant hepatic failure (14) and primary non-function of cadaveric liver graft (1). Of 311 A-A LDLTs, 36 were of medical high urgency, 20 were for acute and subacute hepatic failure, 15 were for hepato-renal syndrome and 1 was for primary non-function. Recipient age ranged from 27 to 64 years. Donor age ranged from 16 to 62 years. There was no donor mortality. Implanted liver grafts were categorized into seven types: 175 modified right lobe (MRL), 70 left lobe, 32 right lobe, 20 dual grafts, 10 left lobe plus caudate lobe, three extended right lobe and one posterior segment. In MRL, the tributaries of the middle hepatic vein were reconstructed by interpositioning a vein graft. Indication for dual graft implantation was the same as single graft A-A LDLT, and four of 20 were emergency cases. Of 20 dual grafts, 14 received two left lobes, four received a left lobe and a lateral segment, one received a right lobe and a left lobe and one received a lateral segment and a posterior segment. Graft volume ranged from 28% to 83% of the standard liver volume of the recipients. There were 33 (10.6%) in-hospital mortalities (< 4 months) among the 310 patients after 311 A-A LDLTs. Of the 36 patients receiving emergency transplants, 31 survived. These encouraging results justify the expansion of A-A LDLT in coping with increasing demands, even in urgent situations. We have aimed to introduce the establishment of the efficacy of A-A LDLT in various end-stage chronic and acute liver diseases, as well as new technical advances to overcome small graft-size syndrome by using dual-graft implantation and MRL, both of which were first developed in our department.

Hepatitis C viral genotype influences the clinical outcome of patients with acute posttransfusion hepatitis C

Most patients with an acute infection of hepatitis C virus (HCV) will develop chronic hepatitis, and only about 15-20% of the cases will resolve spontaneously. The mechanism for the different outcomes in patients with acute HCV infection remains unclear. HCV genotype has been recognized as an important factor affecting the clinical course and outcome of chronic hepatitis C patients. In order to evaluate the role of HCV genotype in the clinical course and outcome of acute posttransfusion hepatitis C, 67 patients with acute posttransfusion hepatitis C from a prospective study of posttransfusion non-A, non-B hepatitis were enrolled. Thirty-nine patients (58.2%) were HCV genotype 1b. Among the 67 patients with acute posttransfusion hepatitis C, 53 (79.1%) progressed to chronic hepatitis. Significantly more patients with genotype 1b than non-1b genotypes developed chronic hepatitis (89.7% vs. 64.3%; P = 0.019). There was no significant difference in gender, mean age, amount of transfused blood, hepatitis symptoms, jaundice, incubation period, peak serum alanine transaminase, or serum HCV RNA titer between patients with HCV genotype 1b and non-1b infections. Patients who developed chronic hepatitis had a significantly greater incidence of genotype 1b infection (66.0% vs. 28.6%; P = 0.013) and a longer incubation period (7.3 weeks vs. 5.4 weeks; P = 0.052) than patients whose infection was resolved. Patients with a genotype 1b infection that resolved itself spontaneously all had an incubation period of less than 6 weeks. Multivariate logistic regression analysis revealed that genotype 1b and an incubation period > or = 6 weeks were significant predictive factors for the development of chronic hepatitis. Therefore, the HCV genotype can influence the outcome of patients with acute HCV infection.

A new 3-D display method for 12-lead ECG

A new three-dimensional (3-D) 12-lead electrocardiogram (ECG) display method is presented which employs a 3-D rectangular coordinate system to display the 12-lead cardiac electric signals in two 3-D graphs. The 3-D graph consists of a temporal axis representing the time domain of the cardiac signals, a spatial axis representing the lead positions, and an amplitude axis representing the voltages of the cardiac signals. The six horizontal plane leads and the other six frontal plane leads were displayed in two 3-D graphs, respectively. The voltages of the cardiac signals were represented in rainbow-like colors. Cubic interpolation was employed to insert interconnecting points between neighboring leads on each plane and to smooth the surface of the 3-D ECG graphs. The 3-D ECG graphs of a normal subject, a patient with myocardial infarction, and a patient with left bundle branch block were presented in this paper. This new display method could not only be used as a complementary display method to the 12-lead ECG, but also provide physicians with an overall integral view about the spatial distribution of the cardiac signals.

Economic decision analysis model of screening for lung cancer

The objective of this study was to evaluate the potential clinical and economic implications of an annual lung cancer screening programme based on helical computed tomography (CT). A decision analysis model was created using combined data from the Surveillance, Epidemiology and End Results (SEER) registry public-use database and published results from the Early Lung Cancer Action Project (ELCAP). We found that under optimal conditions in a high risk cohort of patients between 60 and 74 years of age, annual lung cancer screening over a period of 5 years appears to be cost effective at approximately $19000 per life year saved. A sensitivity analysis of the model to account for a 1-year decrease in survival benefit and changes in assumptions for incidence rate and costs generated cost effectiveness estimates ranging from approximately $10800 to $62000 per life year saved. Based on the assumptions embedded in this model, annual screening of high risk elderly patients for lung cancer may be cost effective under optimal conditions, but longer term data are needed to confirm if this will be borne out in practice.

Deferoxamine-induced dysplasia of the knee: sonographic features and diagnostic performance compared with magnetic resonance imaging

OBJECTIVE

To evaluate the features and diagnostic performance of sonography in the assessment of deferoxamine-induced dysplasia of the knee.

METHODS

The left knees of 32 patients with thalassemia who were receiving regular blood transfusions and chelation therapy were studied with sonography for signs of deferoxamine-induced bone dysplasia. Abnormal physeal and metaphyseal changes detected on sonography included notching at the metaphyseal corner, a blurred or irregular peripheral juxtaphyseal metaphyseal contour, and widening of the peripheral juxtaphyseal metaphyseal echogenic interface. The accuracy of sonography in diagnosing dysplasia was evaluated by using magnetic resonance imaging as the standard of reference.

RESULTS

There were 14 true-positive findings, 10 true-negative findings, 7 false-negative findings, and 1 false-positive sonographic diagnosis of dysplasia, giving 67% sensitivity, 91% specificity, a 93% positive predictive value, and a 59% negative predictive value.

CONCLUSION

Sonography was specific but only moderately sensitive in the diagnosis of deferoxamine-induced dysplasia at the knee when compared with magnetic resonance imaging.

Clinical, virological, and pathological significance of hepatic bile duct injuries in Chinese patients with chronic hepatitis C

PURPOSE

Hepatic bile duct injuries are characteristic histological findings in patients with chronic hepatitis C virus (HCV) infection. However, the pathogenesis and clinical significance of this phenomenon remain unclear. The aims of this study were to evaluate the prevalence and clinical significance of hepatic bile duct injuries in Chinese patients with chronic hepatitis C.

METHODS

One hundred and seventeen Chinese patients with chronic hepatitis C were enrolled. Clinical, biochemical, immunological (serum autoantibodies and cryoglobulinemia), histological, and virological data (serum HCV RNA titer and HCV genotype) were compared between patients with and without hepatic bile duct injuries.

RESULTS

Eighty-three (71%) of the 117 patients with chronic hepatitis C had hepatic bile duct injuries. Patients with hepatic bile duct injuries had a significantly higher frequency of HCV genotype 1b; a higher mean serum globulin level; significantly higher mean scores for histological periportal necro-inflammation, portal inflammation, and fibrosis; and more severe portal lymphoid aggregation/follicles when compared with patients without hepatic bile duct injuries (P < 0.05, all). No significant differences in the presence of serum autoantibodies, cryoglobulinemia, mean serum HCV RNA titer, or response to interferon treatment were noted between the two groups. Multivariate logistic regression analysis showed that HCV genotype 1b infection, portal inflammation, and lymphoid aggregation/follicles were significant independent predictors associated with hepatic bile duct injuries.

CONCLUSIONS

The presence of hepatic bile duct injuries in Chinese patients with chronic hepatitis C was significantly correlated with HCV genotype 1b infection, and the patients with these injuries had more severe portal inflammation and formation of lymphoid aggregates/follicles.

Thermally stable narrow-bandpass filter prepared by reactive ion-assisted sputtering

Thermal stabilities of three-cavity narrow-bandpass (NB) filters with high-index half-wave spacers and 78-102 layers of Ta(2)O(5) and SiO(2) prepared by reactive ion-assisted bipolar direct-current (dc) magnetron sputtering of tantalum and silicon targets, respectively, were investigated. Pure argon and pure oxygen were used as the sputtering gas and the reactant, respectively. The oxygen gas was introduced and ionized through the ion gun and toward the unheated BK7 glass substrate. The refractive indices of single-layer Ta(2)O(5) and SiO(2) films were 2.1 and 1.45, respectively, at 1550 nm, which were comparable with those of films prepared by other ion-assisted coating techniques. The moisture-resistant properties of the films were excellent as evidenced from the water-immersion test, implying that the packing density of the films was close to that of their bulk materials. The temperature-dependant wavelength shifts of the NB filters were <3 x 10(-3) nm/ degrees C at temperatures of <75 degrees C, indicating that the temperature-induced wavelength shift of the filter was <0.15 nm when the temperatures were raised from room temperature to 75 degrees C, which was compliant with Bellcore GR-1209-CORE generic requirements of NB filters used for optical-fiber communication systems.

Clinical, virologic, and pathologic significance of elevated serum alpha-fetoprotein levels in patients with chronic hepatitis C

Elevated serum alpha-fetoprotein (AFP) in patients with chronic hepatitis C is not uncommonly seen, but the pathogenesis of this phenomenon remains unclear. The aims of this study were to assess the prevalence of elevated serum AFP in patients with chronic hepatitis C and to evaluate the clinical, virologic, and histopathologic significance of this phenomenon. One hundred and fifteen Chinese patients with a histologic diagnosis of chronic hepatitis C were enrolled. None had evidence of hepatocellular carcinoma by image study at enrollment and for at least 2 years' follow-up. Of the 115 patients, 33 (29%) had elevated serum AFP (more than 12 ng/mL). There was a significantly lower mean serum albumin (4.0 +/- 0.1 vs. 4.3 +/- 0.1 gm/dL, p <0.001) and higher mean scores for periportal necroinflammation (3.3 +/- 0.3 vs. 2.3 +/- 0.2, p = 0.007) and fibrosis (2.3 +/- 0.2 vs. 1.1 +/- 0.1, p < 0.001) in patients with elevated serum AFP when compared with patients without elevated serum AFP. Patients with elevated serum AFP had significantly more incidences of genotype 1b infection when compared with patients without elevated serum AFP (77% vs. 51%, p = 0.021). Mean serum hepatitis C virus (HCV) RNA titer showed no significant difference between the two groups. Multivariate logistic regression analysis showed that as serum albumin of less than 4.2 gm/dL, a histology fibrotic score of more than 3, and HCV genotype 1b infection were significantly independent predictors associated with elevated serum AFP. In conclusion, elevated serum AFP levels were significantly correlated with lower serum albumin levels, advanced fibrosis/cirrhosis, and genotype 1b infection in patients with chronic hepatitis C.

Hepatic steatosis in chronic hepatitis C virus infection: prevalence and clinical correlation

BACKGROUND AND AIMS

Hepatic steatosis is a histological characteristic in patients with chronic hepatitis C virus (HCV) infection. The aim of this study was to evaluate the prevalence of hepatic steatosis in Chinese patients with chronic hepatitis C, and to look for possible correlation with various histopathological changes and to look for possible correlation with various clinical and pathologic variables.

METHODS

One hundred and six patients were enrolled, and patients with alcoholism or diabetes mellitus were excluded. Clinical, biochemical and virologic data, including HCV genotype and serum HCV-RNA titer and histological findings, were compared between patients with and without hepatic steatosis.

RESULTS

Fifty-five (52%) of the 106 patients with chronic hepatitis C had hepatic steatosis. Patients with hepatic steatosis had significantly higher mean serum levels of triglyceride and gamma-glutamyl transpeptidase, higher body mass index, and a higher incidence of obesity compared with patients without hepatic steatosis. No significant differences in serum HCV-RNA titer and HCV genotype or the response to interferon therapy were noted between the two groups. Histological analysis showed patients with hepatic steatosis had a significantly higher mean fibrotic score than patients without hepatic steatosis (1.9 +/- 1.2 vs 1.3 +/- 1.0; P = 0.016). There were no significant differences in the severity of necroinflammation, the presence of lymphoid aggregation/follicle or bile duct damage between the two groups. Multivariate logistic regression analysis showed that independent predictors associated with hepatic steatosis were obesity or a histology fibrotic score of > or = 2.

CONCLUSION

It was found that 52% of Chinese patients with chronic hepatitis C had hepatic steatosis. Patients with hepatic steatosis were more frequently obese and had more severe hepatic fibrosis.

Comparison of clinical, virologic and pathologic features in patients with acute hepatitis B and C

BACKGROUND AND AIMS

The clinical outcomes of adult-acquired acute infection of hepatitis C virus (HCV) and hepatitis B virus (HBV) are quite different. In order to compare the clinical, biochemical, virologic and pathologic pictures in these two groups of patients, we enrolled 22 adult patients with acute hepatitis C and 16 adult patients with acute hepatitis B, on whom liver biopsies were performed within 3 months of acute onset of the illness.

RESULTS

The results showed that a significantly younger age, a higher ratio of the clinical symptoms of jaundice, nausea, vomiting, and poor appetite, a higher mean serum level of alanine transaminase, aspartate transaminase, and total bilirubin were present in patients with acute hepatitis B patients than in those with acute hepatitis C (P < 0.05). There was a significantly higher degree of periportal inflammation and total necro-inflammatory activity in the acute hepatitis B patients (P = 0.002 and 0.049, respectively). Fifteen (68.2%) of the 22 patients with acute hepatitis C had detectable serum HCV-RNA, but only two (14.3%) of the 14 tested patients with acute hepatitis B had detectable serum HBV-DNA, detected by using the branched DNA signal amplification assay. Eighteen (82%) of the 22 acute hepatitis C patients and none of the 16 acute hepatitis B patients progressed into a chronic hepatitis stage (P < 0.001).

CONCLUSION

The manifestations of mild clinical symptoms, lower mean serum transaminases and bilirubin levels, a lesser degree of histological periportal necroinflammation, and more patients with a high circulatory viral load among the acute hepatitis C patients, may lead to more of that group developing chronicity than patients with acute hepatitis B.

Degradation kinetics of reactive dye by UV/H2O2/US process under continuous mode operation

Degradation of a dye, C. I . Reactive Red 120, in dyeing waatewater by the process o UV/H2O2/US was studied with a bench-scale reactor under the continuous mode of operation. The effects of dyeing wastewater flow rate and the feeding rate of an oxidant, H2O2, on the color removal efficiency of the process were investigated. The significance of ultrasonic (US) combined with UV irradiation was also investigated and the performances of the process on color removal were evaluated. The results showed that the decoloration process followed a pseudo first-order kinetic model and the UV light is the most significant factor on dye removal. Besides, at higher flow rates, incomplete color removal was observed due to relatively insufficient irradiation time (low degradation rate). In order to achieve a higher degradation rate, the feeding rate of H2O2 should be increased.

Chinese alcoholic patients with esophageal cancer are genetically different from alcoholics with acute pancreatitis and liver cirrhosis

OBJECTIVE

It is a mystery why some alcoholic patients acquire certain organ-specific complications of alcoholism, whereas other alcoholic patients acquire different ones. The aim of this study was to investigate the differences among Chinese alcoholic patients with esophageal cancer, acute pancreatitis, and liver cirrhosis by studying the genetic polymorphisms of ADH2, ADH3, ALDH2, and P4502E1.

METHODS

Liver alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH), and cytochrome P4502E1 (P4502E1) are polymorphic at the ADH2, ADH3, and ALDH2 loci and the 5'-flanking region of the P4502E1. Using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method, we determined the polymorphism of the above-mentioned alcohol metabolizing genes in 59 alcoholics with carcinoma of the esophagus (alcoholic esophageal Ca), 87 acute alcoholic pancreatitis patients, 116 alcoholics with liver cirrhosis (alcoholic cirrhosis), 19 alcoholics with both liver cirrhosis and acute pancreatitis (alcoholic P plus C), and 241 nonalcoholic patients.

RESULTS

The results showed that the allele frequency of ALDH2*2 was significantly higher in the alcoholic esophageal Ca group than in the alcoholic pancreatitis and alcoholic cirrhosis groups. The allele frequency of ADH2*1 was significantly higher in the alcoholic esophageal Ca patients than in nonalcoholic control groups. The ALDH2*2 was significantly lower in alcoholic groups (except the alcoholic esophageal Ca group) than in nonalcoholic control groups. The allele frequencies of ADH2*1 and ALDH2*2 are higher in alcoholic patients with esophageal Ca than alcoholic patients without it. The genotype distribution of P4502E1, detected by RsaI and PstI, was not different among alcoholic patients with different organ diseases.

CONCLUSIONS

The allele frequency of ADH2*1 and ALDH2*1 are different among subpopulations of alcoholics, suggesting that alcoholic patients with different specific types of organ damage are genetically different. The Chinese alcoholic patients with the ADH2*1 and ALDH2*2 allele are more susceptible to esophageal Ca.

Seroprevalence of GB virus C/hepatitis G virus-RNA and anti-envelope antibody in high-risk populations in Taiwan

BACKGROUND

GB Virus C (GBV-C)/hepatitis G virus (HGV) was identified in 1995-1996 as a transfusion-transmissible virus. The diagnosis of GBV-C/HGV infection is based on the detection of GBV-C/HGV-RNA by using polymerase chain reaction. Recently, an enzyme immunoassay detecting the antibodies to the viral protein, E2 envelope protein (anti-envelope) of GBV-C/HGV, has been developed.

METHODS

Serum GBV-C/HGV-RNA and anti-envelope antibody were determined in 76 cases of intravenous drug users (IVDU), 76 patients with regular hemodialysis and in 80 prostitutes to evaluate the GBV-C/HGV infection rate among high-risk populations in Taiwan. Seventy-six healthy blood donors were randomly selected and were used as a control group.

RESULTS

The prevalence of GBV-C/HGV-RNA in high-risk populations was 33% for IVDU, 16% for patients with hemodialysis and 13% for prostitutes, which was significantly higher than the 3% obtained in the control group (P < 0.05 for all groups). The prevalence of anti-envelope antibody was 13% for IVDU, 21% for patients with hemodialysis and 23% for prostitutes, which was not significantly different from the control group (11%). Among the 99 subjects who had positive GBV-C/HGV markers, 97 were tested for exclusive positivity for either GBV-C/HGV-RNA or anti-envelope antibody.

CONCLUSIONS

The presence of serum anti-envelope antibody usually indicates the clearance of serum GBV-C/HGV-RNA in patients infected with GBV-C/HGV. GBVirus-C/HGV infection in high-risk populations, determined by the presence of serum GBV-C/HGV-RNA, may underestimate the true level of past and present infection.

Effects of pravastatin on left ventricular mass in patients with hyperlipidemia and essential hypertension

Left ventricular (LV) mass is a powerful predictor for future cardiovascular events. Epidemiologic studies have shown that hyperlipidemia is associated with higher LV mass. The effects of statin therapy for hyperlipidemia on LV mass have not been studied. To determine the effects of statin therapy on LV mass, we prospectively studied 3 groups of age and body surface area-matched patients: group 1 (n = 20), patients with systemic hypertension and hyperlipidemia treated with pravastatin plus anti-hypertensive drugs; group 2 (n = 20), patients with hypertension and hyperlipidemia treated with hypertensive agents and diet control alone; and group 3 (n = 20), hypertensive patients with normolipidemia treated with antihypertensive agents. A group of controls without hypertension or hyperlipidemia was used for comparison. Echocardiograms were recorded at baseline and after 6-month therapy. All hypertensive groups showed significant decreases in LV mass index after treatment. Group 1 had the greatest decrease in LV mass and it was significantly higher than in groups 2 and 3. Multivariate analysis revealed that regression of LV mass was significantly correlated only with the use of statins and sex (p = 0.005 and 0.01, respectively, R(2) = 0.47). Linear regression analysis in group 1 showed a significant correlation between changes in arterial compliance and LV mass regression (r = 0.57, p = 0.01). Thus, the addition of a statin may have an additional effect on reducing LV mass, independent of lipid-lowering effects.

Clinical, virologic and pathologic significance of elevated serum gamma-glutamyl transpeptidase in patients with chronic hepatitis C

BACKGROUND

Elevated serum gamma-glutamyl transpeptidase (GGT) is often seen in patients with chronic hepatitis C virus (HCV) infection and is associated with a poor response to interferon treatment. The pathogenesis of these phenomena is unclear. Therefore, we assessed the prevalence of elevated serum GGT in Chinese patients with chronic hepatitis C and evaluated the clinical, biochemical, virologic and histologic features of this phenomenon.

METHODS

One hundred and twelve patients with biopsy-proven chronic hepatitis C were enrolled. Patients who were habitual alcohol drinkers, alcoholics or had diabetes mellitus were excluded.

RESULTS

Forty-three (38.4%) of 112 patients had elevated serum GGT (> 60 U/l). Patients with elevated serum GGT had significantly higher serum levels of alanine and aspartate aminotransferases, alkaline phosphatase and total bilirubin, significantly higher histologic scores of liver lobular necro-inflammation and fibrosis when compared to patients with normal serum GGT. Elevated serum GGT was not correlated to serum HCV RNA titer or HCV genotype. Multivariate logistic regression analysis showed that a histologic fibrotic score > or = 2 was the only significantly independent predictor associated with elevated serum GGT. Fifty-seven of 112 patients completed a six-month course of interferon treatment. Patients with elevated serum GGT had a significantly lower sustained response rate to interferon when compared to patients with normal serum GGT (8% vs 30%, p = 0.042).

CONCLUSIONS

Elevated serum GGT in chronic hepatitis C patients was frequently associated with more severe hepatic fibrosis or cirrhosis and may, in part, account for poor response to interferon therapy.

Clinical significance of changes in serum hepatitis B virus DNA titer in patients with chronic hepatitis B treated with interferon

BACKGROUND

Interferon (IFN) has been used in the treatment of patients with chronic hepatitis B virus (HBV) infection. Nonetheless, the changes in serum HBV DNA titer during IFN treatment and the effect of these changes on the therapeutic results have not been well studied.

METHODS

Twenty patients with chronic hepatitis B who were positive for serum hepatitis B e antigen (HBeAg) and HBV DNA received IFN-alpha 2a 4.5 million units by subcutaneous injection three times a week for 24 weeks. Twenty age- and sex-matched patients with chronic hepatitis B were selected as a control group. Treatment response was defined as the normalization of serum alanine aminotransferase (ALT) and the seroconversion of serum HBeAg 24 weeks after discontinuation of the IFN treatment. Serum HBV DNA was measured using the branched DNA (bDNA) signal amplification assay.

RESULTS

There was no significant difference in pretreatment mean serum ALT and HBV DNA titer in either the IFN-treated or the control group. Treatment response was found in six (30%) of 20 IFN-treated patients and in four (20%) of 20 control patients (p > 0.05). Serum HBV DNA titer fell after IFN treatment and remained undetectable only in patients with final treatment response. Serum HBV DNA was negative at week 12 of the IFN treatment in four (67%) of six patients with treatment responses, significantly higher than in none (0%) of 14 patients without a treatment response (p = 0.001). Multivariate logistic regression revealed that the negativity of serum HBV DNA at week 12 of the IFN treatment successfully predicted treatment response.

CONCLUSIONS

Thirty percent of the patients with chronic hepatitis B responded to IFN-alpha 2a 4.5 million units subcutaneously injected three times a week for 24 weeks. Negativity of serum HBV DNA measured by bDNA assay at week 12 of the IFN treatment may suggest a beneficial treatment outcome.

Manifestations of hypercholesterolaemia, hypoglycaemia, erythrocytosis and hypercalcaemia in patients with hepatocellular carcinoma: report of two cases

BACKGROUND

Hypercholesterolaemia, hypoglycaemia, hypercalcaemia and erythrocytosis, are well-known paraneoplastic manifestations in patients with hepatocellular carcinoma (HCC). Hepatocellular carcinoma patients manifesting with two or three paraneoplastic manifestations have been previously reported. However, HCC patients presenting with four paraneoplastic syndromes have not been previously reported.

METHODS AND RESULTS

This manuscript describes two HCC patients who manifested with hypercholesterolaemia, hypoglycaemia, hypercalcaemia and erythrocytosis during their clinical course. Erythrocytosis appeared early when HCC was diagnosed and declined to within normal range after optimal therapy for HCC. Hypercholesterolaemia manifested initially after the diagnosis in case 1, declined to within normal range after lobectomy and was re-elevated after tumour recurred. With disease progression, hypercalcaemia and hypoglycaemia occurred 1-3 months after diagnosis and the both patients subsequently died several days later.

CONCLUSIONS

Similar features found in both patients were large tumour burden, high serum alpha-fetoprotein level and rapid downhill clinical course even with optimal therapy. The clinical significance of these paraneoplastic manifestations is discussed.

Flutamide-induced liver injury: a case report

Flutamide is a nonsteroidal antiandrogen agent. Since it was marketed in February of 1989 in the USA for treatment of prostate cancer, its potential for hepatotoxicity has been reported in Western countries. Here we report the case of a 72-year-old patient who suffered from general malaise, poor appetite, nausea and jaundice after six months of flutamide therapy for the treatment of prostate cancer. He had no past history of liver disease and was not receiving other medications. Liver biochemistries revealed elevated serum alanine aminotransferase and aspartate aminotransferase concentrations of up to 1,035 U/l and 745 U/l, respectively. Serum total bilirubin concentration was elevated to 7.0 mg/dl. Serologic markers for acute viral hepatitis were all negative. Serum antinuclear antibody, antimitochondrial antibody and antismooth-muscle antibody were also negative. Percutaneous liver biopsy revealed pericentral zonal necrosis with bridging hepatic necrosis. The patient's clinical symptoms and signs began to improve after discontinuation of flutamide, and his liver function had returned to normal three months later. Roussel Uclaf causality assessment for adverse drug reaction confirmed the diagnosis of drug-induced liver injury. This case reminds us that patients who are receiving flutamide should be regularly monitored for liver function. If drug-induced liver injury is suspected, flutamide must be discontinued promptly to avoid progression of liver injury.