Successful haploidentical hematopoietic stem cell transplantation for paroxysmal nocturnal hemoglobinuria with severe pancytopenia developed after long-term aplastic anemia treatment

Haploidentical hematopoietic stem cell transplantation (HSCT) with posttransplant cyclophosphamide is an alternative treatment for aplastic anemia-paroxysmal nocturnal hemoglobinuria (PNH) syndrome with poor prognostic factors. Ravulizumab treatment for PNH before HSCT might have a beneficial effect.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

The role of surveillance computed tomography in patients with follicular lymphoma

Introduction

Surveillance computed tomography (CT) is performed during the follow-up of patients with lymphoma who have completed initial therapy. However, studies on the clinical benefit of surveillance CT for patients with incurable subtypes, such as follicular lymphoma (FL), are limited. This study aimed to evaluate the value of surveillance CT for patients with FL after achieving the first complete response (CR) or CR unconfirmed in the rituximab era.

Methods

We retrospectively reviewed the medical records of patients with FL who achieved CR with first-line treatment between 2000 and 2016 at our institution. In patients who experienced first relapse, we examined the patient's clinical characteristics at the time of relapse, subsequent therapies, and post-relapse survival, based on the method of relapse detection.

Results

Of the 248 patients who achieved CR after initial therapy, 109 had a relapse, with a median follow-up of 11 years; 100 were enrolled into this study. Relapse was detected by surveillance CT in 61 patients (surveillance CT group) and by means other than surveillance CT, such as the presence of patient-reported symptoms, physical findings, and blood work-up abnormalities (non-surveillance CT group), in 39 patients. There was no significant difference in the patients' characteristics at the time of relapse between the two groups, except for a higher incidence of extranodal involvement in the non-surveillance CT group. The method of relapse detection did not affect therapeutic selection after relapse and post-relapse survival. In this study, 86.8% of the 38 patients who relapsed with only deep lesions, such as mesenteric or retroperitoneal lymph nodes, had surveillance CT-detected relapse.

Conclusion

Surveillance CT did not show any clinical benefit for patients with FL in CR; however, it might lead to early detection of relapse in cases of deep lesions that cannot be identified without imaging.

Use of Core-Needle Biopsy for the Diagnosis of Malignant Lymphomas in Clinical Practice

INTRODUCTION

Excisional biopsy (EB) is considered the gold standard for lymphoma diagnosis. Although recent advances in interventional radiology enable sampling with core-needle biopsy (CNB), only few studies evaluated the utility of CNB compared to that of EB.

METHODS

We analyzed patients with lymphoma who had a diagnostic biopsy at the National Cancer Center Hospital during 2002-2017. We investigated the clinical and pathological characteristics of CNB in 2017.

RESULTS

The proportion of CNB utility in total biopsy procedures had increased from 11 to 48% during the 15 years. In 2017, CNB was opted more frequently than EB for a biopsy of superficial, abdominal, or anterior mediastinal lesions. Only one out of 72 patients who had CNB required re-biopsy with EB because of insufficiency. The incidence of complications was comparable between CNB and EB: 2 (4%) cases of minor bleeding with CNB and 1 (8%) case of minor bleeding with EB. The median time from the first visit to biopsy was significantly shorter with CNB (5.5 days) than with EB (15 days).

CONCLUSION

There is an increasing trend in the utility of CNB. CNB is a less invasive method with shorter time to biopsy and can be considered an alternative to EB.

Clinicopathological analysis of primary refractory diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone chemoimmunotherapy

Background

Approximately 15% of patients with diffuse large B‐cell lymphoma (DLBCL) experience refractory or early relapsed disease after initial rituximab‐containing chemoimmunotherapy is regarded as a primary refractory disease. Although the standard treatment for relapsed DLBCL is high‐dose chemotherapy and autologous stem cell transplantation (HDC‐ASCT), the efficacy of this approach for primary refractory DLBCL is not well understood. We aimed to investigate the clinicopathological characteristics and outcomes of patients with primary refractory DLBCL.

Methods

Sixty‐nine consecutive patients with primary refractory DLBCL who were treated at our institution were categorized as partial responders (partial response to rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone [R‐CHOP] or relapse within 6 months of R‐CHOP) (n = 41) or primary progressors (no response to R‐CHOP) (n = 28). Survival curves were constructed using the Kaplan–Meier method and compared using the log‐rank test.

Results

At initial diagnosis, 70% of patients had Ann Arbor stage III/IV disease, 56% had non‐germinal center B‐cell‐like type DLBCL, and 42% had double‐expressor lymphoma (MYC and BCL2 expression). The 3‐year overall survival rate was significantly poorer in the primary progressors group than in the partial responders’ group (15% vs. 48%, p < 0.001). Four of 17 patients treated with HDC‐ASCT were primary progressors; only one patient survived without relapse. Although double‐expressor lymphoma status did not significantly impact overall survival among all patients (p = 0.794), it was identified as an independent poor prognostic factor in HDC‐ASCT‐treated patients (p = 0.002).

Conclusions

We identified a subgroup of patients with primary refractory DLBCL who may not benefit from current treatment strategies. Further treatment development is needed to improve the outcomes of these patients.

Clinicopathological factors and tumor microenvironment markers predicting watch-and-wait discontinuation in 82 patients with follicular lymphoma

OBJECTIVES

In this study, we aimed to determine the clinicopathological factors influencing the treatment-free period in patients with follicular lymphoma (FL) using a watch-and-wait (WW) strategy.

METHODS

We retrospectively assessed histopathological parameters of 82 patients with FL.

RESULTS

The median time from diagnosis to WW discontinuation was 62 months (range, 3-138), and median follow-up was 86 months (range, 3-183). Intermediate or high-risk Follicular Lymphoma International Prognostic Index score (P = .012), non-duodenal-type (P = .011), higher numbers of interfollicular CD4⁺ (P = .038) and intrafollicular FOXP3⁺ cells (P = .024) in the tumor microenvironment, and Ki-67 index ≥10% (P = .031) were significant adverse factors for WW discontinuation in univariate analyses.

CONCLUSION

Patients with adverse factors for WW discontinuation should be carefully observed during follow-up.

Immunohistochemical CD20-negative change in B-cell non-Hodgkin lymphomas after rituximab-containing therapy

CD20^- change after rituximab-containing therapy is considered one of the main reasons of rituximab resistance of B-cell non-Hodgkin lymphomas (B-NHLs). However, the clinicopathological characteristics of B-NHL with CD20^- change are not entirely understood. In this study, 252 B-NHL patients who were CD20⁺ at initial diagnosis, whose diseases relapsed or were refractory after rituximab-containing therapy, and who were re-biopsied between 2000 and 2018, were included. The median number of rituximab administration was 11 (range, 1-48). Completely negative (cCD20^-) and partially negative (pCD20^-) change of CD20 was observed in 49 (20%) and 16 (6%) cases, respectively. Among cCD20^- and pCD20^- cases, 74% and 62% of the cases changed to CD20^- at the second relapse or later, respectively. Overall survival was significantly shorter in cCD20^- follicular lymphoma (FL) cases than in CD20⁺ FL cases. Seven histopathological patterns, such as CD20^- change without histological change, histological transformation (HT) to CD20^- diffuse large B-cell lymphoma, and proliferation of plasmablastic/plasmacytoid tumor cells, were associated with CD20^- change. HT occurred more frequently in FLs with CD20^- change than in FLs continuously expressing CD20 (P < 0.0001), regardless of the timing of HT. Nine out of 25 cases (36%) showed regain or heterogeneous regain of CD20 expression. In conclusion, 20% and 6% of the 252 B-NHL cases show cCD20^- and pCD20^- changes with 7 histological patterns after rituximab-containing therapy. Because changes in morphology and CD20 expression after rituximab-containing therapy vary, and recovery of CD20 expression is not rare, careful follow-up and re-biopsy in B-NHL patients are recommended.

Alectinib, an anaplastic lymphoma kinase (ALK) inhibitor, as a bridge to allogeneic stem cell transplantation in a patient with ALK-positive anaplastic large-cell lymphoma refractory to chemotherapy and brentuximab vedotin

This is the first case report of alectinib as a bridge to allo-SCT in a patient with ALK-positive ALCL refractory to both conventional chemotherapies and BV. This report offers a ray of hope for a condition with poor prognosis.

EBV-encoded RNA1-positive cells in the bone marrow specimens of patients with EBV-negative lymphomas and sarcomas

Epstein-Barr virus (EBV) infection is associated with pathogenesis of various cancers, including extranodal natural killer/T-cell lymphoma, nasal type (ENKL). ENKL tumor cells are positive for EBV-encoded RNA1 (EBER1), which is the most useful marker to identify ENKL tumor cells in histopathology. Currently, EBER1 in situ hybridization (ISH) is recommended to evaluate bone marrow (BM) involvement of ENKL. However, the actual burden of EBER1-positive cells in normal BM specimens remains unclear. In the present study, we performed EBER1 ISH on 111 BM specimens, which were obtained during an initial staging procedure in patients with EBV-negative cancers and were also negative for BM involvement. One or more EBER1-positive cells per whole specimen were observed in 38 specimens (34%). The number of EBER1-positive cells was distributed as follows: single positive cell, n = 17; two positive cells, n = 13; three positive cells, n = 3; and four positive cells, n = 5. These findings suggest that four or fewer EBER1-positive cells can be observed in BM specimens of patients with non-EBV-related cancers. The clinical implications of a small number of EBER1-positive cells in BM specimens of patients with ENKL should be evaluated in further studies.

Clinicopathological characteristics of diffuse large B-cell lymphoma involving small and large intestines: an analysis of 126 patients

We analyzed the clinicopathologic characteristics of 136 intestinal diffuse large B-cell lymphomas (DLBCLs) among 126 patients. The DLBCL sites were categorized as: duodenum (n = 23), ileocecal region (n = 63), other small intestine (n = 29), rectum (n = 7), and other large intestine (n = 14). Patients with DLBCLs of the ileocecal region or other small intestine frequently underwent surgery for ileus or perforations (P < 0.001), were predominantly male (P = 0.042), and had a higher incidence of limited-stage disease (P = 0.001), lower International Prognostic Index (P = 0.015), and lower incidence of lactate dehydrogenase elevation (P = 0.007) than those with DLBCLs of other regions. Half of the intestinal DLBCLs exhibited the germinal center B-cell phenotype. A low-grade B-cell lymphoma background was found in 21% of the cases; the prevalence was significantly lower in the ileocecal region (13%, P = 0.025), suggesting a higher incidence of de novo DLBCLs. Intestinal follicular lymphoma (FL) and mucosa-associated lymphoid tissue (MALT) lymphoma backgrounds were observed in 10% and 0% of the cases, respectively. Five percent (5/107) of intestinal DLBCL cases were Epstein-Barr virus-encoded RNA-1 positive. The clinicopathologic characteristics of the DLBCLs differed by region. Histologic transformation of intestinal FL was observed in around 10% of the intestinal DLBCL cases.

Successful Treatment of Aggressive Mature B-cell Lymphoma Mimicking Immune Thrombocytopenic Purpura

A 55-year-old woman suffered from hemorrhagic tendency. She had severe thrombocytopenia without any hematological or coagulatory abnormalities, and a bone marrow examination revealed an increased number of megakaryocytes without any abnormal cells or blasts. No lymphadenopathy or hepatosplenomegaly was observed on computed tomography. She was initially diagnosed with immune thrombocytopenic purpura (ITP). None of the treatments administered for ITP produced a response. However, abnormal cells were eventually found during the third bone marrow examination. The pathological diagnosis was mature B-cell lymphoma. Rituximab-containing chemotherapy produced a marked increase in the patient's platelet count, and her lymphoma went into complete remission.

Paraneoplastic Pemphigus Associated with B-cell Chronic Lymphocytic Leukemia Treated with Ibrutinib and Rituximab

Paraneoplastic pemphigus (PNP) is a severe autoimmune blistering disease associated with an underlying malignancy, and its prognosis is poor. We herein report the first patient with B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL)-associated PNP successfully treated with the Bruton's tyrosine kinase inhibitor ibrutinib and rituximab. Although his PNP lesions did not improve with ibrutinib monotherapy, the combination of ibrutinib and rituximab was effective against B-CLL/SLL-associated PNP. This case suggests that ibrutinib plus rituximab may be a potent therapeutic option for B-CLL/SLL-associated PNP that is hard to control with ibrutinib alone.

Successful Cord Blood Stem Cell Transplantation for Primary Cutaneous CD8-positive Aggressive Epidermotropic Cytotoxic T-cell Lymphoma Complicated with Cerebral Infiltration

A 16-year-old boy, who had been initially examined for bilateral blepharedema and slight eruption, presented with rapidly deteriorating symptoms in associating with headache and consciousness disturbance. He was diagnosed to have primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma (PCAE-CTL) by a biopsy of the skin and brain. After whole-brain radiation and some courses of chemotherapy, cord blood transplantation was performed with myeloablative conditioning. After transplantation, the cerebral dysfunction gradually improved. Disease remission was confirmed by the disappearance of any abnormal findings on electroencephalogram and magnetic resonance imaging. PCAE-CTL is reported to be an extremely aggressive disease with a poor prognosis, but the timely performance of cord blood transplantation is considered to be a promising treatment strategy.

Forced FOG1 expression in erythroleukemia cells: Induction of erythroid genes and repression of myelo-lymphoid transcription factor PU.1

The transcription factor GATA-1-interacting protein Friend of GATA-1 (FOG1) is essential for proper transcriptional activation and repression of GATA-1 target genes; yet, the mechanisms by which FOG1 exerts its activating and repressing functions remain unknown. Forced FOG1 expression in human K562 erythroleukemia cells induced the expression of erythroid genes (SLC4A1, globins) but repressed that of GATA-2 and PU.1. A quantitative chromatin immunoprecipitation (ChIP) analysis demonstrated increased GATA-1 chromatin occupancy at both FOG1-activated as well as FOG1-repressed gene loci. However, while TAL1 chromatin occupancy was significantly increased at FOG1-activated gene loci, it was significantly decreased at FOG1-repressed gene loci. When FOG1 was overexpressed in TAL1-knocked down K562 cells, FOG1-mediated activation of HBA, HBG, and SLC4A1 was significantly compromised by TAL1 knockdown, suggesting that FOG1 may require TAL1 to activate GATA-1 target genes. Promoter analysis and quantitative ChIP analysis demonstrated that FOG1-mediated transcriptional repression of PU.1 would be mediated through a GATA-binding element located at its promoter, accompanied by significantly decreased H3 acetylation at lysine 4 and 9 (K4 and K9) as well as H3K4 trimethylation. Our results provide important mechanistic insight into the role of FOG1 in the regulation of GATA-1-regulated genes and suggest that FOG1 has an important role in inducing cells to differentiate toward the erythroid lineage rather than the myelo-lymphoid one by repressing the expression of PU.1.

Impact of TET2 deficiency on iron metabolism in erythroblasts

Sideroblastic anemia is characterized by the presence of ring sideroblasts (RSs), which are caused by iron accumulation in the mitochondria of erythroblasts and are present in both the acquired and congenital forms of the disease. However, the mechanism leading to RS formation remains elusive. Acquired sideroblastic anemia is usually observed in myelodysplastic syndrome (MDS). Because a subset of MDS harbors a somatic mutation of TET2, it may be involved in iron metabolism and/or heme biosynthesis in erythroblasts. Tet2 knockdown (Tet2^trap) induced exhibited mild normocytic anemia and elevated serum ferritin levels in 4-month-old mice. Although typical RSs were not observed, increased mitochondrial ferritin (FTMT) amounts were observed in the erythroblasts of Tet2-knockdown mice. Quantitative real-time polymerase chain reaction demonstrated significant dysregulation of genes involved in iron and heme metabolism, including Hmox1, Fech, Abcb7, and Sf3b1 downregulation. After the identification of a cytosine-guanine island in the promoters of Fech, Abcb7, and Sf3b1, we evaluated DNA methylation status and found significantly higher methylation levels at the CpG sites in the erythroblasts of Tet2-knockdown mice. Furthermore, Tet2 knockdown in erythroblasts resulted in decreased heme concentration and accumulation of FTMT. Therefore, TET2 plays a role in the iron and heme metabolism in erythroblasts.

Vibrational spectroscopic evidence for (NO)3 formation on Cu(111)

The formation of (NO)3 on Cu(111) was recently reported based on scanning tunneling microscopy observations [A. Shiotari et al., J. Chem. Phys. 141, 134705 (2014)]. We herein report studies into this system using electron energy loss spectroscopy and verify the above findings through vibrational analysis. For the surface covered with mixed isotopes of N(16)O and N(18)O, we observed four peaks corresponding to N-O stretching vibrations, which were ascribed to the four isotopic combinations of the trimer. Dynamic coupling within the trimer was evaluated from model calculations of the coupled oscillators. Furthermore, we observed hindered rotation and translation modes in the dipole scattering regime, suggesting that the molecular axis is tilted from the surface normal. These results provide spectroscopic support for the formation of (NO)3 on Cu(111).

Adsorbed states of chlorophenol on Cu(110) and controlled switching of single-molecule junctions

A molecular junction of substituted benzene (chlorophenol) is fabricated and controlled by using a scanning tunneling microscope (STM). Prior to the junction formation, the bonding geometry of the molecule on the surface is characterized by STM and electron energy loss spectroscopy (EELS). EELS shows that the OH group of chlorophenol is dissociated on Cu(110) and that the molecule is bonded nearly flat to the surface via an O atom, with the Cl group intact. We demonstrate controlled contact of an STM tip to the "available" Cl group and lift-up of the molecule while it is anchored to the surface via an O atom. The asymmetric bonding motifs of the molecule to the electrodes allow for reversible control of the junction.

Validation Study of the Malay version of the Neuropsychiatric Inventory

OBJECTIVES

There is a lack of local instruments to assess behavioural and psychological symptoms of dementia (BPSD). This 2-stage cross-sectional study was aimed at validating a Malay translated version of the Neuropsychiaric Inventory (MvNPI).

MATERIALS AND METHODS

It was conducted on a selected group of 138 elderly outpatients with dementia and their caregivers in Hospital Pulau Pinang. Severity of dementia was assessed using the Malay-translated version of Mini Mental State Examination (MMSE). The original NPI was translated and then back-translated before it was pilot-tested. The MvNPI was administered twice, a week apart on the same caregiver by the same investigator.

RESULTS

The individual items and total scale score of MvNPI had high internal consistency, with Corrected Item-Total Correlation ranging from satisfactory to good (0.41 to 0.77). The Cronbach's alpha for all the NPI domains showed high internal consistency (0.83), and subtotal for severity and distress scores were perfect (0.998 to 1.00). There was no significant difference between test-retest mean scores (p>0.05) and their correlations were perfect (0.996 to 1.00). Content validity indicated mild and inverse relationship between MMSE scores and severity, and distress score (-0.281 and -0.268, respectively, with p<0.001). Discriminant validity calculated using Mann-Whitney U test was found to be significant (p<0.001) in differentiating severity of cognitive impairment. Factor analysis revealed four possible components existed in MvNPI.

CONCLUSIONS

The MvNPI is a valid and reliable tool for assessing BPSD among Malay speaking populations of Malaysia and its neighbouring South East Asian countries.

Configuration change of NO on Cu(110) as a function of temperature

The bonding structure of nitric oxide (NO) on Cu(110) is studied by means of scanning tunneling microscopy, reflection absorption infrared spectroscopy, and electron energy loss spectroscopy at 6-160 K. At low temperatures, the NO molecule adsorbs at the short bridge site via the N end in an upright configuration. At around 50 K, this turns into a flat configuration, in which both the N and O atoms interact with the surface. The flat configuration is characterized by the low-frequency N-O stretching mode at 855 cm(-1). The flat-lying NO flips back and forth when the temperature increases to ~80 K, and eventually dissociates at ~160 K. We propose a potential energy diagram for the conversion of NO on the surface.

Sexual dysfunction among postmenopausal women

INTRODUCTION AND OBJECTIVE

Female sexual dysfunction (FSD) has a major impact on interpersonal relationships and quality of life. For many women it has been emotionally distressing, physically disconcerting, and socially disruptive. To determine the prevalence and factors that contribute to female sexual dysfunction (FSD) and to evaluate the different sexual domains that influence sexual function amongst post menopausal women.

MATERIALS AND METHODS

This was a cross-sectional study among postmenopausal women attended the Menopause Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). It was conducted over a period of one year. A validated English and Malay Version of the Female Sexual Function Index (FSFI) were used to assess female sexual function.

RESULTS

The median age of menopause in this study population was 50 years and majority of these patients was on hormonal therapy (58.2%). The prevalence for sexual dysfunction was high (85.2%). The most affected sexual domains were: dissatisfaction (89.0%), arousal (67.0%) and desire (62.4%). Factors associated with sexual dysfunction among post menopausal women that were statistically significant were age more than 60 (p=0.033), lower educational level (p<0.001), and type of menopause (p=0.029). Women with naturally occurring menopause were found to be 2.5 times more likely to have sexual dysfunction.

CONCLUSIONS

The prevalence of sexual dysfunction among post menopausal women was high. The most affected domains were satisfaction, desire and arousal. The associated factors were older age, lower education level, and type of menopause.

Effects of Selective Serotonin Reuptake Inhibitors (SSRIs) therapy on the female sexual response cycle of women with major depression

OBJECTIVE

Depression and its treatment may influence all aspects of the female sexual function from desire to sexual satisfaction. This study aimed to examine the components of the female sexual response cycle (SRC) of women with major depression treated with Selective Serotonin Reuptake Inhibitors.

MATERIALS AND METHODS

The correlations structure of the items of the SRC's phases (i.e. desire, arousal, orgasm, satisfaction and pain) in a validated Malay version of Female Sexual Function Index (FSFI) was determined using principal component analysis (PCA), with varimax rotation method. The number of factors obtained was decided using Kaiser's criteria. Factor loadings using PCA with varimax rotation divided the sexual domains into three components based on Kaiser's criteria.

RESULTS

Sexual desire, sexual arousal, lubrication and orgasm were highly correlated, to form a "sexual drive" construct. Sexual satisfaction and pain made up the second and third components, respectively. SSRIs may affect the components of the SRC causing highly overlapping constructs of sexual drive including orgasm. Recognizing this helps strategizing the treatment approach of female sexual dysfunction in depression particularly in relation to the role of SSRIs.

Associated risk factors to Non-compliance to Methadone Maintenance Therapy

The escalating problem of opiate dependence in Malaysia and the limitations of regimental approach of forced admission to rehabilitation centres had triggered the government to expand the methadone maintenance therapy to become a national programme. This study aimed to evaluate the short-term outcomes of the Methadone Maintenance Therapy programme in one of the busiest hospital in east coast Malaysia. We also explored the prevalence on non-compliance and factors associated to it. A total of 172 patient case notes at Methadone Clinic Hospital Tengku Ampuan Afzan (HTAA) were retrieved for relevant data. A short survey was also conducted to determine the subjects' current employment and marital status. The programme's retention rate was 62% and factors associated with poor compliance were unemployment, low quality of life scores and low dose of methadone. A special attention on the patients with these three risk factors may improve their compliance to MMT. The short-term evaluation of MMT at HTAA revealed favourable findings.

CD20-positive and CD4/CD8-double-negative peripheral T-cell lymphoma of spleen complicated with severe disseminated intravascular coagulation and enteropathy

A 71-year-old woman presented with massive splenomegaly. Open splenectomy was performed, and the diagnosis of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), was made, with a characteristic immunophenotype of CD3(+), CD4(-), CD8(-), T-cell receptor (TCR)αβ(+), and TCRγδ(-). After splenectomy, she suffered abrupt exacerbation of the lymphoma with disseminated intravascular coagulation and enteropathy. Although chemotherapy was started, her medical condition did not improve and she died a week later. Postmortem reevaluation of the pathological specimen confirmed her diagnosis as CD20(+) PTCL-NOS. Although it is a rare disease entity, CD20(+) T-cell lymphoma can demonstrate aggressive clinical behavior.

Vaginismus and subfertility: case reports on the association observed in clinical practice

OBJECTIVE

To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman's wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms.

METHOD

We report a series of cases of Malaysian women who had been suffering from vaginismus and 'infertility'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety.

CONCLUSION

The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.

A metallic surface state with uniaxial spin polarization on Tl/Ge(111)-(1 × 1)

We show that a metallic surface state is formed on Tl/Ge(111)-(1 × 1). The surface state forms electron pockets around K of the surface Brillouin zone. A first-principles calculation reveals that the electron pockets are composed of a single branch of a spin-split surface-state band. The spin quantization axis is along the surface normal and inverts according to the time-reversal symmetry. Since this spin-split branch is the unique metallic band on this surface, the surface conductivity should be governed by this spin-split branch, suggesting a possible spin-polarized electric current.

H-atom relay reactions in real space

Hydrogen bonds are the path through which protons and hydrogen atoms can be transferred between molecules. The relay mechanism, in which H-atom transfer occurs in a sequential fashion along hydrogen bonds, plays an essential role in many functional compounds. Here we use the scanning tunnelling microscope to construct and operate a test-bed for real-space observation of H-atom relay reactions at a single-molecule level. We demonstrate that the transfer of H-atoms along hydrogen-bonded chains assembled on a Cu(110) surface is controllable and reversible, and is triggered by excitation of molecular vibrations induced by inelastic tunnelling electrons. The experimental findings are rationalized by ab initio calculations for adsorption geometry, active vibrational modes and reaction pathway, to reach a detailed microscopic picture of the elementary processes.

Imaging sequential dehydrogenation of methanol on Cu(110) with a scanning tunneling microscope

Adsorption of methanol and its dehydrogenation on Cu(110) were studied by using a scanning tunneling microscope (STM). Upon adsorption at 12 K, methanol preferentially forms clusters on the surface. The STM could induce dehydrogenation of methanol sequentially to methoxy and formaldehyde. This enabled us to study the binding structures of these products in a single-molecule limit. Methoxy was imaged as a pair of protrusion and depression along the [001] direction. This feature is fully consistent with the previous result that it adsorbs on the short-bridge site with the C-O axis tilted along the [001] direction. The axis was induced to flip back and forth by vibrational excitations with the STM. Two configurations were observed for formaldehyde, whose structures were proposed based on their characteristic images and motions.

Water clusters on Cu(110): chain versus cyclic structures

Water clusters are assembled and imaged on Cu(110) by using a scanning tunneling microscope. Water molecules are arranged along the Cu row to form "ferroelectric" zigzag chains of trimer to hexamer. The trimer prefers the chain form to a cyclic one in spite of the reduced number of hydrogen bonds, highlighting the crucial role of the water-substrate interaction in the clustering of adsorbed water molecules. On the other hand, the cyclic form with maximal hydrogen bonds becomes more favorable for the tetramer, indicating the crossover from chain to cyclic configurations as the constituent number increases.

Imaging covalent bonding between two NO molecules on Cu(110)

Using a scanning tunneling microscope, we found metastable upright NO on Cu(110) with the 2π* molecular resonance at the Fermi level. Upon heating above 40 K, it converts to a bent structure with the loss of molecular resonance. By manipulating the distance between two upright NO, we controlled the overlap between 2π* orbitals and observed its splitting below and above the Fermi level, thus visualizing the covalent interaction between them.

Direct observation of hydrogen-bond exchange within a single water dimer

The dynamics of water dimers was investigated at the single-molecule level by using a scanning tunneling microscope. The two molecules in a water dimer, bound on a Cu(110) surface at 6 K, were observed to exchange their roles as hydrogen-bond donor and acceptor via hydrogen-bond rearrangement. The interchange rate is approximately 60 times higher for (H2O)2 than for (D2O)2, suggesting that quantum tunneling is involved in the process. The interchange rate is enhanced upon excitation of the intermolecular mode that correlates with the reaction coordinate.

Adsorbed states and scanning tunneling microscopy induced migration of acetylene on Cu(110)

The authors have studied adsorption of acetylene on Cu(110) by means of low-temperature scanning tunneling microscopy. Adsorbed molecules preferentially aggregate at 40 K to yield dimer, trimer, and larger islands on the surface. Isolated species (monomer) adsorbs on the fourfold hollow site with approximately sp3 rehybridization as characterized by inelastic electron tunneling spectroscopy. Tunneling electron induces an acetylene molecule to migrate along the trough of Cu(110). The migration proceeds in two steps: the molecule first hops to the adjacent long-bridge site and then to the next fourfold site. The voltage and current dependencies of the hopping probability show that the migration is induced by inelastic electron tunneling that causes vibrational excitation of mainly C-H stretch mode.

Role of Nup98 in nuclear entry of human immunodeficiency virus type 1 cDNA

Human immunodeficiency virus type 1 (HIV-1), like other lentiviruses, can infect non-dividing cells. The lentiviruses are most likely to have evolved a nuclear import strategy to import HIV-1 cDNA and viral protein complex through the nuclear pore complex (NPC) formed by nucleoporin proteins (Nup). In this study, we found that synthesis of integrated and 2LTR but not full-length form of HIV-1 cDNA was clearly impaired in culture via transduction of vesicular stomatitis virus matrix protein (VSV M), an inhibitor protein, through binding to the phenylalanine-glycine (FG) repeat region of Nup98. The impairment of synthesis of integrated and 2LTR DNA with VSV M was restored by ectopic overexpression of Nup98. A series of experiments using Nup98-depleted NPC by the small interfering RNA (siRNA) technique showed specific impairment of NPC structure and some functions, including nuclear import of HIV-1 cDNA. Our results suggest that Nup98 on the NPC specifically participates in the nuclear entry of HIV-1 cDNA following HIV-1 entry.

Identification of two cDNAs for human actin-related proteins (Arps) that have remarkable similarity to conventional actin

We identified two cDNAs coding for the novel human actin-related proteins (Arps) hArpM1 and hArpM2. Both of them show remarkable similarity to conventional actin, and the ATP-binding motif and nuclear-export signals of actin are highly conserved. Their mRNAs are expressed in all tested human tissues, but in smaller amounts than that of actin. These features suggest that hArpM1 and M2 are involved in cytoskeletal organization like other cytoplasmic Arp subfamilies.

Clinical application of full-arc, depth-dependent, astigmatic keratotomy

PURPOSE

To report a case series of the first clinical application of a new method of astigmatic keratotomy termed full-arc, depth-dependent astigmatic keratotomy (FDAK).

METHODS

The type of astigmatism was analyzed by corneal topography. If the astigmatism was regular, paired arcuate incisions of 90 degrees length were used. Incision depth varied between 40% and 75% of local corneal thickness for controlling the level of astigmatic correction.

RESULTS

All 13 cases had regular astigmatism, and paired arcuate incisions of 90 degrees length were used. Four cases with incisions at 40% depth, five cases at 50% depth, three cases at 60% depth, and one case at 75% depth induced vector astigmatic change of 0.93 +/- 0.33 D, 1.92 +/- 0.24 D, 3.17 +/- 0.26 D, and 4.44 D, respectively, 3 months after surgery. From 3 months to 1 year or 3 years, the postoperative astigmatism was stable, and no cases showed astigmatic regression of 0.50 D or more. Every topographic difference map indicated effective flattening and steepening occurring with a 1:1 coupling ratio. All postoperative color maps showed a marked improvement in corneal sphericity.

CONCLUSIONS

In FDAK using paired 90 degrees incisions at 40-75% depth, an almost linear relationship between the incision depth and degree of astigmatic change was observed. FDAK may be an effective and safe method of astigmatic keratotomy that accurately controls the level of astigmatic correction. More clinical applications are necessary for drawing final conclusions and making a nomogram.

Management of posterior capsule rupture during phacoemulsification using the dry technique

To manage posterior capsule rupture during phacoemulsification, we use a dry technique in which all procedures are performed without an irrigation/aspiration system. The dry technique is characterized by (1) continuous viscoelastic injection instead of fluid irrigation to maintain anterior chamber depth with the posterior capsule and vitreous located posteriorly and (2) static removal of most residual lens material by viscoexpression and/or manual small incision extracapsular cataract extraction without aspiration and dynamic water flow. In 16 cases of posterior capsule rupture managed using the dry technique, the residual nucleus and cortex were readily removed with minimum extension of the ruptured area and new vitreous loss. Although large amounts of viscoelastic material (mean 5.8 mL) were required, rapid and stable visual recovery was comparable to that in patients having uneventful surgery. The dry system is a safe and reliable technique for managing posterior capsule rupture during phacoemulsification.

Experimental study using pig eyes for realizing ideal astigmatic keratotomy

PURPOSE

The effects of varying the incision length and depth were analyzed using pig eyes to acquire information for realizing an ideal method of astigmatic keratotomy (AK).

METHODS

Single and paired arcuate incisions were made on pig corneas using a diamond knife. Incisions with varying lengths of 40 degrees, 60 degrees, and 90 degrees were made with the incision depth fixed at 90% of corneal thickness. Next, paired incisions with varying incision depth from 20% to 95% of corneal thickness were made with the incision length fixed at 90 degrees. The changes in corneal shape were analyzed using corneal topography and the degrees of astigmatic change were measured using a surgical keratometer.

RESULTS

For short single and paired incisions (40 degrees or 60 degrees in length), narrow areas of flattenings occurred, and steepenings were observed on both sides adjacent to the flattened areas. For long paired incisions of 90 degrees length, wide areas of flattenings and steepenings were observed with an approximately 1:1 coupling ratio, and a positive linear relationship between the incision depth and degree of astigmatic change was observed in the range of incision depth between 40% and 80% of corneal thickness.

CONCLUSION

This experimental study suggests that for achieving ideal corneal sphericity after AK, long incisions covering the entire steep areas (paired 90 degrees incisions for regular astigmatism) should be used and the degree of astigmatic correction may be controlled by varying the incision depth.

Guided knives

A new type of knife that enables a surgeon to easily create tunnel-shaped incisions with a prescribed depth has been developed. The knife features an incision guide, the arm of which extends just beyond the tip of the blade. The space between the blade and the arm can be set at the desired width. By moving the knife as if sliding the arm across the corneal or scleral surface, the blade can move to a certain depth from the surface. The guided knife enables even novice surgeons to easily make a self-sealing incision during cataract surgery. In addition, the innovative nature of this device seems to be applicable to many other surgeries that require a partial-thickness incision.

Controlling astigmatism in cataract surgery requiring relatively large self-sealing incisions

PURPOSE

To evaluate the results of a modified self-sealing incision for achieving astigmatic neutrality in cataract surgery requiring a 6.0 to 7.0 mm incision as well as the methods of correcting preexisting astigmatism using these incisions.

SETTING

Department of Ophthalmology, Kushimoto Rehabilitation Center, Kushimoto, Japan.

METHODS

To achieve astigmatic neutrality, a frown-shaped, oblique incision-the BENT (between 9 and 12 o'clock) frown-was used. To reduce preexisting against-the-rule or with-the-rule astigmatism, the incisions were placed on the temporal or superior steep astigmatic axis, respectively. A frown incision was used when aiming for mild astigmatic reduction and an arcuate incision when aiming for relatively large astigmatic reduction.

RESULTS

In the 6.0 to 7.0 mm BENT frown incision group, mean flattening was minimal throughout 6 months of follow-up, with a maximum of 0.18 diopter (D) 1 week postoperatively. Surgically induced astigmatism was less than that with other incisions. Ninety-four percent of cases had a difference in absolute astigmatism of less than 0.50 D between preoperatively and 6 months postoperatively. Relatively large flattening was observed in eyes with 6.0 to 7.0 mm steep-axis incisions of superior arcuate, temporal arcuate, superior frown, and temporal frown, with means of 1.03, 0.79, 0.64, and 0.52 D, respectively, at 6 months. Ninety-eight percent of cases had a reduction in preexisting absolute astigmatism postoperatively.

CONCLUSIONS

In cataract surgery using relatively large scleral self-sealing incisions, the BENT frown incision effectively achieved astigmatic neutrality. The incisions on the temporal or superior steep astigmatic axis (with selective shape) reduced astigmatism in almost all cases.

Bilobalide prevents reduction of gamma-aminobutyric acid levels and glutamic acid decarboxylase activity induced by 4-O-methylpyridoxine in mouse hippocampus

We previously reported that bilobalide, a constituent of Ginkgo biloba L. leaves, protected mice against convulsions induced by 4-O-methylpyridoxine (MPN). To elucidate the mechanism of the anticonvulsant activity of bilobalide, this study examined the effect of bilobalide on MPN-induced changes in the levels of gamma-aminobutyric acid (GABA) and glutamate, and in the activity of glutamic acid decarboxylase (GAD) in the hippocampus, cerebral cortex and striatum of the mouse. GABA levels and GAD activity in the hippocampus and cerebral cortex were significantly enhanced by bilobalide treatment (30 mg/kg, p.o., for 4 days) alone. MPN significantly decreased GABA levels and GAD activity in the three brain regions tested compared with those in the control. Pretreatment with bilobalide effectively suppressed the MPN-induced reduction in GABA levels and GAD activity in the hippocampus and cerebral cortex. On the other hand, there were no significant differences in the glutamate levels in the three regions despite various treatments. These results suggested that bilobalide prevents MPN-induced reduction in GABA levels through potentiation by bilobalide of GAD activity, and this effect of bilobalide contributes to its anticonvulsant effect against MPN-induced convulsions.

Manual sutureless cataract surgery using a claw vectis

Two-handed sandwich methods of extracapsular cataract extraction using a self-sealing incision have proved difficult for many inexperienced surgeons. We developed a simpler 1-handed technique using a claw vectis-a vectis with a claw placed on its tip. When the nucleus is pulled through the scleral tunnel, it is fixed by the claw and is smoothly removed from a wound of a size comparable to that in the sandwich method. During nucleus removal, viscoelastic material is constantly injected through the irrigation vectis to maintain the anterior chamber depth, resulting in a low incidence of complications. We have performed 620 cases using the technique and found it safe and easy for both novice and experienced surgeons.