Invasive infection caused by Penicillium marneffei: an emerging pathogen in Taiwan.
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Adolescent↗
Biomedical subjects
S C Chang
Publications and source records attributed to S C Chang.
Transzygomatic coronoidectomy through an extended coronal incision for treatment of trismus due to an osteochondroma of the coronoid process of the mandible.
Osteochondroma is the most common benign tumor of the skeletal system. In the craniofacial skeleton, however, osteochondroma is uncommon. Even more rare is osteochondroma of the coronoid process. A review of the literature reveals only 31 reported cases of osteochondroma of the coronoid process of the mandible. The preponderance of patients were young men (67.7%) and most presented with a facial deformity. As a benign tumor, the problems with surgical treatment have dealt with the inaccessibility of the lesion and hence the surgical approach of choice. The previous surgical approaches have either been intraoral, external, or a combination of both. We present a transzygomatic approach via a coronal incision that gives excellent access and a good cosmetic result, and protects the facial nerve from damage.
Bone Plates↗
Smoking-associated mitochondrial DNA mutations and lipid peroxidation in human lung tissues.
To investigate the effect of cigarette smoking on mitochondrial DNA (mtDNA) mutation and lipid peroxidation in lung tissues, 152 samples from lung resections were collected. A novel deletion of 4,839 bp of mtDNA was found in 80 (52.6%) of the 152 lung samples. The breakpoints of the 4,839-bp mtDNA deletion were flanked by a nine-nucleotide direct repeat (5'-CATACACAA-3'). The frequency of occurrence and the proportion of the 4,839-bp mtDNA deletion in the lung increased significantly with the smoking index in terms of pack-years (P < 0.05). The incidence and proportion of the 4,839-bp mtDNA deletion in the lung tissues of current smokers were significantly higher than in those of nonsmokers (P < 0.05). In addition, we found that the content of lipid peroxides in the lung tissues of the smokers was significantly higher than in that of nonsmokers, and increased with the smoking index. The average malondialdehyde level in the lung tissues was 12.81 +/- 4.99 micromol/g for subjects with a smoking index of more than 50 pack-yr, and was 5.39 +/- 0.48 micromol/g for nonsmokers (P < 0.05). Multiple regression analysis showed that the smoking index, tissue lipid-peroxide content, and FEV1/FVC ratio were correlated with the proportion of the 4,839-bp mtDNA deletion in the lung. These results suggest that cigarette smoke plays an important role in the increase in mtDNA mutation and lipid peroxidation in the lung tissues of smokers.
Adult↗
An effective analytical psychotherapy in crosscultural context. An East Asian student in the United States.
An effective analytical psychotherapy of a severe anxiety disorder with panic, in a crosscultural context of East Asia and the United States, specifically a Japanese student studying English, is presented. What was crucial in facilitating the therapeutic process was an introduction of analytical way of looking at life born of Western culture into an integrative orientation of Asian culture and mentality.
Acculturation↗
Cerebral air embolism complicating bilevel positive airway pressure therapy.
A 13 yr old male with acute lymphoblastic leukaemia who received bilevel positive airway pressure ventilation via a face mask for post-transplant pneumonitis developed subcutaneous emphysema, radiographic evidence of pulmonary interstitial emphysema, pneumomediastinum and 6 h later, right hemiparesis and focal livedo reticularis. This case illustrates that severe barotrauma may complicate noninvasive bilevel positive airway pressure ventilation.
Adolescent↗
Site-directed mutagenesis of large plasmids.
A protocol combining recombination PCR and long-distance PCR is demonstrated to be highly accurate and rapid for site-directed mutagenesis of large (> 10 kb) plasmids. Application of this protocol to the generation of mutant rabies virus glycoproteins expressed by the baculovirus/insect cell system illustrates the usefulness of this approach in facilitating structure-function relationships in this important eukaryotic expression system.
Animals↗
Efficacy and adverse effects of higher dose amphotericin B monotherapy for cryptococcal meningitis in patients with advanced HIV infection.
Treatment with a low daily dose of amphotericin B (0.4 mg/kg) in AIDS patients with cryptococcal meningitis has been associated with low efficacy and high mortality. We report our successful clinical experiences on a higher daily dose of amphotericin B (0.8-1.0 mg/kg) monotherapy in treating cryptococcal meningitis from June 1994 to August 1997 in 13 cases of advanced HIV infection. Most of them (12/13) had at least one of several poor prognostic factors. The mean duration of amphotericin B administration was 26 days (range, 3 to 58 days). Both microbiologically and clinically successful rates of treatment at the end of amphotericin B therapy were high (85%, 11/13). The median duration of negative CSF culture post therapy was 17 days (range, 8 to 33 days). Bone marrow toxicities were; thrombocytopenia (46%) and significant anemia (92%) after a mean of 9 days of treatment. Both, impaired renal function and hypokalemia, were seen in 10 cases (77%), while elevation of amylase and lipase values were present in 6 cases (46%). Our report reveals that a higher daily dose of amphotericin B can achieve a high efficacy in treatment of cryptococcal meningitis in AIDS patients, even though most cases had poor prognostic factors and were in severe immunocompromised states. However, clinicians should monitor higher dose-related adverse effects carefully.
AIDS-Related Opportunistic Infections↗
Tuberculous peritonitis: analysis of 35 cases.
Thirty five patients with tuberculous peritonitis were studied retrospectively. Tuberculous peritonitis was defined as the isolation of Mycobacterium tuberculosis from ascites or dialysate, and/or caseating granuloma/acid-fast bacilli from peritoneal biopsy specimens from patients with pulmonary tuberculosis or a response to treatment for tuberculosis. Among the patients studied, nine with cirrhosis of the liver; seven with diabetes mellitus and six with end-stage renal disease, of whom four had undergone continuous ambulatory peritoneal dialysis. The most frequent signs of tuberculous peritonitis included ascites, fever and anemia. Ascites was found in 31 patients (89%). Abnormal findings on chest radiographs were found in 26 patients (74%), of whom 22 patients (63%) had pleural effusion and five had miliary lung lesions. Seven out of 35 patients were found to have positive culture of sputum or pleural effusion for M. tuberculosis. Two patients were found to have concomitant tuberculous peritonitis and enteritis. Multiple organ involvement was found in eight patients. Eleven patients (31%) died: eight were older than 60 years; six had cirrhosis of the liver and nine were diagnosed post-mortemly. In Taiwan, tuberculous peritonitis should be considered in patients with abnormality of chest radiography and nonresolving peritonitis.
Adolescent↗
Capnocytophaga bacteremia: clinical features of patients and antimicrobial susceptibility of isolates.
Capnocytophaga has been recognized as an opportunistic pathogen causing systemic infections in immunocompromised individuals with granulocytopenia and oral ulceration. Treatment of Capnocytophaga infection is often empiric. We retrospectively analyzed the clinical features of all patients with Capnocytophaga bacteremia seen at the National Taiwan University Hospital between January 1981 and December 1996 and the antimicrobial susceptibility of the isolates recovered from these patients. All the patients had underlying diseases, namely neoplastic disease (9 patients), hyperthyroidism (1), and bronchiectasis and tetralogy of Fallot (1). The clinical features of these patients were primary bacteremia (10) and pneumonia (1). Nine patients had nosocomial bacteremia and 10 patients had monomicrobial bacteremia. None had septic shock. All the patients responded well to appropriate antimicrobial therapy and survived. All isolates were susceptible to amoxicillin-clavulanate, imipenem, ciprofloxacin, erythromycin, clindamycin, tetracycline, and chloramphenicol but resistant to aminoglycosides and sulfamethoxazole-trimethoprim. The susceptibilities to penicillin, ampicillin, piperacillin, cephalosporins, and aztreonam were variable. Capnocytophaga bacteremia should be included in the differential diagnosis of febrile neutropenia in immunocompromised patients, especially in the presence of oral mucositis and ulceration.
Adolescent↗
Interstitial photodynamic therapy in the canine prostate with disulfonated aluminum phthalocyanine and 5-aminolevulinic acid-induced protoporphyrin IX.
BACKGROUND: Photodynamic therapy (PDT) is an experimental approach for treating prostate cancer localized to the gland that does not involve surgery or irradiation. Second-generation photosensitizers 5-aminolevulinic acid (ALA) and aluminum disulfonated phthalocyanine (AlS2Pc) were studied in the normal canine prostate. METHODS: Tissue biodistribution of photosensitizers on serial biopsies was examined using fluorescence microscopy. Photodynamic therapy was done by delivering red light interstitially at 100 mW through fibers placed under transrectal ultrasound guidance. RESULTS: Peak levels of AlS2Pc appeared at 5-24 hr and at 3 hr for ALA. Macroscopic PDT lesions were up to 12 mm in diameter using AlS2Pc, but only 1-2 mm with ALA. Light at 300 mW caused thermal lesions. At 28 days, damaged glands remained atrophic, but the interlobular supporting stroma was well-preserved. Urethral lesions healed by 28 days without functional impairment. CONCLUSIONS: Although the results with ALA were disappointing, PDT using AlS2Pc looks like a promising modality for treatment of localized prostate cancer.
Aminolevulinic Acid↗
Variations in oligosaccharide-protein interactions in immunoglobulin G determine the site-specific glycosylation profiles and modulate the dynamic motion of the Fc oligosaccharides.
Glycoproteins, such as immunoglobulin G (IgG), consist of an ensemble of glycosylated variants, or glycoforms, which have different oligosaccharides attached to a common peptide. Alterations in the normal glycoform populations of IgG are associated with certain disease states, notably rheumatoid arthritis and its remission during pregnancy. In this paper, we show that two sets of IgG Fc glycoforms have quite different physical properties. The first set has 1,6 arm terminal galactose residues which interact with the protein, resulting in glycan binding to the protein surface, in agreement with the crystal structure. In contrast, the second set of glycoforms which lack galactose does not bind to the protein surface. Recently developed HPLC techniques combined with enzymatic digestion and mass spectrometry have been used to assign the glycan structures on IgG, Fab, and Fc. Comparison of Fab with Fc shows that glycosylation is site-specific. Two major glycan structures are present on Fab (fucosylated digalacto-bianntenary with and without bisect) and three on Fc (fucosylated agalacto-, 1,6 arm monogalacto-, and digalacto-bianntenary). In comparison to Fab, Fc glycans contain (i) lower levels of bisecting GlcNAc, (ii) lower levels of galactose, (iii) higher than expected levels of 1,6 arm galactose relative to 1,3 arm, and (iv) no 1,6 arm sialylation. We interpret these differences to indicate a role for both the protein quaternary structure and specific protein-glycan interactions in determining the glycoform populations. NMR relaxation measurements have been used to probe the mobility of the glycans in the Fc. By comparing two samples with different glycoform populations, we conclude that this mobility is dependent on the primary sequence of the glycan. Glycans carrying a galactose residue on the 1,6 arm have relaxation properties very similar to those of the peptide backbone and thus do not have independent motion. Glycans lacking galactose have relaxation rates 30 times slower than that of the peptide and thus a higher degree of mobility. These agalactosyl glycans do not interact with the protein, resulting in exposure of previously covered regions of the peptide surface and making the glycan more accessible. This implies that at the early stages of glycan processing the Fc glycans are mobile and only partially protected by the protein quaternary structure. Immobilization of the glycans occurs as a consequence of addition of galactose to the 1,6 arm and results in increased protection.
Carbohydrate Sequence↗
The wheat poly(A)-binding protein functionally complements pab1 in yeast.
Poly(A)-binding protein (PAB) binds to the poly(A) tail of most eukaryotic mRNAs and influences its translational efficiency as well as its stability. Although the primary structure of PAB is well conserved in eukaryotes, its functional conservation across species has not been extensively investigated. In order to determine whether PAB from a monocot plant species could function in yeast, a protein characterized as having PAB activity was purified from wheat and a cDNA encoding for PAB was isolated from a wheat seedling expression library. Wheat PAB (72 kDa as estimated by SDS/PAGE and a theoretical mass of 70 823 Da as determined from the cDNA) was present in multiple isoforms and exhibited binding characteristics similar to that determined for yeast PAB. Comparison of the wheat PAB protein sequence with PABs from yeast and other species revealed that wheat PAB contained the characteristic features of all PABs, including four RNA binding domains each of which contained the conserved RNP1 and RNP2 sequence motifs. The wheat PAB cDNA functionally complemented a pab1 mutant in yeast suggesting that, although the amino acid sequence of wheat PAB is only 47% conserved from that of yeast PAB, this monocot protein can function in yeast.
Amino Acid Sequence↗
Roles of the signal peptide and mature domains in the secretion and maturation of the neutral metalloprotease from Streptomyces cacaoi.
The neutral metalloprotease (Npr) of Streptomyces cacaoi is synthesized as a prepro-Npr precursor form consisting of a secretory signal peptide, a propeptide and the mature metalloprotease. The maturation of Npr occurs extracellularly via an autoproteolytic processing of the secreted pro-Npr. The integrity of the propeptide is essential for the formation of mature active Npr but not for its secretion [Chang, Chang and Lee (1994) J. Biol. Chem. 269, 3548-3554]. In this study we investigated whether the secretion and maturation of Npr require the integrity of its signal peptide region and mature protease domain. Five signal peptide mutants were generated, including the substitution mutations at the positively charged region (mutant IR6LE), the central hydrophobic region (mutants GI19EL and G19N), the boundary of the hydrophobic core-cleavage region (mutant P30L) and at the residues adjacent to the signal peptidase cleavage site (mutant YA33SM). All these lesions delayed the export of Npr to the growth medium and also resulted in a 2-10-fold decrease in Npr export. The most severe effect was noted in mutants GI19EL and P30L. When these signal peptide mutations were fused separately with the propeptide lacking the Npr mature domain, the secretory defect on the propeptide was also observed, and this impairment was again more severely expressed in mutants GI19EL and P30L. Thus the Npr signal peptide seems to have more constraints on the hydrophobic core region and at the proline residue within the boundary of the hydrophobic core-cleavage site. Deletion mutations within the C-terminal mature protease domain that left its active site intact still blocked the proteolytic processing of mutant precursor forms of pro-Npr, although their secretions were unaffected. These results, together with our previous findings, strongly suggest that the signal peptide of Npr plays a pivotal role in the secretion of both Npr and the propeptide, but not in the maturation of Npr. On the contrary, the integrity of mature domain and propeptide is not critical for secretion of the Npr derivative but is essential for the formation of a functional Npr. Therefore the secretion and maturation of Npr are dependent on the integrity of the signal peptide, propeptide and mature protease domains, and the roles of these domains in this regard are functionally distinct.
Amino Acid Sequence↗
5-Aminolevulinic acid (ALA)-induced protoporphyrin IX fluorescence and photodynamic effects in the rat bladder: an in vivo study comparing oral and intravesical ALA administration.
BACKGROUND AND OBJECTIVE: Photodynamic therapy (PDT) using 5-aminolevulinic acid (ALA)-induced protoporphyrin IX (PpIX) for sensitization is a promising treatment for carcinoma in situ and diffuse premalignant changes of the bladder. We studied the biodistribution of PpIX in a range of tissues with oral and intravesical routes of administration of ALA and compared the photodynamic effects on bladder and skin. STUDY DESIGN/MATERIALS AND METHODS: Normal Wistar rats were given oral or intravesical ALA and PpIX levels in the liver, kidney, skin, and bladder measured by fluorescence microscopy on tissue sections. At the time of maximum PpIX levels, the bladder and skin on the back were illuminated with light at 630 nm and the PDT effects compared. RESULTS: PpIX fluorescence in the urothelium after 200 mg/kg given intravesically was comparable to that found after 100 mg/kg orally. The ratio of PpIX levels between the urothelium and the underlying muscle was the same for both routes of administration, although there appeared to be more selectivity of urothelial PDT necrosis after intravesical administration. Skin photosensitization was greater after oral ALA, the epidermal PpIX level being three times higher than after intravesical administration for comparable urothelial levels and the PDT effect being more marked. CONCLUSIONS: Intravesical instillation is preferable to oral administration of ALA for PDT ablation of the urothelium of the rat bladder without damage to the underlying tissue layers and for minimizing skin photosensitivity. The technique is now ready for clinical trials.
Administration, Intravesical↗
Social anxiety (phobia) and east Asian culture.
Since the introduction of the concept of social anxiety (or phobia) to the American nosological system in DSM-III (1980), it has become increasingly apparent that the condition is also prevalent in other cultures. In Japan, for example, the condition, called taijinkyofusho (usually abbreviated as TKS in English), is widespread and has been extensively discussed since the turn of the century, a fact not well known in the English-speaking psychiatric community. In comparing social phobia in Japanese society (and in other East Asian societies) with North American societies, two questions stand out. First, if TKS is social phobia, why is it so different from the American form of social phobia? In particular, why do typical TKS patients fear the possibility of distressing, and even harming, others, whereas their American counterparts feel anxious at the possibility of being embarrassed by others? In other words, why is TKS other-oriented (allocentric), whereas social phobia is self-oriented (egocentric)? Second, is TKS specific to Japanese culture? In this paper, I suggest that the allocentric nature of TKS reflects those elements of Japanese culture that are common to East Asian societies as seen in their pattern of child-rearing practices, language, and social ideals. In short, TKS is an East Asian cultural patterning of social anxiety (phobia).
Adult↗
Haemophilus aphrophilus bacteraemia complicated with vertebral osteomyelitis and spinal epidural abscess in a patient with liver cirrhosis.
Haemophilus aphrophilus is rarely implicated as an aetiology of spinal epidural abscess. A 73-year-old woman with liver cirrhosis who developed H. aphrophilus bacteraemia complicated with vertebral osteomyelitis and spinal epidural abscess is presented. Without surgical decompression, she was successfully treated with cefotaxime for 3 weeks, followed by maintenance with ciprofloxacin for another 10 weeks. The clinical features of eight previously reported cases of vertebral osteomyelitis without epidural abscess due to H. aphrophilus are reviewed.
Abscess↗
Therapeutic effects of diuretics and paracentesis on lung function in patients with non-alcoholic cirrhosis and tense ascites.
BACKGROUND/AIMS: Ascites may cause or aggravate pulmonary dysfunction in patients with liver cirrhosis. Diuretics and paracentesis are the main therapies for ascites. The aim of the present study was to evaluate and compare the therapeutic effects of diuretics and large-volume paracentesis on lung function in 26 male patients with non-alcoholic cirrhosis and tense ascites. METHODS: The patients were divided into two groups. Group A was composed of 13 subjects who were treated with diuretics including spironolactone (100-400 mg/day) and furosemide (80-320 mg/day). In group B, 13 subjects received large-volume paracentesis plus intravenous albumin (6-8 g/l ascites removed). Pulmonary function tests including spirometry, plethysmography, single-breath carbon-monoxide diffusing capacity (DLco) and arterial blood gases, were done 1 day before diuretic treatment and 1 day after termination of the study in group A patients, and 1 day before and after large-volume paracentesis in group B subjects. RESULTS: Before treatment, the clinical and laboratory data were comparable between the two groups. After treatment, ventilatory function as evidenced by forced expiratory volume in 1 s, forced vital capacity, total lung capacity, functional residual capacity and expiratory reserve volume, and DLco increased significantly in both groups. Arterial PO2 and PCO2 increased significantly and AaPO2 (alveolar-arterial PO2 difference) decreased significantly in the subjects treated with diuretics. Nevertheless, paracentesis did not improve arterial blood gases. The changes in lung volumes, DLco and PaO2 after treatment (the data after minus those before treatment) were comparable, except that a significant decrease in AaPO2 was observed in the diuretic group. CONCLUSIONS: Both diuretic therapy and large-volume paracentesis significantly improved the ventilatory function in patients with tense cirrhotic ascites. In terms of oxygenation improvement as evaluated by AaPO2, diuretic treatment may be superior to large-volume paracentesis.
Aged↗
Outbreak of scarlet fever at a hospital day care centre: analysis of strain relatedness with phenotypic and genotypic characteristics.
An outbreak of scarlet fever involving 12 children occurred at a hospital day care centre from February to March 1996. Twenty-five throat isolates of Streptococcus pyogenes (GAS, group A streptococcus) available from 24 children, including 10 children with scarlet fever and 14 asymptomatic carriers, and one asymptomatic staff member were studied for the presence of genes encoding streptococcal pyrogenic exotoxin types A (speA), B (speB), and C (speC) and for protease activity. Antimicrobial susceptibilities using the E-test, cluster analysis by cellular fatty acid composition and random amplified polymorphic DNA (RAPD) patterns by means of arbitrarily-primed polymerase chain reaction (APPCR) of the isolates were performed to investigate the outbreak. Only one isolate from an asymptomatic child possessed the speA gene. All isolates possessed the speB gene and 24 (96%) isolates were positive for the speC gene. There was no difference in protease activity between isolates from children with scarlet fever and from asymptomatic carriers. Thirteen isolates (10 recovered from children with scarlet fever, two from asymptomatic children, and one from the staff member) were considered to be the same strain according to the identical antimicrobial susceptibility profile and RAPD patterns and were also considered to be similar by cluster analysis of fatty acid composition. These findings suggest that the outbreak was caused by a unique clone of GAS. We conclude that RAPD typing and cluster analysis by cellular fatty acids composition both provide a powerful tool for epidemiological investigation of GAS infections.
Child Day Care Centers↗