Medical Sciences

Grail suppresses stress-induced apoptosis and colony formation in oral cancer cells Pei-Yao Liu, Ying-Chuan Chen Journal of Medical Sciences 2019 39(2):61-66 Aims: The purpose of this study is to investigate the role of Grail in stress-induced apoptosis and tumorigenesis in oral cancer cells. Subjects and Methods: We analyzed gene expression of Grail in oral cancer cell lines (KB, SAS, SCC-4, and SCC-25) treated with 5-azadC or/and trichostatin A (TSA) by RT-PCR. The effects of Grail on the expression of p53 and p21 were analyzed by real-time polymerase chain reaction and Western blot for KB cells (KB/vector, KB/Grail and KB/shGrail). The anti-apoptotic effects of Grail were determined by fluorescence-activated cell sorting in KB/vector and KB/Grail cells. The effects of Grail on tumorigenesis were through clonogenic analysis in KB cells (KB/vector, KB/Grail and KB/shGrail). Results: Treatment with 5-azadC or/and TSA-induced Grail mRNA expression in oral cancer cells. Grail overexpression reduced p53 and p21 expression. Conversely, p53 and p21 expressions were increased in KB/shGrail cells. Furthermore, Grail can inhibit resveratrol-or etoposide-induced apoptosis in KB cells. Finally, Grail can significantly suppress colony formation in KB cells. Conclusions: The expression of Grail is epigenetically regulated in oral cancer cells. Grail can reduce p53 and p21 expression and stress-induced cell death and suppress the colony formation in KB cells.

Prospective randomized comparison of ultrasound-guided percutaneous needle aspiration with percutaneous catheter drainage of liver abscesses Paramdeep Singh, Chaitanya Tapasvi, Rupinderjeet Kaur, Simmi Aggarwal, Nitin Nagpal, Rashmeet Kaur Journal of Medical Sciences 2019 39(2):67-73 Background and Aims: Modern treatment of liver abscesses comprises combination of antibiotics and image-guided percutaneous needle aspiration (PNA) or percutaneous catheter drainage (PCD). However, there is debate regarding the choice of these interventions as the first line of management. Our aim was to compare the results of ultrasound-guided PCD with PNA in the management of liver abscesses. Materials and Methods: A total of 66 patients (55 males; 11 females, 18–65 years) who were diagnosed with liver abscesses were randomly divided into two groups of 33 patients each, namely ultrasound-guided PNA group (with a maximum of three attempts) and the PCD group. The outcomes of the treatment of the patients of these groups were documented and analyzed. Results: PNA was effective in 20 (61%) of the 33 patients after one (n = 14), two (n = 4), or three (n = 2) aspirations while PCD was therapeutic in all 33 patients after one (n = 29) or two (n = 4) procedures and without any major complications in both groups. All abscesses 45 mm or less in longest dimension were efficaciously managed, by both PCD as well as PNA while the later failed in case of multiloculated abscesses. The mean duration of intravenous antibiotics and time to clinical relief were significantly lesser in the PCD group. However, a period of hospital stay and time to complete resolution of abscess cavities did not differ significantly between the groups. Conclusions: Overall, PCD is more effective than PNA in the management of liver abscesses; the later, however, can be employed for smaller and simple abscesses.

Association between aortic aneurysm and ulcerative colitis: A nationwide taiwanese retrospective cohort study Chih-Jen Yang, Chi-Hsiang Chung, Sy-Jou Chen, Wen-I Liao, Yi-Da Tsai, Jen-Chun Wang, Wu-Chien Chien Journal of Medical Sciences 2019 39(2):74-80 Background: Ulcerative colitis (UC) is an immune-mediated inflammatory disease that is associated with an increased incidence of cardiovascular events. Several inflammatory mechanisms associated with the pathogenesis of UC are involved in the initiation and progression of aortic aneurysms (AAs). We aimed to evaluate whether patients with UC have an increased risk of AA. Methods: We conducted a retrospective cohort study using data extracted from Taiwan's National Health Insurance Research Database. All medical conditions for each case and control subject were categorized using the International Classification of Diseases, 9th Revision. Hazard ratios and 95% confidence intervals for associations between UC and AA were estimated using the Cox regression adjusted for comorbidities. Results: Our analyses included 7256 UC patients and propensity score-matched controls. Compared to the controls, UC patients exhibited a significantly increased risk of developing an AA (adjusted odds ratio = 3.154, P < 0.001). Conclusion: UC patients have an increased risk of developing an AA, and healthcare professionals should be aware of this risk when treating UC patients. Aortic surveillance may be required for UC patients.

Detection of malingering in the memory of patients with dementia: A pilot study on coin-in-the-hand test in a Northern Taiwan Memory Clinic Ta-Chuan Yeh, Yu-Ching Chou, Ju-Ping Weng, Hui-Wen Yeh, Yu-Chen Kao, Wei-Shan Chiang, Tien-Yu Chen, Je-Ming Hu, Nian-Sheng Tzeng Journal of Medical Sciences 2019 39(2):81-89 Background: The aim of this study is to investigate the validity of the coin-in-the-hand (CIH) test with other neuropsychological tests for the detection of malingering in the memory. Materials and Methods: A simulated scenario design was developed to investigate the validity of the CIH test, entitled the Test of Memory Malingering (TOMM), associated with the Clinical Dementia Rating, the cognitive abilities screening instrument, the Mini-Mental Status Examination, and the WHO Quality of Life-BREF. The performances of the patients with dementia (n = 25) were compared with one group of normal controls (n = 9), and another group instructed to simulate malingering dementia (n = 19). Results: The CIH test demonstrated good validity and displayed a better sensitivity and a positive likelihood ratio than the TOMM, while patients with dementia could provide, on average, more than nine correct answers, in comparison to only more than six correct answers in the simulated malingering group. The optimal cutoff score of the CIH test is ≤8. Conclusions: This pilot study showed that the CIH test is a quick and practical test for detecting malingering in the memory.

Early diagnosis of a case of infantile cystic fibrosis and review of literature in Taiwan Hsiao-Chi Lin, Shao-Wei Huang, Ying-Chun Lu, Chih-Chien Wang Journal of Medical Sciences 2019 39(2):90-93 Few cystic fibrosis (CF) cases in Taiwan have been published. We report a case of 2.5-month-old male infant presented recurrent infection, failure to thrive, and nutritional deficiency dermatitis initially. Sweat chloride test confirmed the diagnosis at 4 months old. We highlight that CF should always be the differential diagnosis of patient with failure to thrive and recurrent pulmonary infections.

Sarcomatoid carcinoma of the pyriform sinus: A rare malignancy in a rare location responsive to combination of chemotherapy and radiotherapy Abhishek Purkayastha, Sankalp Singh, Niharika Bisht, Divya Shelly, Vikas Gupta, Azhar Husain Journal of Medical Sciences 2019 39(2):94-97 Sarcomatoid carcinoma (SaC) is a rare variant of squamous cell carcinoma with sarcomatoid features having biphasic characteristic malignant mesenchymal spindle cell and squamous cell component comprising of dysplasia, carcinoma in situ, or invasive carcinoma. Most information about this malignant entity in the head-and-neck region has emerged from larynx and oral cavity with an incidence of 0.5%–3% and 1%, respectively, with very few cases reported in hypopharynx. We hereby report such a case in a 76-year-old male who presented with dysphagia and swelling right side neck. Clinicopathological evaluation showed a localized SaC hypopharynx. In view of old age and comorbidities of hypertension and diabetes, no surgical intervention was contemplated, and he was treated with definitive concurrent chemo-radiotherapy (CCRT). A thorough review of the literature revealed that while earlier reported cases underwent upfront surgery followed by adjuvant RT or adjuvant CCRT, we treated this case with combination of chemotherapy and RT resulting in a significant therapeutic effect.

Primary thoracic endovascular aortic repair to aortic coarctation complicating with spontaneous epidural hemorrhage Ching-Wei Lin, Yi-Ting Tsai Journal of Medical Sciences 2019 39(2):98-101 Development of collateral circulation belongs among the typical signs of aortic coarctation (CoA) and can lead to the growth of ectatic, fragile spinal neurovascular malformations. Spontaneous spinal epidural hemorrhage (SSEH) as a complication of CoA is exceptionally rare, with only few case reports proposed up to date. At our institute, we had two experiences of SSEH complicated by CoA. The first case had been published in 2016, with disappointing neurologic outcome. As for the second case, presenting with extremely sharp upper back pain followed by paraplegia and anal sphincter impairment, we chose immediate surgical intervention with thoracic endovascular aortic repair (TEVAR), aiming at amelioration of the pressure gradient across the juxtaductal coarctation in the aorta, to ensure the safety and the completeness of following surgical decompression of the spinal epidural hematoma. To our knowledge, this case is the first one featuring TEVAR to the CoA immediately followed by surgical decompression of SSEH in this kind of emergent setting. This case recovered satisfactorily without neurologic deficit. Conservative treatment for SSEH caused by CoA may not succeed at all times. Emergent TEVAR to CoA immediately followed by surgical decompression is achievable, making following surgical decompression of the epidural hematoma easier and safer.

Absence of capnography from tracheostomy: An indicator of tracheostomy tube dislodgement Meng-Fu Lai, Zhi-Fu Wu, Chi-Yi Lin, Yuan-Shiou Huang Journal of Medical Sciences 2019 39(2):102-104 Tracheostomy is a common artificial airway in the operative room (OR) or intensive care units for maintaining airway patency. Patients with tracheostomy are generally considered with a “secure” airway and would be preoxygenated before anesthesia induction. However, there are some pitfalls for an anesthesiologist when confronting with tracheostomy management. As a crucial component for ventilation, any management of tracheostomy should be conducted prudently. We report a case with tracheostomy presented to OR with loss of capnography but fair oxygen saturation which proved to be tube dislodgement by fiber-optic bronchoscopy timely without further desaturation.

False-negative diffusion-weighted imaging in large vessel territory infarct Halil Onder, Guven Arslan, Erdal Cicek, Merih Karbay Efendioglu Journal of Medical Sciences 2019 39(2):105-106