Contrast medium induces a direct toxic effect on renal tubular cells. This toxic effect may have a role in the pathophysiology of contrast medium-induced nephropathy. Contrast medium has been shown to affect the endoplasmic reticulum (ER)-related capacity. Unfolded protein response (UPR) is known as a pro-survival response to reduce the accumulation of unfolded proteins and restore normal ER function. However, the role of ER stress-related UPR in the contrast medium-induced renal cell injury still remains unclear. In this study, we examined whether UPR participates in urografin (an ionic contrast medium)-induced renal tubular cells apoptosis. Treatment with urografin in normal rat renal tubular cell line (NRK52E) markedly increased cell apoptosis and decreased cell viability with a dose and time-dependent manner. The cell necrosis was not increased in urografin-treated cells. Urografin also enhance the induction of ER stress-related markers in NRK52E cells including glucose-regulated protein (GRP)78 and GRP94 expressions, pro-caspase 12 cleavage, phosphorylation of PERK (PKR (double-stranded RNA-activated protein kinase)-like ER kinase) and eIF-2alpha (eukaryotic initiation factor 2alpha). Salubrinal, a selective inhibitor of eIF2alpha de-phosphorylation, effectively decreased urografin-induced cell apoptosis. Furthermore, transfection of GRP78 siRNA in NRK52E cells significantly enhanced urografin-induced cell apoptosis. These results suggest that GRP78/eIF2alpha-related signals play a protective role during UPR, and the activation of ER stress-related UPR may play an important regulative role in urografin-induced renal tubular injury.

Objectives: Organising pneumonia as a localised process has sometimes been managed by surgery. This poorly defined entity has been mistaken clinically, roentgenographically and usually at exploratory thoracotomy for lung cancer. This series details our experiences with surgical resections in 27 patients during the past 13 years. Methods: Surgical lung resection was performed through wedge resection or lobectomy with or without video-assisted thoracoscopic surgery. Resected specimens were swabbed for aerobic and anaerobic bacterial, fungal and mycobacterial cultures. Clinical presentation, roentgenological examination, location and size of the tumourous lesions, pathological finding and treatment were investigated. Results: The patients were between 41 and 80 years of age. Most of the patients (81.5%) presented with cough, haemoptysis and weight loss. The common radiographic findings were round or oval mass with occasionally air bronchogram. Thirteen patients underwent non-invasive biopsy without conclusive diagnosis. The tumour size ranged from 1.5cm to 8.5cm. The typically grossly involved area was sharply outlined, firm and extended to the pleura, which was invariably thickened. The microscopic pattern was also rather similar, with inflammation in various degrees of organisation, sometimes accompanied by necrotising changes in the bronchi. Viridans Streptococci and Neisseria spp. were identified as the aetiologic agents in 15 cases (55.6%). All patients had an excellent outcome. Conclusion: The usual investigative procedures for pulmonary mass were of little aid in establishing the differential diagnosis of organising pneumonia from neoplasm. Surgical resection should be considered in the absence of a positive diagnosis of a persistent pulmonary mass.

Convulsive status epilepticus is a medical emergency with significantly associated mortality and morbidity. The demographic data and outcomes of convulsive status epilepticus in children were collected for descriptive analysis. We retrospectively reviewed cases of convulsive status epilepticus in the Pediatric Intensive Care Unit of Chang Gung Children's Hospital between 1999 and 2006. We enrolled 141 patients with 198 episodes of convulsive status epilepticus, aged 2 months to 18 years: 24.8% of first episodes developed convulsive status epilepticus, with a duration of over 60 minutes. First episodes of convulsive status epilepticus were most often evidenced in febrile status during acute central nerve system infections (48.2%), and in nonfebrile status during acute noncentral nerve system illness in previously epileptic children (28.4%). Before their first episode, 63.8% of children were neurologically healthy, and 12.2% exhibited a prolonged febrile seizure. The most common etiology of mortality was acute central nervous system infection. The immediate mortality rate was 7.1%. Convulsive status epilepticus in childhood is more common, with a different range of causes and a lower risk of death, than convulsive status epilepticus in adults. Acute central nervous system infections appear to be markers for morbidity and mortality.

Abstract Aim: Influenza B-associated rhabdomyolysis (IBAR) is an infrequent and little-known complication of influenza B virus infection in children. Diagnosis is usually made based on clinical history, the presence of influenza in the community and detection of virus in nasopharyngeal specimens. The aim of this study was to describe the clinical and laboratory manifestations, complications and outcomes of IBAR in Taiwanese children. Methods: A retrospective analysis was conducted in patients aged <17 years who had been diagnosed with IBAR at a university children's hospital in North Taiwan during 2000-2007. All children enrolled in the study had presented with rhabdomyolysis associated with laboratory-confirmed influenza B infections. Demographic data, clinical manifestations, complications and outcomes were included in the analysis. Results: Overall, 24 IBAR cases were analysed. IBAR typically occurred in school-aged children with a 7:3 male:female ratio. The mean age was 7.2 +/- 1.9 years. Nearly 63% of cases occurred between the ages of 6 and 9 years. The median interval between the onset of influenza and onset of IBAR was 3.4 days (range, 1-14). The calf muscles were involved in all cases. Laboratory tests indicated a mean initial blood creatine kinase of 4212 U/L. The median time to clinical recovery was 5 days (range 1-24). No patient had renal failure. IBAR tends to occur mainly in winter and spring during influenza B outbreaks. IBAR sometimes induces some complications, and early detection and careful medical treatment are necessary. Conclusion: The results of this study indicate that outcomes of IBAR are good with proper medical care.

Influenza virus is a seasonal cause of community-acquired pneumonia, and Streptococcus pneumoniae is one of the most common pathogens causing secondary bacterial pneumonia. S. pneumoniae-induced haemolytic uremic syndrome is an uncommon condition mainly observed in young children. We present a patient who had invasive pneumococcal disease and haemolytic uremic syndrome. Simultaneous viral cultures grew influenza A. To the best of our knowledge, this is the first such reported case.

BACKGROUND: Left atrioesophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation. We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation. METHODS AND RESULTS: Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and randomized, including those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2). All patients underwent esophageal temperature monitoring during the procedure. The day after ablation, all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus. We observed esophageal tissue damage in 12 (48%) patients of group 1 and 1 esophageal tissue damage in a single patient (4%) of group 2 (P<0.001). The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia (group 1) versus patients undergoing conscious sedation (group 2)(40.6+/-1 degrees C versus 39.6+/-0.8 degrees C; P< 0.003). The time to peak temperature was 9+/-7 seconds in group 1 and 21+/-9 seconds in group 2, and this difference was statistically significant (P<0.001). No complication occurred during or after the administration of the pill cam or during the procedures. All esophageal lesions normalized at the 2-month repeat endoscopic examination. CONCLUSIONS: The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy.

Superconductivity was recently found in the tetragonal phase FeSe. A structural transformation from tetragonal to orthorhombic (or monoclinic, depending on point of view) was observed at low temperature, but was not accompanied by a magnetic ordering as commonly occurs in the parent compounds of FeAs-based superconductors. Here, we report the correlation between structural distortion and superconductivity in FeSe1-x thin films with different preferred growth orientations. The films with preferred growth along the c axis show a strong thickness dependent suppression of superconductivity and low temperature structural distortion. In contrast, both properties are less affected in the films with (101) preferred orientation. These results suggest that the low temperature structural distortion is closely associated with the superconductivity of this material.

Chlorpyrifos is an organophosphorus anticholinesterase insecticide, and organophosphate intoxication can induce symptoms such as miosis, urination, diarrhea, diaphoresis, lacrimation, excitation of central nervous system, salivation, and consciousness disturbance (MUDDLES). Although accidental poisoning of children with drugs and chemicals is a common cause for consciousness disturbance in children, the possibility of deliberate poisoning is rarely considered. We report on a healthy 5-year 6-month-old boy with recurrent organophosphate intoxication. Reports of chlorpyrifos intoxication in children are quite rare. This case report demonstrates decision-making process and how to disclose deliberate chlorpyrifos poisoning of the toddler by the stepmother, another example of Munchausen syndrome by proxy.

Investigating aberrant DNA methylation in the cancer genome may identify genes that play an important role in tumor progression. In this study, we combined differential methylation hybridization and a CpG microarray platform to characterize methylation profiles and identify novel candidate genes associated with hepatocellular carcinoma (HCC). The genomic DNA of 21 paired adjacent normal and HCC samples was used, and results were analyzed by hierarchical clustering. Twenty-seven hypermethylated candidates and 38 hypomethylated candidates were obtained. Six candidate genes from the hypermethylated group were validated by combined bisulfite restriction analysis; two genes, human kallikrein 10 gene (KLK10) and oxoglutarate (alpha-ketoglutarate) receptor 1 gene (OXGR1), were further analyzed by bisulfite sequencing. The DNA hypermethylation status of KLK10 and OXGR1 were subsequently examined in HCC cell lines and clinical samples using methylation-specific PCR. In 49 HCC samples, 46 (94%) showed that at least one of these two genes was highly methylated. Moreover, KLK10 and OXGR1 mRNA levels were inversely correlated (r =-0.435 and -0.497, P < 0.05) with DNA methylation as examined in paired adjacent normal and tumor samples. Statistical analyses further indicated that KLK10 hypermethylation was significantly associated with cirrhosis (P = 0.042) and HCV infection (P = 0.017) as well as inversely associated with HBV infection (P = 0.023). Furthermore, restoration of KLK10 and OXGR1 expression reduced the ability of anchorage-independent growth, and sensitized HCC cells to doxorubicin- or 5-fluorouracil-induced cytotoxicity. Our results suggest that the hypermethylated KLK10 and OXGR1 are frequent in HCC and may be useful as markers for clinical application.(c) 2009 Wiley-Liss, Inc.

Altered mental status can have many causes, some of which are life threatening, especially in children. In addition to the usual central nervous system and metabolic causes, such as meningitis, encephalitis, seizure, electrolyte imbalance, and inborn errors of metabolism, some less common causes of altered mental status, which if not diagnosed and managed rapidly, can have poor consequences. We present a case of a child with a life-threatening unusual cause of altered mental status, a mesenteric hernia with hypovolemic shock. The hernia was reduced successfully at laparotomy. The postoperative course was uneventful.