Background: Metastatic cancer with invasion of skin, soft tissue and skeletal muscle is not common. Examples presenting as soft tissue masses could sometimes lead to misdiagnosis with delayed or inappropriate management. The purpose of current study was to investigate clinical characteristics in the involvement of metastatic cancer. Materials and Methods: A total of 1,097 patients complaining of skin or soft tissue masses and/or lesions were retrospectively reviewed from January 2012 to June 2013. Tumors involving skin, soft tissue and skeletal muscle of head and neck, chest wall, abdominal wall, pelvic region, back, upper and lower extremities were included in the study. Results: Fifty-seven (5.2%) patients were recognized as having malignancies on histopathological examination. The most common involvement of malignancy was basal cell carcinoma, followed by cutaneous squamous cell carcinoma, sarcoma and melanoma. The most common anatomical location in skin and soft tissue malignancies was head and neck (52.6% of the malignancies). Four (0.36%) of the malignant group were identified as metastatic cancer with the primary cancer source from lung, liver and tonsil and the most common site was upper extremities. One of them unexpectedly expired during the operation of metastatic tumor excision at the scalp. Conclusions: Discrimination between benign and malignant soft tissue tumors is crucial. Performance of imaging study could assist in the differential diagnosis and the pre-operative risk evaluation of metastatic tumors involving skin, soft tissue and skeletal muscle.
Background: It is reported that the percentage of smudge cells in the blood smear could be a prognostic indicator in chronic lymphocytic leukemia. However, the clinical significance of smudge cells in other hematological malignancies, solid tumors or non-malignant diseases is less clear. Hence, this study was conducted to survey the clinical significance of smudge cells in hematological cancers and other disorders. Materials and Methods: From January to November, 2015, the clinical data of patients who received blood examination with differential counts for clinical purpose and were found to have smudge cells in the peripheral blood film in Far Eastern Memorial Hospital were selected. The percentage of smudge cells and patient outcomes were evaluated for further univariate and survival analyses. Results: A total of 102 patients with smudge cells in their blood smears were included. Smudge cells were frequently presented in out-of-hospital cardiac arrest (OHCA; n=30), infections (n=23), hematological cancers (n=23) and solid cancers (n=10). There was no relationship between the percentage of smudge cells and the patient mortality in all diseases (OR: 1.08, 95% CI: 0.47-2.48, P=1.000) as well as the OHCA group (OR: 1.91, 95% CI: 0.38-9.60, P=0.694). It was observed that in patients with all cancers with the percentage of smudge cells less than 50% had a lower mortality rate in comparison with those who had the percentage of smudge cells of 50% or more (OR: 22.29, 95% CI: 2.38-208.80, P<0.001). Additionally, it was seemingly that patients with smudge cells of 50% or more had a lower survival rate than those with smudge cells less than 50% in all cancers with follow-up at 2-month intervals, but without statistical significance (P=0.064). Conclusions: Our survey indicated that in all cancers, those who had higher percentage of smudge cells were prone to have poor outcomes when compared with the subjects with lower percentage of smudge cells. This finding was quite different from the results of previous studies in which the race-ethnicity of most study populations was non-Asian; hence, further investigations are required. Besides, there was no apparent association of the percentage of smudge cells with patient outcomes in all diseases, including OHCA.
In this study we define the two different types of El $Ni{\tilde{n}}o$, i.e., the eastern Pacific El $Ni{\tilde{n}}o$ (i.e., EP-El $Ni{\tilde{n}}o$) versus the central Pacific El $Ni{\tilde{n}}o$ (i.e., CP-El $Ni{\tilde{n}}o$), during the boreal summer (June-July-August, JJA) and winter (December-January-February, DJF) using the two NINO indices in the tropical Pacific. The two different types of El $Ni{\tilde{n}}o$ significantly differ in terms of the location of the maximum anomalous sea surface temperature (SST) in the tropical Pacific. The CP-El $Ni{\tilde{n}}o$ has been observed more frequently during recent decades compared to the EP-El $Ni{\tilde{n}}o$. In addition, our analysis indicates that the statistics of CP-El $Ni{\tilde{n}}o$ during JJA is closely associated with the warming trend in the central equatorial Pacific. We also examine the different responses of the East Asian marginal SST to the two types of El $Ni{\tilde{n}}o$ during JJA and DJF. The CP-El $Ni{\tilde{n}}o$ during both JJA and DJF is concurrent with warm SST anomalies around the Korean Peninsula including the East China Sea, which is in contrast to the EP-El $Ni{\tilde{n}}o$. Such different responses are associated with the difference in tropics/mid-latitude teleconnections via atmosphere between the two types of El $Ni{\tilde{n}}o$. Furthermore, our results indicate that atmospheric diabatic forcing in relation to the precipitation variability is different in the tropical Pacific between the EP-El $Ni{\tilde{n}}o$ and the CP-El $Ni{\tilde{n}}o$.
A sediment trap had been deployed at 1250 m depth in the Eastern Tropical Pacific (ETP) from September 2009 to July 2010, with the aim of understanding the temporal and vertical variability of particle flux. During the monitoring period, total particle flux varied from 12.4 to 101.0 mg m-2day-1, with the higher fluxes in January-March 2010. Biogenic particle flux varied in phase with the total particle flux. The increase in total particle flux during January-March 2010 was attributed to the enhanced biological production in the surface layer caused by wind-driven mixing in response to the seasonal shifts in the location of the Intertropical convergence zone. The export ratio (e-ratio) was estimated using the particulate organic carbon flux and satellite-derived net primary production data. The estimated e-ratios changed between 0.8% and 2.8% (1.4±0.6% on average). The ratio recorded in the negative phase of Pacific decadal oscillation (PDO) was similar to the previous results obtained from the ETP during the 1992/93 periods in the positive phase of PDO. This suggests that the regime shift of the PDO is not related to the carbon export ratio.
The time-series of Walker circulation index (WCI) in this study shows the strengthening of the Walker circulation in recent years. To further understand the large-scale features related to the WCI strengthening, a difference between the averaged meteorological variables in two time periods 1999-2013 and 1984-1998 is analyzed. The difference in 850 hPa stream flows between the two periods shows that the anomalous easterlies (anomalous trade wind) are dominant due to the strengthening of anomalous anticyclonic circulations at the subtropical Pacific of both hemispheres. The difference between the averaged zonal atmospheric circulations over $5^oS-5^oN$ in the two periods confirms that upward flows are strengthened at the tropical western Pacific and downward flows are strengthened at the tropical central and eastern Pacific in recent years. It matches the WCI strengthening in recent years. The time-series of tropical cyclone (TC) genesis frequency from July to September shows that a mean TC genesis frequency from 1999-2013 decreases compared to that of the time period 1984-1998. The monsoon trough in the period 1984-1998 was located in the further east direction and stronger than that in the period 1999-2013. TCs in the recent period that are generated in further west than TCs in the past period moved from the west. Thus, the TC intensity along the coasts in East Asia becomes weaker in recent period. The intensification of Walker circulation in recent years is related to the weaker TC intensity in East Asia through strengthened anomalous anticyclones at the subtropical western Pacific.
Background: Potential disadvantages of blood transfusion during curative gastrectomy for gastric cancer have been reported, and the role of peri-operative transfusions remains to be ascertained. Thus, the aim of our study was to survey its impact in patients with gastric cancer undergoinging gastrectomy. Materials and Methods: Clinical data of patients receiving curative gastrectomy at Far Eastern Memorial Hospital were obtained. Findings for pre-operative anemia states, pre-, peri- and post-operative transfusion of red blood cell (RBC) products as well as post-operative complication events were collected for univariate analysis. Results: A total of 116 patients with gastric cancer received gastrectomy at Far Eastern Memorial Hospital from 2011 to 2014. Both pre-operative and intra- and post-operative transfusion of RBC products were markedly associated with post-operative infectious events (OR: 3.70, 95% CI: 1.43-9.58, P=0.002; OR: 8.20, 95% CI: 3.11-22.62, P<0.001, respectively). In addition, peri- and post-operative RBC transfusion was significantly associated with prolonged hospital stay from admission to discharge (OR: 8.66, 95% CI: 1.73-83.00, P=0.002) and post-operative acute renal failure (OR: 19.69, 95% CI: 2.66-854.56, P<0.001). Also, the overall survival was seemingly decreased by peri-operative RBC transfusion in our gastric cancer cases (P=0.078). Conclusions: Our survey indicated that peri-operative RBC transfusion could increase the risk of infectious events and acute renal failure post curative gastrectomy as well as worsen the overall survival in gastric cancer cases. Hence, unnecessary blood transfusion before, during and after curative gastrectomy should be avoided in patients with gastric cancer.
The trajectory analysis of boundary layer ozone data at four regional sites in the East Asian outflow regions in Japan was carried out together with boundary layer ozone data observed at Mt. Tai and Mt. Huang in the source region of central eastern China during the monsoon onset in May-June 2003 and 2004. At all sites, the influences of anthropogenic emissions from East Asia have been found. During May and June 2004, the evidences of direct pollution transport from central eastern China to Hedo, an outflow site in Okinawa Island were observed. Ozone mixing ratios associated with air masses from central eastern China averaged 45 ppb while those associated with clean air masses from the Pacific were only 14 ppb, which resulted in averaged 31 ppb increase of ozone mixing ratios during the pollution episodes from central eastern China at Cape Hedo. Using transport time analysis and averaging all ozone episodes transported from central eastern China, the ozone dilution rate of 5.4 ppb per day was roughly estimated during air masses transported from source to outflow regions at Hedo. In the regions nearby Japanese mainland, however ozone increases by long-range transports were more related to both domestic and East Asian sources as a whole.
Background: Eosinophilic pleural effusion (EPE) is an eosinophil count more than 10% on cytology of pleural samples. Recently, it was reported that malignancy had been the most prevalent cause inducing EPE. Therefore, we conducted an analysis on the prevalence and etiology of EPE and investigated the relationship between EPE and malignancy. Materials and Methods: Data for pleural cell differential count from patients receiving thoracentesis during the period from January 2008 to December 2013 were compared with clinical data and established diagnosis of patients obtained via electronic chart review. Results: A total of 6,801 requests of pleural cytology from 3,942 patients with pleural effusion who had received thoracentesis were available at Far Eastern Memorial Hospital from 2008 to 2013, and of these subjects, 115 (2.9%) were found to have EPE. The most frequent cause of EPE was malignancy (33.0%, n=38), followed by parapneumonic effusions (27.8%, n=32), tuberculosis pleuritis (13.9%, n=16), transudate effusions (12.2%, n=14) and the presence of blood or air in pleural space (10.4%, n=12). Additionally, an inverse relationship of eosinophilia in pleural fluid was identified in patients with malignancy and EPE. The cut-off eosinophil count in pleural fluid was 15% for the most accurate discrimination between malignancy and benign disorders in patients with EPE. At the cut-off level, the sensitivity and specificity were 65.8% and 67.5%, respectively. Conclusions: Pleural fluid eosinophilia was a speculative negative predictor for malignancy, despite the fact that cancers, including lung cancers and metastatic cancers to lung, were the most leading cause of pleural fluid eosinophilia. An inverse correlation was observed between the pleural eosinophil percentage and the likelihood of malignancy in patients with EPE.
Background: The incidence of breast cancer in India is on the rise and is rapidly becoming the number one cancer in females, pushing the cervical cancer to the second position. Most of the predisposition to hereditary breast and ovarian cancer has been attributed to inherited defects in two tumor suppressor genes BRCA1 and BRCA2. Alterations in these genes have been reported in different populations, some of which are population-specific mutations showing founder effects. Two specific mutations in the BRCA1 (185delAG) and BRCA2 (6174delT) genes have been reported to be of high prevalence in different populations. The aim of this study was to estimate the carrier frequency of 185delAG and 6174delT mutations in eastern Indian breast cancer patients. Materials and Methods: We selected 231 histologically confirmed breast cancer patients from our tertiary cancer care center in eastern India. Family history was obtained by interview or a self-reported questionnaire. The presence of the mutation was investigated by allele specific duplex/multiplex-PCR on genomic DNA extracted from peripheral blood. Results: A total of 231 patients (age range: 26-77 years), 130 with a family history and 101 without were screened. The two founder mutations 185delAG in BRCA1 and 6174delT in BRCA2 were not found in any of the subjects. This was confirmed by molecular analysis. Conclusions: Our findings suggest that these BRCA mutations may not have a strong recurrent effect on breast cancer among the eastern Indian population. The contribution of these founder mutations to breast cancer incidence is probably low and could be limited to specific subgroups. This may be particularly useful in establishing further pre-screening strategies.
Background: Oesophageal squamous cell carcinoma (ESCC) is endemic in the Eastern Anatolian region of Turkey. The present study was performed to identify risk factors for ESCC that specifically reflect the demography and nutritional habits of individuals living in this region. Materials and Methods: The following parameters were compared in 208 ESCC patients and 200 control individuals in the Eastern Anatolian region: age, sex, place of living, socioeconomic level, education level, smoking, alcohol intake, nutritional habits, and food preservation methods. Results: The mean age of ESCC patients was 56.2 years, and 87 (41.8%) were 65 years-old or older. The ratio of women to men in the patient group was 1.39/1. ESCC patients consumed significantly less fruit and yellow or green vegetables and more hot black tea, 'boiled yellow butter', and mouldy cheese than did control individuals. Residence in rural areas, smoking, and cooking food by burning animal manure were also significantly associated with ESCC. Conclusions: The consumption of boiled yellow butter and mouldy cheese, which are specific to the Eastern Anatolian region, and the use of animal manure for food preparation were identified as risk factors in this region. Further studies are required to potentially identify the carcinogenic substances that promote the development of ESCC in this region.
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