Prevalence of bancroftian filariasis on the Thai-Myanmar border

To achieve the goal of eliminating lymphatic filariasis by the year 2020, close monitoring systems and effective control strategies need to be implemented and the real disease burden needs to be assessed. Bancroftian filariasis is endemic at the Thai-Myanmar border. However, there are only limited data on the prevalence of this disease in Thailand available. We employed microscopic examination, together with ELISA kits to detect W. bancrofti-specific Og4C3 circulating antigen and specific anti-filarial IgG4 antibodies to determine the burden of bancroftian filariasis in an endemic area at the Thai-Myanmar border in Umphang District, Tak province, Thailand. A total of 433 Thai-Karen blood samples were analyzed. The microfilarial rate determined by microscope was 6% and the W. bancrofti-specific Og4C3 antigenemia rate was 22%, while the specific anti-filarial IgG4 antibody rate was 54%. There were statistically significant higher levels of W. bancrofti-specific Og4C3 antigen in the microfilaremic-antigenemic group than in the amicrofilaremic-antigenemic group (unpaired Student's t-test; p < 0.001), similar to the specific anti-filarial IgG4 antibody results (unpaired Student's t-test; p < 0.001). A statistically significant correlation of moderate degree between the presence of W. bancrofti-specific Og4C3 antigen and of specific anti-filarial IgG4 antibody was found in the amicrofilaremic group (r = 0.474, p < 0.001), but not in the microfilaremic group (r = 0.291, p > 0.05). Our study revealed a very high prevalence of bancroftian filariasis in this endemic area and thus emphasized the importance of using highly sensitive and specific diagnostic tools to evaluate the true prevalence of the disease.     

Role of P57KIP2 Immunohistochemical Expression in Histological Diagnosis of Hydatidiform Moles

Purpose: To determine the significance of P57KIP2 immunohistochemistry expression in the histopathological diagnosis of hydatidiform mole. Materials and Methods: Hydatidiform mole patients at King Chulalongkorn Memorial Hospital between January 1999 and December 2011 were recruited. Two gynecologic pathologists reviewed histopathologic slides to confirm diagnosis. Formalin-fixed, paraffin-embedded tissue sections were stained using a bstandard immunostaining system with monoclonal antibodies against P57KIP2 protein. Correlations among pathological features, immunohistochemical expression and clinical data were analyzed. Results: One hundred and twenty-seven hydatidiform mole patients were enrolled. After consensus review, 97 cases were diagnosed as complet (CHM) and 30 cases as partial (PHM). Discordance between the first and final H and E diagnoses was found in 19 cases (14.9%, k= 0.578). Significant pathological features to classify the type of hydatidiform mole are central cisterns, trophoblastic proliferation, trophoblastic atypia, two populations of villi, fetal vessels and scalloped borders. After performing immunohistochemistry for P57KIP2, 107 cases were P57KIP2 negative and 20 cases positive. Discordant diagnoses between final H and E diagnosis and P57KIP2 immunohistochemistry was identified in 12 cases (9.4%). Sensitivity of final H and E diagnosis for CHM was 89.7%; specificity was 95.0%. PHM sensitivity and specificity of final H and E diagnosis was 95.0% and 89.7%, respectively. Conclusions: Histopathological diagnosis alone has certain limitations in accurately defining types of hydatidiform mole; P57KIP2 immunohistochemistry is practical and can be a useful adjunct to histopathology to distinguish CHM from non-CHM.     

Serotypes and antimicrobial resistance of streptococcus pneumoniae in Thailand 2002-2004

Information on pneumococcal isolates is limited in Asia. Among children younger than 5 years in rural Thailand, nasopharyngeal colonization was 60%, and 55% of carried and 62% of invasive isolates were serotypes in the 7-valent pneumococcal conjugate vaccine. Nonsusceptibility was common among the serotypes included in the vaccine. Pneumococcal conjugate vaccine might be a useful prevention tool in Thailand.     

High-Risk Human Papillomavirus Detection via Cobas® 4800 and REBA HPV-ID® Assays

Persistent infection with high-risk human papillomaviruses (HR-HPVs), particularly HPV16 and 18, has long been known to induce cervical cancer progression. However, given that a minority of HPV-infected women develop cancer, analysis of HR-HPV-infected women could help to predict who is at risk of acquiring cervical cancer. Therefore, to improve HR-HPVs detection, we used the FDA-approved cobas^® 4800 HPV and REBA HPV-ID^® HPV assays to detect HR-HPVs in colposcopy-derived cervical cells from 303 patients, detecting 72.28% (219) and 71.62% (217) of HR-HPVs positive cases, with HPV16 detection rates of 35.64% (108) and 30.69% (93), respectively. Of the HPV16-positive cases, cobas^® 4800 and REBA HPV-ID^® identified 28.81% (51) and 25.42% (45) of the CIN1 cases, and 55% (33) and 50% (30) of the 60 CIN2/3 cases, respectively. HPV-diagnostic concordance was 82.17% overall (kappa = 0.488), 87.45% for HR-HPVs (kappa = 0.689), and 88.33% for CIN2/3 (kappa = 0.51). The HR-HPVs detection rates of these assays were comparable. Our findings reveal that the FDA-approved HR-HPVs detection assay is appropriate for screening women with HR-HPVs infection, and for predicting increased risk of cervical cancer progression. REBA HPV-ID^® can be used to detect low risk-HPV types in high-grade cervical lesions that are HR-HPV negative as well as in the distribution of HPV types.     

HPV genotyping in adenocarcinoma of the uterine cervix in Thailand

Objective

To determine the distribution of human papillomavirus (HPV) genotypes in cervical adenocarcinoma in Thailand and to evaluate the clinicopathologic characteristics associated with common HPV genotypes.

Methods

Formalin-fixed, paraffin-embedded tissues from 150 patients with adenocarcinoma were collected from 4 areas of Thailand. Infection with HPV was detected by nested polymerase chain reaction (PCR) with primers MY09/11 and GP5 +/6 +. Genotyping was performed using a linear array assay, followed by type-specific PCR targeting the E6/E7 regions of HPV-16, HPV-18, and HPV-52 if the linear array test was negative.

Results

Human papillomavirus DNA was detected in 145 (97%) adenocarcinomas (132 single infections; 11 multiple infections; 2 tumors with undetermined HPV type). Genotype 18 was most common (66%), followed by HPV-16 (30%) and HPV-45 (3%). Infection with only HPV-16 and/or HPV-18 accounted for 88% of the HPV-positive tumors. Patients with HPV-18 infection had a younger age (P = 0.009) and higher tumor grade (P < 0.001) than patients with HPV-16 infection.

Conclusion

The HPV detection rate in cervical adenocarcinomas in Thailand is high. The predominant genotype is HPV-18, being twice as common as HPV-16. Genotype variations are associated with patient age and tumor grade. Vaccination against HPV-16/HPV-18 might prevent almost 90% of adenocarcinomas.     

Roles of the MEK1/2 and AKT pathways in CXCL12/CXCR4 induced cholangiocarcinoma cell invasion

AIM:To evaluate the expression of C-X-C motif chemokine receptor 4(CXCR4)and its signaling cascades,which were previously identified as a key factor for cancer cell progression and metastasis,in cholangiocarcinoma cell lines.METHODS:The expression of CXCR4 and its signaling cascades were determined in the cholangiocarcinoma cell lines(RMCCA1 and KKU100)by Western blotting.The invasion assays and the detection of actin polymerization were tested in these cholangiocarcinoma cells treated with CXC chemokine ligand-12(CXCL12).RESULTS:Expression of CXCR4 was detected in both cholangiocarcinoma cell lines and activation of CXCR4 with CXCL12 triggered the signaling via the extracellular signal-regulated kinase-1/2(ERK1/2)and phosphoinositide 3-kinase(PI3K)and induction of cholangiocarcinoma cell invasion,and displayed high levels of actin polymerization.Addition of CXCR4 inhibitor(AMD3100)abrogated CXCL12-induced phosphorylation of MEK1/2 and Akt in these cells.Moreover,treatment with MEK1/2 inhibitor(U0126)or PI3K inhibitor(LY294 002)also attenuated the effect of CXCL12-induced cholangiocarcinoma cell invasion.CONCLUSION:These results indicated that the activation of CXCR4 and its signaling pathways(MEK1/2 and Akt)are essential for CXCL12-induced cholangiocarcinoma cell invasion.This rises Implications on a potential role for the inhibition of CXCR4 or its signal cascades in the treatment of cholangiocarcinoma.     

Lack of prognostic significance of HER-2/neu in early epithelial ovarian cancer

A total of 74 patients with apparent early stage epithelial ovarian cancer who underwent exploratory laparotomy at King Chulalongkorn Memorial Hospital or other hospitals and were referred for further treatment, were evaluated. Formalin fixed paraffin-embedded ovarian tissue specimens were collected and immuno-stained with HER-2/neu antibodies for comparison with clinicopathologic data after median follow up of 46 months (range 3 - 83 months). The prevalence of HER-2/neu overexpression in these patients was 10.2%. No significant correlation between HER-2/neu overexpression and clinicopathological parameters (stage, ascites, capsular rupture, capsular adherence, histological subtype and histological grade) was found. Disease free survival and overall survival did not statistically differ between those with lesions positive or negative for HER-2/neu overexpression.     

Concurrent radiotherapy with temozolomide followed by adjuvant temozolomide and cis-retinoic acid in children with diffuse intrinsic pontine glioma

The prognosis of children with diffuse intrinsic pontine glioma (DIPG) is very poor. Radiotherapy remains the standard treatment for these patients, but the median survival time is only 9 months. Currently, the use of concurrent radiotherapy with temozolomide (TMZ) has become the standard care for adult patients with malignant gliomas. We therefore investigated this approach in 12 children diagnosed with DIPG. The treatment protocol consisted of concurrent radiotherapy at a dose of 55.8-59.4 Gy at the tumor site with TMZ (75 mg/m(2)/day) for 6 weeks followed by TMZ (200 mg/m(2)/day) for 5 days with cis-retinoic acid (100 mg/m(2)/day) for 21 days with a 28-day cycle after concurrent radiotherapy. Ten of the 12 patients had a clinical response after the completion of concurrent radiotherapy. Seven patients had a partial response, four had stable disease, and one had progressive disease. At the time of the report, 9 of the 12 patients had died of tumor progression, one patient was alive with tumor progression, and two patients were alive with continuous partial response and clinical improvement. The median time to progression was 10.2 +/- 3.0 months (95% confidence interval [CI], 4.2-16.1 months). One-year progression-free survival was 41.7% +/- 14.2%. The median survival time was 13.5 +/- 3.6 months (95% CI, 6.4-20.5 months). One-year overall survival was 58% +/- 14.2%. The patients who had a partial response after completion of concurrent radiotherapy had a longer survival time (p = 0.036) than did the other patients (those with stable or progressive disease). We conclude that the regimen of concurrent radiotherapy and TMZ should be considered for further investigation in a larger series of patients.     

Multiloculated peritoneal inclusion cyst treated successfully with laparoscopic surgery

Background: Multiloculated peritoneal inclusion cysts or benign cystic mesotheliomas are most commonly found in women of reproductive years; the disease involves the abdomen, pelvis and retroperitoneum. Case: A 33-year-old, para 3-0-0-3, Thai woman presented to the hospital upon an incidental finding of left ovarian cyst and a mild pelvic pain for three months. Her pelvic examination revealed left ovarian cyst. Transvaginal ultrasonogram demonstrated a multiloculated cyst size 61×40×55 mm³ adherent to the normal left ovary. Laparoscopic surgery was performed. There was a multiloculated cyst 6 cm in diameter in the left pelvic cavity. The cyst was excised and the histopathology revealed inclusion cysts. She was well at discharge and throughout the four-week and six-month follow-up periods. Conclusion: Although multiloculated peritoneal inclusion cyst is uncommon, it should be included in the differential diagnosis of adnexal masses. Surgical excision remains the current recommended treatment for symptomatic disease. Surgical excision by laparoscopy might be an alternative method for successful management.     

Neonatal seizures and familial hypomagnesemia with secondary hypocalcemia

This report describes two female siblings suffering from hypomagnesemia with secondary hypocalcemia, diagnosed at the third and fifth week of age. They both presented with recurrent generalized convulsions. Because their serum calcium levels were low at the early stage, the diagnosis of late-onset neonatal hypocalcemia was mistakenly made. Their seizures did not respond to parenteral calcium initially, but were completely terminated after the administration of magnesium. The possible cause of hypomagnesemia in these two patients was the selective defect of magnesium absorption in the small intestine. Both patients continued to receive daily supplement of magnesium orally to the last follow-up appointment at the ages of 23 and 12 years, respectively. Despite having several generalized seizures before the correct diagnosis and proper treatment, normal physical and mental development was achieved in both patients.