Pulmonary amyloidosis and multiple myeloma mimicking lymphoma in a patient with Sjogren’s syndrome: A case report

BACKGROUNDSjogren’s syndrome (SS), which affect salivary gland function, is an autoimmune disease. SS may involve extraglandular organs. Approximately 10 to 20 percent of SS patients have clinically significant lung disease, but presentation of pulmonary amylodosis is extremly rare. The incidence of benign monoclonal gammopathy in SS patients is high, but multiple myeloma is rare. No case involving the simultaneous occurrence of two rare diseases, pulmonary amyloidosis and multiple myeloma, in the same patient with SS has been reported so far. CASE SUMMARYA 41-year-old male patient was referred to our hematology department due to incidentally detected gastric plasmacytoma. He had been diagnosed with SS four years earlier. Multiple miliary nodules, ground glass opacity in both lung fields, and enlargement of both inguinal lymph nodes was observed on chest and abdomen computer tomography. Based on the pathological findings of lung and lymph node biopsied specimens, the patient was diagnosed with pulmonary amyloidosis and multiple myeloma. Pulmonary amyloidosis and multiple myeloma associated with SS has rarely been reported.CONCLUSIONThis is an extremely rare case of simultaneous pulmonary amyloidosis and multiple myeloma in the same patient with SS.     

Coixlachryside B: a new benzoxazinoid glycoside from the roots of Coix lachryma-jobi var. ma-yuen (Gramineae)

Coix lachryma-jobi L. var. ma-yuen has been a source of food and traditional folk medicine in some parts of Asia for thousands of years; however, the roots of this plant have not been phytochemically investigated. Herein, we report the isolation of a new benzoxazinoid glycoside, coixlachryside B (1), along with ten known compounds (2–11), from the roots of C. lachryma-jobi var. ma-yuen using a variety of chromatographic methods. Among the known compounds, the absolute configuration of compound 4 was determined. The structures of all compounds were elucidated by interpreting NMR spectroscopic data, and experimental and calculated electronic circular dichroism spectra.     

Hepatocellular carcinoma: preoperative gadoxetic acid–enhanced MR imaging can predict early recurrence after curative resection using image features and texture analysis

Abdominal Radiology - To investigate whether pre-operative gadoxetic acid–enhanced MRI can predict early recurrence after curative resection of single HCC using image features and texture...     

Risk factors for failure of initial intravenous immunoglobulin treatment in Kawasaki disease

The aims of this study were to determine the occurrence and variables associated with the initial intravenous immunoglobulin (IVIG) treatment failure in Kawasaki disease (KD) and to categorize differences in clinical characteristics between responders and nonresponders to initial IVIG treatment. Patients were classified into two groups. Group A included 33 patients who received a single dose of IVIG treatment and responded. Group B included 18 patients who received more than two doses of IVIG due to failure of the initial treatment. The mean duration of fever after initial treatment in group B was significantly longer than it was in group A. In group B, we found that higher bilirubin, aspartate aminotransferase (AST), polymorphonuclear cells (PMN) (%), and lower platelet values at baseline were independent predictors of persistent or recurrent fever in patients with KD. Coronary artery abnormalities were found in 8 patients (44.4%) in group B and in two patients (6.1%) in group A. We found that abnormal liver function tests and a lower platelet count at baseline were possible predictors of nonresponders to IVIG in patients with KD. There is a need for a prospective study focused on baseline hepatobiliary parameters.     

Early detection and intervention in first-episode schizophrenia: a critical review

OBJECTIVE: To review the literature on early intervention in psychosis and to evaluate relevant studies. Method: Early intervention was defined as intervention in the prodromal phase (primary prevention) and intervention after the onset of psychosis, i.e. shortening of duration of untreated psychosis (DUP) (secondary prevention). RESULTS: We found few studies aimed at early intervention, but many papers discussing the idea at a more general level. We identified no studies that prove that intervention in the prodromal phase is possible without a high risk for treating false positives. We identified some studies aimed at reducing DUP, but the results are ambiguous and, until now, no follow-up data showing a positive effect on prognosis have been presented. CONCLUSION: Early intervention in psychosis is a difficult and important challenge for the psychiatric health services. At the time being reduction of DUP seems to be the most promising strategy. Intervention in the prodromal phase is more ethically and conceptually problematic.     

Mechanical Properties and Eco-Efficiency of Steel Fiber Reinforced Alkali-Activated Slag Concrete

Conventional concrete production that uses ordinary Portland cement (OPC) as a binder seems unsustainable due to its high energy consumption, natural resource exhaustion and huge carbon dioxide (CO₂) emissions. To transform the conventional process of concrete production to a more sustainable process, the replacement of high energy-consumptive PC with new binders such as fly ash and alkali-activated slag (AAS) from available industrial by-products has been recognized as an alternative. This paper investigates the effect of curing conditions and steel fiber inclusion on the compressive and flexural performance of AAS concrete with a specified compressive strength of 40 MPa to evaluate the feasibility of AAS concrete as an alternative to normal concrete for CO₂ emission reduction in the concrete industry. Their performances are compared with reference concrete produced using OPC. The eco-efficiency of AAS use for concrete production was also evaluated by binder intensity and CO₂ intensity based on the test results and literature data. Test results show that it is possible to produce AAS concrete with compressive and flexural performances comparable to conventional concrete. Wet-curing and steel fiber inclusion improve the mechanical performance of AAS concrete. Also, the utilization of AAS as a sustainable binder can lead to significant CO₂ emissions reduction and resources and energy conservation in the concrete industry.     

Course and Predictors of Suicidality Over the First Two Years of Treatment in First-Episode Schizophrenia Spectrum Psychosis

The objective of this study was to investigate the course of suicidal behavior over the first 2 years of comprehensive, integrated treatment in two groups of patients with DSM-IV first episode schizophrenia spectrum psychosis, where one group was recruited through an early detection program. We have previously shown that the rate of severe suicidal behavior was lower in the earlier detected group than in the other. First episode schizophrenia is a high risk period for suicidality, but we found low rates of completed suicides and suicide attempts in both groups after 2 years in treatment, with no between-groups differences. Severe suicidality (plans and attempts) was predicted by drug abuse, dissatisfaction with life and severe suicidality at start of treatment.     

Naso-orbicular tissue necrosis by Streptococcus parasanguis in a patient with Fanconi anemia: clinical and laboratory aspects.

Fanconi anemia (FA) is a rare autosomal recessive disorder, characterized by pancytopenia and progressive hypoplasia of the bone marrow. A 23-year-old woman with FA showed severe pancytopenia and developed an abscess on the infraorbicular region on the right side of the face that progressed to phlegmon and caused tissue necrosis of the nostrils, nasal septum, nasal fossa, and posterior orbital region. Laboratory examination showed Streptococcus parasanguis as the etiologic agent of the phlegmon. Supportive treatment was recommended due to donor incompatibility for bone marrow transplant. The intraoral examination showed spontaneous gingival bleeding, edema of the interdental papillae, hematomas on the superior and inferior lips, bacterial and fungal infections, and adequate oral hygiene. The patient was treated with the administration of an antibiotic (imipenem), an antifungal (amphotericin B), and mouth washing with antiseptic solutions. Periodontal prophylaxis and orientation to and control of oral hygiene and diet were also used during the remission period. For functional and esthetic rehabilitation of the alar regions and nasal dorsum, an acrylic resin nasal prosthesis was made, supported by a spectacle frame.