Philip I. Song

Morphological types and connectivity of horizontal cells found in the adult zebrafish (Danio rerio) retina

We describe here different types of horizontal cells in the zebrafish retina and how they connect to photoreceptors. To label horizontal cells, crystals of DiI were placed onto the tips of pulled glass pipettes and inserted into the inner nuclear layer of fixed whole‐mount retinas. The DiI‐labeled horizontal cells were imaged by confocal microscopy and analyzed according to dendritic arborization, cell depth, dendritic terminal morphology, and connectivity with photoreceptors. Three types of horizontal cells were unequivocally identified: two cone‐connecting (H1/2 and H3) and one rod‐related cell. H1/2 cells have dendritic terminals that are arranged in “rosette” clusters and that connect to cone photoreceptors without any apparent specificity. H3 cells are larger and have dendritic terminal doublets arranged in a rectilinear pattern. This pattern corresponds to the mosaic of the single cones in the zebrafish photoreceptor mosaic and indicates that H3 cells connect specifically to either the blue‐sensitive (long‐single) or ultraviolet‐sensitive (short‐single) cones. Thus, H3 cells are likely to be chromaticity‐type cells that process specific color information, whereas H1/2 cells are probably luminosity‐type cells that process luminance information. Rod horizontal cells were identified by their shape and dendritic pattern, and they connect with numerous rod photoreceptors via small spherical terminals. J. Comp. Neurol. 506:328–338, 2008.

Long-term survival after esophagectomy for early esophageal squamous cell carcinoma in Linxian, China†

Linxian in Henan Province, China, has among the highest rates of esophageal cancer worldwide. Little is known about long‐term survival after esophagectomy for early neoplastic lesions found during early detection screening. A long‐term survival analysis was performed for 315 patients from Linxian who received esophagectomy for early esophageal squamous cell carcinoma (ESCC).

Resolution of pansclerotic morphea after treatment with antithymocyte globulin.

Background. A previously healthy 50-year-old man presented with thickening and hardening of the skin on his trunk, neck and upper extremities that had started after the appearance of a 5 cm web-like patch of blood vessels on his upper chest and progressed over 4 months. He also reported difficulties with swallowing and a 20 kg weight loss.Investigations. Physical examination, laboratory testing, including complete blood count, autoimmune serology for antiplatelet, antinuclear and extractable nuclear antibodies, direct antiglobulin test, incisional skin biopsy, bone-marrow biopsy, and MRI of the upper extremities.Diagnosis. Pansclerotic morphea associated with red cell aplasia and immune-mediated thrombocytopenia.Management. Treatment with prednisone 60 mg per day and methotrexate 15 mg per week was started, but symptoms worsened. Methotrexate was replaced by pulsed intravenous methylprednisolone (1 g daily for 3 days), followed by mycophenolate mofetil started at 1 g per day and titrated up over 4 weeks to 3 g per day. Severe bicytopenia developed that did not improve with an 8-week washout of immunosuppressive agents. His fibrotic skin and hematologic conditions dramatically responded to antithymocyte globulin 40 mg/kg daily for 4 days, plus 10 mg/kg ciclosporin and methylprednisolone 1 mg/kg per day.

The Clinical Profile of Merkel Cell Carcinoma in Mainland China

Background  Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy, but little is known about the presence or characteristics of MCC in mainland China. A retrospective chart review was conducted to describe the clinical profile of MCC in China.

An Empirical Analysis of Overlap Publication in Chinese Language and English Research Manuscripts

Background There are a number of sound justifications for publishing nearly identical information in Chinese and English medical journals, assuming several conditions are met. Although overlap publication is perceived as undesirable and ethically questionable in Europe and North America, it may serve an important function in some regions where English is not the native tongue. There is no empirical data on the nature and degree of overlap publication in English and Chinese language journals. Methods/Principal Findings A random sample of 100 English manuscripts from Chinese institutions was selected from PubMed. Key words and institutions were searched in the China National Knowledge Infrastructure, a comprehensive Chinese language research database. Unacknowledged overlap was a priori defined according to International Committee of Medical Journal Editor (ICMJE) guidelines following examination by two individuals. 19% (95% CI 11–27) of English manuscripts from Chinese institutions were found to have substantial overlap with Chinese published work based on full text examination. None of the manuscripts met all of the criteria established by the ICMJE for an acknowledged overlap publication. Individual-level, journal-level, and institutional factors seem to influence overlap publication. Manuscripts associated with an institution outside of China and with more than one institution were significantly less likely to have substantial overlap (p<0.05). Conclusions/Significance Overlap publication was common in this context, but instances of standard ICMJE notations to acknowledge this practice were rare. This research did not cite the identified overlap manuscripts with the hope that these empirical data will inform journal policy changes and structural initiatives to promote clearer policies and manuscripts.

Vesiculobullous and hemorrhagic erythema migrans: uncommon variants of a common disease.

The diagnosis of Lyme disease relies on the accurate diagnosis of erythema chronicum migrans (ECM) because serologic tests, culture, and polymerase chain reactions are often inaccurate. Although ECM is classically associated with a targetoid rash, there are many variants of this lesion. These variants of ECM are often initially diagnosed as cellulitis or spider bite reactions and treated with oral antibiotics. Inappropriate treatment further delays the diagnosis of Lyme disease, leading to late complications.

Heparin, warfarin, or calciphylaxis?

and Elizabeth M. Van CottA 68-year-old male with chronic kidney disease presented with painful recent-onset lower extremity skin lesions (Image 1). These lesions hadbeen slowly developing over the previous 3 months, following a recent admission for treatment of acute membranous glomerulonephritis and deepvein thrombosis for which warfarin was initiated. His past medical history is significant for coronary artery disease and Type 2 diabetes mellitus,well controlled on insulin. Phosphorus (5.5 mg/dL) and parathyroid hormone (113 pg/mL) were elevated and calcium (8.6 mg/dL) was normal.The initial differential diagnoses were warfarin-induced skin necrosis, calciphylaxis, and ischemic necrosis with secondary cellulitis. Surgicaldebridement revealed full-thickness necrosis of the skin. Biopsies of the lesions revealed subcutaneous arteriolar calcifications typical of calciphy-laxis (Image 2).Warfarin skin necrosis or heparin-induced thrombocytopenia (HIT) may present with cutaneous lesions similar to calciphylaxis [1]. Histologi-cally, warfarin necrosis and HIT typically show widespread thrombosis without arteriolar calcification. The lesions of warfarin necrosis typicallyappear within 3–10 days of commencing warfarin therapy and tend to occur in a similar distribution to those of calciphylaxis. HIT skin lesionsmostly occur at the site of injection approximately 1 week after heparin initiation. In contrast to typical HIT, which has a characteristic decline inplatelet count, the platelet count is often normal when skin lesions are the presenting sign of HIT [2]. In the present case, HIT testing was notperformed, because biopsy results were already available when he was admitted to our hospital.Calciphylaxis is the disastrous consequence of prolonged calcium-phosphate balance dysregulation, affecting up to 5% of hemodialysis patients [3].The pathogenesis is incompletely understood. It is believed that a combination of factors, such as an increased concentration of reactive oxygen spe-cies, inhibition of anti-calcification factors, and a prolonged hyperphosphatemic state lead to the transformation of vascular smooth muscle cellsintoosteoblast-like calcifying vascular cells (CVCs). CVCs then lay down a hydroxyapatite-like substance in the media of small arterioles, leading to ische-mia and thrombosis of the overlying tissues. The typical histological picture is a triad of vascular calcification, intimal fibrosis, and panniculitis. Der-mal or subcutaneous thrombosis can also be present [4].Calciphylaxis characteristically presents with retiform purpura, in which there are violaceous skin lesions with jagged, geometric borders adja-cent to fairly normal-appearing skin, which steadily enlarge, ulcerate, and become necrotic over a period of weeks. These lesions are painful andtypically occur in areas with significant subcutaneous adipose tissue; including buttocks, lower extremities, and breasts. Vital organs are almost