fluconazole dose was increased to 200 mg/d; thus, she was referred Candida Endocarditis Following Percutaneous to our hospital for further care. Transluminal Coronary Angioplasty Physical examination on admission revealed fever (temperature, 38.6ЊC) and tachycardia without any peripheral embolic signs in Although percutaneous transluminal coronary angioplasty the eyes and oral cavity. The heartbeat was regular, with a splitting (PTCA) is performed frequently, to our knowledge, it has not been of S 1 ; a grade 2/6 systolic murmur was heard over the right and associated with subsequent serious infection. We report a case of left upper sternal borders, with radiation to the neck. The chest candida endocarditis that occurred after PTCA was performed. was clear without basal rales. Splinter hemorrhagic spots were A 42-year-old female was admitted to the hospital with a found on the right 2nd and 4th fingers and the left 3rd finger, and 4-month history of fever. Five months before admission, she had Janeway lesions were seen over both palms. The right leg was cold undergone emergent PTCA twice at a local hospital because of and tender to palpation, and the right pedal pulse was diminished. acute myocardial infarction involving the right coronary artery. Findings of the remainder of the physical examination were unre-She was discharged after 1 week of hospitalization. Two weeks markable. later, she developed intermittent fever (temperature, £39ЊC) in Four sets of cultures of blood obtained at admission all yielded association with dizziness, black floaters, soreness over her right Candida parapsilosis. A transthoracic echocardiogram showed leg, and pain on pressure over her nails. vegetations on the aortic valves, which were associated with mild She was readmitted to the same hospital because of the persistent aortic regurgitation and mitral regurgitation. Left aortoiliac embolifever, soreness over her right leg, and painful nails. Blood cultures zation was disclosed by a Doppler study of the lower extremities. yielded Candida species, and nosocomial fungemia was diagnosed. Therapy with intravenous amphotericin B (0.5 mg/kg) was initiated Oral fluconazole was prescribed at a dose of 100 mg/d, and she immediately on admission, and therapy with oral fluconazole was was discharged 3 weeks later with instructions to continue taking discontinued. oral fluconazole. The fever and the symptoms of painful nails and Aortic valve replacement with a mechanical valve (Carbomedright leg soreness subsided during hospitalization but recurred 2 ics, Austin, TX) and left aortoiliac embolectomy were performed days after discharge. The fever persisted despite the fact that the on the 7th hospital day. Large vegetations were found over all three leaflets of the aortic valve, but there was no significant aortic valvular dilatation. Culture of the valve tissue yielded C. parapsilosis and Candida albicans.

High cellular heterogeneity within neuroblastomas (NBs) may account for the non-uniform response to treatment. c-KIT(+) cells are frequently detected in NB, but how they influence NB behavior still remains elusive. Here, we used NB tumor-initiating cells to reconstitute NB development and demonstrated that c-KIT(+) cells are de novo generated and dynamically maintained within the tumors to sustain tumor progression. c-KIT(+) NB cells express higher levels of neural crest and stem cell markers (SLUG, SOX2 and NANOG) and are endowed with high clonogenic capacity, differentiation plasticity and are refractory to drugs. With serial transplantation assays, we found that c-KIT expression is not required for tumor formation, but c-KIT(+) cells are more aggressive and can induce tumors ninefold more efficiently than c-KIT(-/low) cells. Intriguingly, c-KIT(+) cells exhibited a long-term in vivo self-renewal capacity to sustain the formation of secondary and tertiary tumors in mice. In addition, we showed that Prokineticin signaling and mitogen-activated protein kinase pathways are crucial for the maintenance of c-KIT(+) cells in tumor to promote NB progression. Our results highlight the importance of this de novo population of NB cells in sustainable growth of NB and reveal specific signaling pathways that may provide targets leading to more effective NB therapies.

This study evaluated a new multiplex kit, Luminex NxTAG Respiratory Pathogen Panel, for respiratory pathogens and compared it with xTAG RVP Fast v2 and FilmArray Respiratory Panel using nasopharyngeal aspirate specimens and culture isolates of different swine/avian-origin influenza A subtypes (H2N2, H5N1, H7N9, H5N6, and H9N2). NxTAG RPP gave sensitivity of 95.2%, specificity of 99.6%, PPV of 93.5%, and NPV of 99.7%. NxTAG RPP, xTAG RVP, and FilmArray RP had highly concordant performance among each other for the detection of respiratory pathogens. The mean analytic sensitivity (TCID50/ml) of NxTAG RPP, xTAG RVP, and FilmArray RP for detection of swine/avian-origin influenza A subtype isolates was 0.7, 41.8, and 0.8, respectively. All three multiplex assays correctly typed and genotyped the influenza viruses, except for NxTAG RRP that could not distinguish H3N2 from H3N2v. Further investigation should be performed if H3N2v is suspected to be the cause of disease. Sensitive and specific laboratory diagnosis of all influenza A viruses subtypes is especially essential in certain epidemic regions, such as Southeast Asia. The results of this study should help clinical laboratory professionals to be aware of the different performances of commercially available molecular multiplex RT-PCR assays that are commonly adopted in many clinical diagnostic laboratories.

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