A 16-year-old girl (gravida 0, para 0) presented to the emergency department with a 2-week history of nausea, vomiting, vaginal spotting, and lower leg edema. On examination we found a palpable lower abdominal mass. The patient acknowledged recent sexual activity but denied having any sexually transmitted diseases.

The risk of hematologic malignancies in rheumatoid arthritis (RA) patients has been an important clinical concern. The information of age effect on the interval from the diagnosis of RA to that of hematologic malignancies is limited. This study aimed to define the age-risk relationship between hematologic malignancies and RA. A retrospective cohort study was conducted nationwide with 17,472 patients and 87,360 controls from the Taiwan National Health Insurance Database covering 1997-2008. The subsequent development of hematologic malignancy was observed. The age-adjusted standardized incidence ratios (SIRs), incidence per 1000 person-years, follow-up duration for the diagnosis of hematologic malignancies, and cumulative hazard rates of hematologic malignancies between RA and controls were analyzed. Significantly higher incidences of both lymphoid and myeloid malignancies were found in male RA patients compared with RA-free patients (SIR 3.36, 95% CI = 2.03-5.57, and SIR: 3.69, 95% CI = 2.46-5.53). A significantly increased overall incidence risk was found in lymphoid malignancies (SIR 3.00, 95% CI = 2.22-4.05) but not significantly increased in myeloid malignancies (SIR 1.54, 95% CI = 0.95-2.50) in female RA. The follow-up duration for hematologic malignancies was significantly shorter in RA patients than in RA-free patients in both males and females (70.70 vs. 103.80 months and 67.73 vs. 100.93 months, respectively). Additionally, higher cumulative hazard rates in both lymphoid and myeloid malignancies were found in male RA patients (p < 0.0001). RA patients have a shorter incubation time to hematological malignancies while comparing to the RA-free people, and the risks are variable in gender and different age groups.

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is a well-established, popular treatment choice for renal stones. Traditionally, the semi-liquid gel is used as a coupling medium in ESWL. During ESWL, body fluid or blood might transmit between the patients when the probe or gel used in the procedure is contaminated and cause potential nosocomial infections. To solve this problem, we developed a solid coupling medium (isolation coupling pad, referred to as “icPad”) between the patient’s skin and the probe as a shock wave transmission medium to prevent contamination. This study aimed to investigate the isolative efficacy of the icPad in blocking the permeation of microbes. Method: Rhodamine 6G (a fluorescent dye) was used as a tracer to simulate the microorganisms. The penetration of the fluorescent dye on the longitudinal section of the icPad was observed by a microscope after the dye was placed on the body side of the icPad for 40 min. After the shock wave, icPad was extracted with 75% ethanol, and fluorescence intensity was measured with a fluorescence spectrometer. Results: Our results revealed that the body side of icPad is free of fluorescent dye during lithotripsy. Qualitative analysis results confirmed that icPad has an isolative effect on simulating contaminants such as bacteria or viruses. Conclusion: In this in vitro phantom study, a proprietary icPad can be an isolative coupling medium and is speculated to avoid cross-contamination of bacterial or viral infection during ESWL.