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Purpose: The aim of this study was to determine if self-threading dental implants placed using stopper drills to bicortically engage both the alveolar crest and sinus floor (bicortical fixation) achieved primary and/or secondary stability comparable to that of short implants only engaging alveolar crest cortical bone (unicortical fixation) or implants engaging both the crest and sinus floor but via greenstick fracture and grafting (indirect sinus elevation)., Materials and Methods: Thirty-eight patients exhibiting 7 to 11 mm of bone coronal to the sinus floor as confirmed by preoperative CBCT were recruited. Forty-five implants were randomly assigned to one of the placement techniques. No patient received more than two implants, which were placed in opposite sides of the maxilla while using different surgical techniques. An Osstell ISQ was employed immediately after implant placement to measure stability six times in a buccolingual dimension. Secondary stability was measured at stage-two surgery after a 3- to 6-month healing period., Results: The greatest primary implant stability was achieved via indirect sinus elevation. However, no statistically significant difference was found among the three surgical techniques (P = .13; bicortical fixation: 71.4 [standard error = 2.1]), unicortical fixation: 69.6 [2.1], indirect sinus elevation: 75.9 [2.3]). The three techniques had similar secondary stability (P > .999; 79.9 [1.2], 80.0 [1.2], and 80.0 [1.3], respectively). Baseline residual ridge height measured on CBCT was similar (P = .1; 8.8, 9.9, and 9.4 mm, respectively), but implant diameter and length placed in the maxilla differed (P = .03/P < .001; 4.7/11.4 mm, 4.3/8.1 mm, and 4.7/11.8 mm, respectively). Primary implant stability was significantly correlated to CBCT bone density (r = 0.37)., Conclusion: Primary and secondary implant stabilities of bicortical fixation did not differ significantly from those of unicortical fixation and indirect sinus elevation. However, use of the bicortical fixation technique is warranted since it is simpler and more economical than indirect sinus elevation; plus, it allows for longer implants than the unicortical fixation while yielding similar secondary implant stability.

Objective: To evaluate fetal cardiopulmonary stress in pregnancies complicated by preeclampsia (PE), fetal growth restriction (FGR), preterm birth (PT), and fetal distress (FD) using umbilical arterial blood N-terminal pro-B-type natriuretic peptide (NT-proBNP)., Materials and Methods: The study included 146 blood samples that were drawn from umbilical arteries at the time of delivery (20 cases of PE, 11 cases of FGR, 31 cases of PT, 23 cases of FD, and 61 cases of gestational age-matched controls) and analyzed. The main outcome measures included neonatal birthweight, cord pH, and umbilical arterial NT-proBNP., Results: The umbilical arterial NT-proBNP levels were significantly higher in the PE, FGR, PT, and FD groups than in the control group. The umbilical arterial NT-proBNP levels were negatively correlated with gestational age, birthweight, and umbilical arterial pH., Conclusions: Umbilical arterial NT-proBNP levels are elevated in stressful fetal conditions and have the potential to be considered as a marker for fetal cardiopulmonary stress.

Objective: The purpose of this study was to investigate whether amniotic fluid (AF) CA-125 in patients with preterm labor or preterm premature rupture of membranes can help predict intra-amniotic inflammation (IAI), microbial invasion of the amniotic cavity (MIAC) and imminent delivery., Methods: We recruited 36 women who admitted with impending preterm delivery and suspicious AF infection. AF matrix metalloproteinase-8 (MMP-8), white blood cell (WBC) count, glucose levels, and CA-125 levels were measured, and the MMP-8 bedside rapid test was also performed. AF culture and PCR were subsequently performed to confirm MIAC. We compared AF CA-125 levels according to the presence of IAI or MIAC and assessed its predictive value for delivery within 7 days of admission., Results: AF CA-125 levels were significantly higher in the IAI group than in the non-IAI group (mean ± standard deviation: 5608 ± 864 vs 904 ± 84 IU/ml; p = 0.001). AF CA-125 levels showed a negative correlation with gestational age and a positive correlation with AF WBC counts and MMP-8 levels. AF CA-125 levels were higher in the MIAC group, though this difference was not statistically significant (p = 0.064). Delivery within 7 days of admission was significantly more common in patients with higher AF CA-125 levels (cut-off: 1650 IU/ml, sensitivity: 71.4 %, specificity: 86.4 %, p = 0.005)., Conclusion: AF CA-125 levels are increased in patients with AF inflammation and can be a predictor of imminent preterm delivery.

The aim of this study was to investigate differences in amino-terminal proB-type natriuretic peptide (NT-proBNP) levels in the cord blood of neonates according to the type of congenital heart disease (CHD) and to evaluate the usefulness of NT-proBNP as a prognostic marker. We included 76 neonates with prenatally diagnosed CHD and 45 controls without CHD. Neonates were classified into five groups based on echocardiographic findings. The levels of NT-proBNP in the cord blood were examined and analyzed according to the neonatal outcomes. The levels of NT-proBNP were significantly elevated in the cord blood of neonates with CHD compared with that in the cord blood of controls. The levels of NT-proBNP in the group with right ventricular outflow tract obstruction without a ventricular septal defect were significantly increased compared to that in the other groups. The neonates that required acute surgical correction had higher levels of NT-proBNP in the cord blood, though they were not statistically significant. Meanwhile, NT-proBNP levels in the cord blood of neonates with functional single ventricle were significantly higher than that in the cord blood of those with functional biventricles. Significant differences in the levels of NT-proBNP between survivors and nonsurvivors were observed within 1 year of birth. In this study, we found that the levels of NT-proBNP in the cord blood of neonates with CHD were higher than the levels in controls. This finding was striking in the group with right ventricular outflow tract obstruction, and it was associated with surgery for functional single ventricle and 1-year survival.

Objective: To analyze practice patterns and checklists of second trimester ultrasonography, and to investigate management plans when soft markers are detected among Korean Society of Ultrasound in Obstetrics and Gynecology (KSUOG) members., Methods: An internet-based self-administered questionnaire survey was designed. KSUOG members were invited to the survey. Checklists of the second trimester ultrasonography were also requested. In the questionnaire survey, general practice patterns of the second trimester ultrasonography and management schemes of soft markers were asked. In the checklists analysis, the number of items were counted and also compared with those recommended by other medical societies., Results: A total of 101 members responded. Eighty-seven percent routinely recommended second trimester fetal anatomic surveillance. Most (91.1%) performed it between 20+0 and 23+6 weeks of gestation. Written informed consents were given by 15.8% of respondents. Nearly 60% recommended genetic counseling when multiple soft markers and/or advanced maternal age were found. Similar tendencies were found in the managements of individual soft markers. However, practice patterns were very diverse and sometimes conflicting. Forty-eight checklists were analyzed in context with the number and content of the items. The median item number was 46.5 (range, 17 to 109). Of 49 items of checklists recommended by International Society of Ultrasound in Obstetrics and Gynecology and/or American Congress of Obstetricians and Gynecologists, 14 items (28.6%) were found in less than 50% of the checklists analyzed in this study., Conclusion: Although general practice patterns were similar among KSUOG members, some of which were conflicting, and there is a need for standardization of the practice patterns and checklists of second trimester ultrasonography, which also have very wide range of spectrum.

Aim: In the present study, we aimed to assess the biomarkers in mid-trimester cervical fluid that can predict early stage cervical shortening., Material and Methods: We obtained cervical swab specimens from 96 gravidas, after which the cervical length was measured, at approximately 20 weeks of gestation. Cervical length was measured again at 4 weeks after the initial examination. Cervical shortening was noted in 20 women between 20 and 24 weeks of gestation (group A), whereas no cervical shortening was noted in 76 women (group B). We evaluated the use of the levels of tumor markers, proinflammatory cytokines, and matrix metalloproteinase-8 (MMP-8) as candidate biomarkers. CA-125 and carcinoembryonic antigen levels were determined by using an automatic immunoassay system in both groups. Furthermore, IL-1β, IL-8, tumor necrosis factor-α, and MMP-8 levels were measured using an enzyme-linked immunosorbent assay., Results: The levels of inflammatory cytokines and MMP-8 did not differ between the two groups, and were not correlated with cervical length or the change in cervical length. Although CA-125 and carcinoembryonic antigen levels were higher in group A, they were not statistically significant (P = 0.304 and 0.092, respectively)., Conclusion: Early stage cervical shortening in mid-trimester was not associated with an increase in the levels of tumor markers or proinflammatory cytokines in cervical fluid., (© 2015 Japan Society of Obstetrics and Gynecology.)

Wilson's disease is an inherited disease of copper metabolism leading to the toxic accumulation of copper, primarily in the liver and brain. Although the literature shows successful outcomes after proper treatment, pregnant patients with Wilson's disease still need close monitoring and management. Here, we report the case of a successful pregnancy in a Korean woman with Wilson's disease. A 33-year-old primigravid patient with Wilson's disease visited our antenatal clinic. Of her own volition, she had stopped her medication 2 years earlier. Oral zinc oxide therapy was started, and she was closely monitored throughout her pregnancy. She delivered a healthy female infant weighing 3.13 kg through a cesarean section. After delivery, the clinical course of both the mother and the baby were uneventful. We review crucial points in the treatment and the management dilemmas raised by the patient.

We report a case of prenatally detected pulmonary atresia with an intact ventricular septum accompanied by multiple ventriculocoronary connections. This lesion was diagnosed by using ultrasonography at 20 weeks' gestation, and this antepartum diagnosis was confirmed with both postnatal echocardiography and chest computed tomography. The neonate underwent a modified Blalock-Taussig shunt on the 15th day of life, and was discharged 8 days after the surgery., (© 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.)

Heavy metals and persistent organic pollutants (POPs), including Pb, Cd, T-Hg, MeHg, PCDD/Fs, PCBs, PBDEs, PCNs, and PBDD/Fs, were analyzed in 20 paired samples of cord blood, maternal blood, maternal urine, and placenta. The samples were collected from pregnant mothers and neonates from South Korea in 2010. The distribution of heavy metals among the samples varied with their physicochemical characteristics. The concentrations of Pb and Hg in the maternal and the cord blood samples were significantly correlated each other, implying efficient transplacental transport (TPT). Cd and Hg were accumulated in the placenta, forming protein conjugates, and T-Hg was higher in the cord blood samples than the maternal blood samples due to the binding affinity of Hg with fetal proteins. POPs generally showed the highest concentrations in the maternal serum samples, and the POPs levels in the cord serum and the placenta samples were dependent on the degree of halogenation. The TPT of POPs was seemingly related to lipoprotein transportation. Some PBDE congeners, however, showed their highest concentrations in the cord serum samples, suggesting an additional TPT mechanism. This is the first study to detect PCNs and PBDD/Fs in the cord serum samples, showing that the PCN levels were comparable to other POPs. According to the principal component analysis (PCA) results of the contaminant levels, POPs and heavy metals showed significantly different characteristics, whereas PBDEs had an intermediate attribute. Despite the limited number of participants, the comprehensive analysis of trace contaminants in the paired sample sets enabled us to infer the distribution and TPT mechanism of various contaminants.

Background: Uhl's anomaly is an extremely rare cardiac defect characterized by absence of the myocardium of the right ventricle. Until now, only three cases have been diagnosed or have showed suspicious diagnosis in prenatal period., Case: A 28-year-old nulliparous woman was referred to the present hospital for counseling the risk of drug medication. The authors found dilatation of the right ventricle and thinning of the right ventricular wall in the fetus at 25 weeks gestation. No other structural abnormalities were found concerning the great arteries and all heart valves demonstrated normal function. Uhl's anomaly was suspected on fetal echocardiography and it was confirmed postnatally by echocardiography and computed tomography (CT). The infant showed stable condition during neonatal period and is doing well in the ambulatory care after three-years follow up:, Conclusion: Although the outcomes of Uhl's anomaly are generally unfavorable, the duration of survival shows wide variation according to the cardiac function. To estimate the postnatal outcomes, it is highly recommended to perform the accurate differential diagnosis by using fetal echocardiography during pregnancy.

Objective: To compare the influence of ritodrine alone or in combination with nifedipine on maternal side effects and suppressing preterm labor., Materials and Methods: This retrospective study included 213 pregnancies with preterm labor (20-34 weeks) from May 2002 to April 2010 in Kyungpook National University Hospital in Daegu, Korea. Obstetric medical records were reviewed for both maternal characteristics and neonatal outcomes, including birth weight, Apgar score, admission to neonatal intensive care unit (NICU), ventilator support, and neonatal mortality. Maternal side effects such as tachycardia, pulmonary edema, and hyperglycemia were also reviewed., Results: Of 213 patients, 109 received ritodrine only and 104 were given ritodrine and nifedipine. There was no statistical difference between the two groups with regards to pregnancy outcomes and neonatal complications. Pregnancy prolongation over seven days was achieved more in the combination therapy group, with borderline statistical significance (59.6% vs. 72.1%, p = 0.055). Sixty-nine cases experienced maternal side effects; four cases were categorized as serious and 65 cases were mild., Conclusion: In the treatment of preterm labor, the combination regimen of ritodrine and nifedipine can be more effective than ritodrine alone for prolonging gestation over seven days. Moreover, as the combination did not cause severe maternal side effects, it may be considered as a safe and effective method to prolong gestation in patients with preterm labor.

Postpartum genital tract adhesions are unusual, and their cause has not been evaluated. However, severe dystocia and numerous pelvic examinations have been suggested as possible causes. Here, we report a case of vaginal adhesions following a difficult labor that presented as dyspareunia for 5 months. Pelvic examination and ultrasonography revealed a transverse vaginal septum that obstructed the vaginal cavity, and fluid collection proximal to this septum. The patient was successfully treated with surgical resection and administration of antibiotics.

Pneumatization of the maxillary sinus limits the quantity of alveolar bone available for implant placement and may result in a lack of primary stability and difficulty in achieving osseointegration. The purpose of this study was to retrospectively analyze a group of patients who had implants placed in the posterior maxilla, calculate the prevalence of sinus augmentation, and identify factors related to sinus augmentation. With institutional review board approval, dental records from a population of patients who had implants placed in the maxillary posterior region between January 2000 and December 2004 were used to create a database. Independent variables were classified as continuous (age of the patient at stage 1 implant surgery [S1], time between extraction and S1, time between extraction and sinus augmentation, and time between sinus augmentation and S1) and categorical (gender, implant failure, American Society of Anesthesiologists system classification, smoking, osteoporosis, residual crestal bone height, implant position, implant proximity, prostheses type, and implant diameter and length). The dependent variable was the incidence of a sinus augmentation procedure. Simple logistic regression was used to assess the influence of each factor on the presence of sinus augmentation (P < .05). The final database included 502 maxillary posterior implants with an overall survival rate of 93.2% over a mean follow-up period of 35.7 months. Of 502 implants, 272 (54.2%) were associated with a sinus augmentation procedure. Among variables, residual crestal bone height (P < .001), implant position (P < .001), implant proximity (P < .001), prosthesis type (P < .001), implant failure (P < .01), and implant diameter (P < .01), were statistically associated with sinus augmentation. Within the limitations of this retrospective study, the results suggest that more than half (54.2%) of the maxillary posterior implants were involved with a sinus augmentation procedure. The prevalence of sinus augmentation increased with decreased residual crestal bone height, more posterior implant locations, and complete or partial edentulism. Sinus augmentation was significantly associated with implant failure and wide implants.

We report a case of a viable abdominal pregnancy with successful outpatient management until fetal lung maturation and planned delivery. Advanced abdominal pregnancy is a very rare extrauterine pregnancy, which results in serious maternal and fetal morbidity. A 28-year-old nullipara was referred from the local clinic to our tertiary center at 18 weeks' gestation. We diagnosed an extrauterine fetus on sonographic examination. The patient had weekly antenatal sonographic examinations. We performed a planned laparotomy at 34 weeks' gestation, and a female baby weighing 2,100 g was delivered. The placenta was completely removed and the uterus was preserved. Both the mother and the baby had no postoperative morbidity., (Copyright © 2012 Wiley Periodicals, Inc.)

Invasion of trophoblasts into maternal uterine tissue is essential for establishing mature feto-maternal circulation. The trophoblast invasion associated with placentation is similar to tumor invasion. In this study, we investigated the role of KAI1, an antimetastasis factor, at the maternal-fetal interface during placentation. Mouse embryos were obtained from gestational days 5.5 (E5.5) to E13.5. Immunohistochemical analysis revealed that KAI1 was expressed on decidual cells around the track made when a fertilized ovum invaded the endometrium, at days E5.5 and E7.5, and on trophoblast giant cells, along the central maternal artery of the placenta at E9.5. KAI1 in trophoblast giant cells was increased at E11.5, and then decreased at E13.5. Furthermore, KAI1 was upregulated during the forskolin-mediated trophoblastic differentiation of BeWo cells. Collectively, these results indicate that KAI1 is differentially expressed in decidual cells and trophoblasts at the maternal-fetal interface, suggesting that KAI1 prevents trophoblast invasion during placentation.

Objectives: Aluminum step wedge (ASW) equivalent radiodensity (eRD) has been used to quantify restorative material's radiodensity. The aim of this study was to evaluate the effects of image acquisition control (IAC) of a digital X-ray system on the radiodensity quantification under different exposure time settings., Materials and Methods: Three 1-mm thick restorative material samples with various opacities were prepared. Samples were radiographed alongside an ASW using one of three digital radiographic modes (linear mapping (L), nonlinear mapping (N), and nonlinear mapping and automatic exposure control activated (E)) under 3 exposure time settings (underexposure, normal-exposure, and overexposure). The ASW eRD of restorative materials, attenuation coefficients and contrasts of ASW, and the correlation coefficient of linear relationship between logarithms of gray-scale value and thicknesses of ASW were compared under 9 conditions., Results: The ASW eRD measurements of restorative materials by three digital radiographic modes were statistically different (p = 0.049) but clinically similar. The relationship between logarithms of background corrected grey scale value and thickness of ASW was highly linear but attenuation coefficients and contrasts varied significantly among 3 radiographic modes. Varying exposure times did not affect ASW eRD significantly., Conclusions: Even though different digital radiographic modes induced large variation on attenuation of coefficient and contrast of ASW, E mode improved diagnostic quality of the image significantly under the under-exposure condition by improving contrasts, while maintaining ASW eRDs of restorative materials similar. Under the condition of this study, underexposure time may be acceptable clinically with digital X-ray system using automatic gain control that reduces radiation exposure for patient.

Purpose: This study aimed to investigate whether push-in and pull-out tests measure mechanical properties of the bone-implant interface differently, and which test is more sensitive to changes over the healing period., Materials and Methods: Two identical self-threading dental implants (3.3×8.5mm) were placed in medial surface of the proximal condyles of left and right tibias of 20 rabbits (40 implants total). Five rabbits each were sacrificed after 1, 4, 8, and 12 weeks of healing. Push-in test was performed on one side's tibia implant and pull-out on the other side's implant, at a rate of 6mm/min. Primary and secondary implant stabilities and tibia weight were measured on all implants., Results: The push-in test generated significantly higher failure load (p=.0001; 530N vs 279N), lower displacement at failure (p=.0003; 0.436mm vs 0.680mm), and higher interface stiffness (p<.0001; 1,641N/mm vs 619N/mm) than pull-out test. Failure load, stiffness, and secondary implant stability were significantly higher for longer compared with shorter healing periods, while displacement, tibia weight, and primary stability were not. Failure load and stiffness differed significantly for four healing times for the push-in but not for the pull-out test. Failure load was significantly correlated with secondary implant stability for both push-in (r=0.66) and pull-out (r=0.48) tests, but stiffness was significantly correlated with secondary stability only for the push-in test (r=0.72; pull-out test r=0.40)., Conclusion: The push-in test appeared more sensitive than pull-out to changes in mechanical properties at bone-implant interfaces during healing in rabbit tibia model., (© 2011 Wiley Periodicals, Inc.)

Escherichia coli prophages confer virulence and resistance to physico-chemical, nutritional, and antibiotic stresses on their hosts, and they enhance the evolution of E. coli. Thus, studies on profiles of E. coli prophages are valuable to understand the population structure and evolution of E. coli pathogenicity. Large terminase genes participate in phage genome packaging and are one of the cornerstones for the identification of prophages. Thus, we designed primers to detect 16 types of large terminase genes and analyzed the genomes of 48 E. coli and Shigella reference strains for the prophage markers. We also investigated the distribution of the 16 prophage markers among 92 avian pathogenic E. coli (APEC) strains. APEC strains were classified into 61 prophage types (PPTs). Each strain was different from the reference strains as measured by the PPTs and from the frequency of each prophage marker. Investigation of the distribution of prophage-related serum resistance (bor), toxin (stx1 and cdtI), and T3SS effector (lom, espK, sopE, nleB, and ospG) genes revealed the presence of bor (44.1%), lom (95.5%) and cdtI (9.1%) in APEC strains with related prophages. Therefore, the molecular prophage typing method may be useful to understand population structure and evolution of E. coli pathogenicity, and further studies on the mobility of the prophages and the roles of virulence genes in APEC pathogenicity may be valuable., (Copyright © 2012 Elsevier B.V. All rights reserved.)

In this study, multiplex nested RT-PCR (mnRT-PCR) was applied to simultaneous detect multiplex PCR with the higher sensitivity of nested PCR that is required for avian influenza, infectious bronchitis and Newcastle disease virus using two steps of amplification. For the first PCR, primers that were specific for each virus were newly designed from the nucleoprotein gene of AIV, the nucleocapsid protein gene of IBV and the fusion protein gene of NDV to amplify products of 665, 386 and 236 nucleotides, respectively. The multiplex PCR step provides mass amplification using common primers, which increased markedly the sensitivity of the test. Non-specific reactions were not observed when other viruses and bacteria were used for evaluating the mnRT-PCR. As a field application, 172 samples were tested by RT-PCR and mnRT-PCR. Among these samples, the concordance rates for mnRT-PCR and the single conventional RT-PCR showed 98.9% (kappa=0.98) and 98.8% (kappa=0.96) similarity for IBV and AIV, respectively. As a result, it is recommended the multiplex nested PCR as an effective tool for detecting and studying the molecular epidemiology of various mixed infections of one or more of these viruses in poultry., (Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.)

The present study determined the complete rpoB and seven partial house-keeping gene sequences of 29 human (20) and poultry (9) strains of Staphylococcus aureus, and conducted a phylogenetic analysis together with 39 strains in the GenBank and EMBL databases. On the basis of complete rpoB gene sequence (RS) typing , 28 different rpoB sequence types (RSTs) were identified; however, only 23 multilocus sequence types (STs) were identified by multi-locus sequence typing (MLST). RST 2-1 was a major RST covering 23.5% (16/68) of the analyzed strains followed by RST 4-1 (14.7%, 10/68). Out of 10 poultry strains including one in the database, 9 and 1 were classified into unique RSTs 3-1 and 6-3, respectively. According to the MLST, ST5 was a major sequence type covering 25.0% (17/68) of them, followed by STs 228 and 239 (for each ST, 11.8%, 8/68), and poultry strains were grouped into ST5 (9/10) and ST692 (1/10). The poultry ST5 strains were differentiated from human ST5 strains and rifampin resistance-related mutations were observed in some human S. aureus strains by RS typing. Thus, RS typing was more discriminative and informative than MLST, and it can be a simple and economic alternative to MLST for identification and phylogenetic analysis of S. aureus.

Serotyping has been the gold standard for identifying Salmonella, but it requires large amounts of standard antisera. Multilocus sequence typing (MLST) has been applied to identify Salmonella serovars, but the recombination of 4-7 housekeeping genes and multiple analytic steps diminish its applicability. In the present study, we determined the complete sequences of the RNA polymerase beta subunit gene (rpoB) and 7 housekeeping genes (aroC, dnaN, hemD, hisD, purE, sucA, and thrA) for 76 strains of 33 Salmonella enterica serovars and conducted phylogenetic analyses together with the corresponding gene sequences of 24 reference strains registered in the GenBank database. Based on the phylogenetic analyses, 100 strains from 40 serovars and 91 strains from 37 serovars were classified into 60 rpoB (RST) and 49 multilocus sequence types (ST), respectively. The nucleotide similarities were 98.8-100% and 96.9-100% for the complete rpoB gene and the seven concatenated housekeeping genes, respectively. The strains of 35 and 30 serovars formed serovar-specific branches or clusters in the rpoB and housekeeping gene phylogenetic trees, respectively. Therefore, complete rpoB gene sequencing and phylogenetic analysis may be a useful method for identifying Salmonella serovars that is a simpler, more cost-effective, and less time-consuming alternative or complementary method to MLST and conventional serotyping.

Implant position is a key determinant of esthetic and functional success. Achieving the goal of ideal implant position may be affected by case selection, prosthodontically driven treatment planning, site preparation, surgeon's experience and use of a surgical guide. The combined effect of surgical guide design, surgeon's experience, and size of the edentulous area on the accuracy of implant placement was evaluated in a simulated clinical setting. Twenty-one volunteers were recruited to participate in the study. They were divided evenly into 3 groups (novice, intermediate, and experienced). Each surgeon placed implants in single and double sites using 4 different surgical guide designs (no guide, tube, channel, and guided) and written instructions describing the ideal implant positions. A definitive typodont was constructed that had 3 implants in prosthetically determined ideal positions of single and double sites. The position and angulation of implants placed by the surgeons in the duplicate typodonts was measured using a computerized coordinate measuring machine and compared to the definitive typodont. The mean absolute positional error for all guides was 0.273, 0.340, 0.197 mm in mesial-distal, buccal-lingual, vertical positions, respectively, with an overall range of 0.00 to 1.81 mm. The mean absolute angle error for all guides was 1.61° and 2.39° in the mesial-distal and buccal-lingual angulations, respectively, with an overall range of 0.01° to 9.7°. Surgical guide design had a statistically significant effect on the accuracy of implant placement regardless of the surgeon's experience level. Experienced surgeons had significantly less error in buccal-lingual angulation. The size of the edentulous sites was found to affect both implant angle and position significantly. The magnitude of error in position and angulation caused by surgical guide design, surgeon's experience, and site size reported in this study are possibly not large enough to be clinically significant; however, it is likely that errors would be magnified in clinical practice. Future research is recommended to evaluate the effect of surgical guide design in vivo on implant angulation and position error.

We report a case of a cystic adenomyoma in a 19-year-old nullipara who presented with severe dysmenorrhea and pelvic pain. Preoperative magnetic resonance imaging showed a 3-cm well-circumscribed mass with a 2.1-cm cystic cavity in the myometrium of the left fundus. The tumor, including the cyst, was excised via laparoscopy with a part of the normal myometrium using a modified myomectomy method. On histologic examination, the cystic cavity was lined by endometrial tissue composed of endometrial epithelium and stroma. After 12 months of postoperative follow-up, the patient had significant improvement of dysmenorrhea.

Fetal scalp cysts are rare, and they may be easily misdiagnosed as meningoceles or encephaloceles. A 38-year-old pregnant woman was referred to our hospital for ultrasound examination, which revealed a small cyst above the skull with no defect in the skull. The cyst could not be seen on follow-up ultrasound examinations. After delivery, a three-dimensional CT scan of the head revealed no defect in skull and scalp. Fetal scalp cysts usually require surgical excision after birth, but can regress without any treatment., (Copyright © 2011 Wiley Periodicals, Inc.)

Purpose: Dental implant bone cement (DIBC) was developed to rescue unstable implants at the time of placement. The purpose of this study was to compare the mechanical properties of bone-cement-implant interfaces of cemented implants that were unstable initially and bone-implant interfaces of self-threaded implants placed in rabbit femurs after various healing periods. Interfaces and failure modes were also characterized using histology and scanning electron microscopy (SEM)., Materials and Methods: Eighty dental implants were placed in 20 rabbits. In each rabbit, two experimental and two control implants were placed in the right or left femur; one was in the distal epiphysis and the other in the cortical shaft. The experimental implants were cemented in loosely prepared bony sockets, while the control implants were self-threaded. The rabbits were sacrificed after varying healing periods. Magnetic pulse stability and push-in yield tests on ex vivo specimens measured secondary implant stability, 0.2% yield load, displacement, interface stiffness, and load at 100 μm. After loading tests, interfaces were evaluated with histology and SEM. Most analyses used mixed linear models., Results: The 0.2% yield load, interface stiffness, load at 100 μm, and secondary stability were significantly higher for bone-cement-implant interfaces than for bone-implant interfaces. Mechanical properties of bone-cement-implant interfaces plateaued at 1 week, with minimal change over the following 12 weeks, whereas bone-implant interfaces improved gradually. SEM and histology showed intimate bone-cement-implant interfaces without soft tissue intervention and mainly cohesive failures within DIBC. Secondary stability was significantly correlated with interface stiffness and load at 100 μm., Conclusion: The results suggest that DIBC can provide early implant stability and mechanical properties superior to those of self-threaded implants while maintaining intimate interfaces without signs of osteonecrosis or soft tissue intervention.

Objective: To determine the impact of uterine artery ligation in laparoscopic myomectomy, according to surgical results and clinical outcomes., Design: Single-center, nonrandomized, comparative study., Setting: University hospital, tertiary referral center., Patient(s): Ninety women undergoing laparoscopic myomectomy., Intervention(s): Laparoscopic myomectomy with or without uterine artery ligation., Main Outcome Measure(s): Surgical results and clinical outcomes., Result(s): Fifty-one patients (56.6%) underwent laparoscopic myomectomy with uterine artery ligation (group A), and 39 patients (43.3%) underwent laparoscopic myomectomy alone (group B). The mean operating time was 100.0 ± 33.8 minutes in group A and 90.0 ± 37.1 minutes in group B. Both groups were similar with respect to mean blood loss (72.3 ± 109.0 mL vs. 62.6 ± 77.3 mL). The myoma recurrence rate in group A was significantly less than in group B after a median follow-up period of 11.1 months (2% vs. 13%)., Conclusion(s): Both groups were similar with respect to surgical results. However, the recurrence rate was significantly lower in group A compared with group B., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to retrospectively analyze a cohort of patients who had implants placed in the posterior maxilla and assess and identify the predictors of implant failure., Materials and Methods: With institutional review board approval, dental records from a population of patients who had maxillary posterior implants placed were used to create a database. Independent variables were divided into continuous (age of the patient at stage-one implant surgery [S1], time between extraction and S1, time between extraction and sinus augmentation, time between sinus augmentation and S1, time between S1 and stage-two implant surgery [S2], and the time between S2 and restoration of the implant) and categorical (gender, American Society of Anesthesiologists [ASA] status, current smoking status, implant position, implant proximity, residual crestal bone height, implant length and diameter, and sinus augmentation technique and materials). The dependent variable was implant failure, which was defined as complete removal of the implant. Simple logistic regression was used to assess the influence of each of the predictors on implant failure (P < .05)., Results: The final database included 504 maxillary posterior implants with an overall survival rate of 93.2% over a mean follow-up period of 35.7 months. For the continuous variables, the age of the patient at S1 was statistically associated with implant failure (P = .028), as was the time between extraction and S1 (P = .014). For the categorical variables, ASA status (P < .001), implant proximity (P = .043), residual crestal bone height (P < .001), implant diameter (P = .050), sinus augmentation technique (P = .002), and sinus graft materials (P < .001) were statistically associated with implant failure., Conclusion: Within the limitations of this retrospective study, the results suggest that there are risk factors associated with maxillary posterior implant failure. Implants placed in areas with inadequate residual crestal bone height that required sinus augmentation were statistically associated with implant failure.

Objective: Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is synthesized in cardiac ventricles in response to volume expansion. This study evaluated NT-proBNP levels to determine the clinical correlation with the severity of hypertensive disorders complicating pregnancy., Methods: NT-proBNP levels of 95 pregnant women (severe preeclampsia [n = 26], mild preeclampsia [n = 15], gestational hypertension [n = 9], and healthy controls [n = 45]) were determined using an electrochemiluminescence immunoassay., Results: Comparisons of the mean values of NT-proBNP levels in the different groups were significantly different, as follows: 1766.43 ± 4197.39 pg/mL (median, 339.8 pg/mL) in severe preeclampsia, 214.97 ± 226.35 pg/mL (median, 152.3 pg/mL) in mild preeclampsia, 39.75 ± 24.85 pg/mL (median, 34.09 pg/mL) in gestational hypertension, and 78.78 ± 81.56 pg/mL (median, 48.54 pg/mL) in the healthy controls. The NT-proBNP levels of the patients with mild and severe preeclampsia were significantly higher than in the patients with gestational hypertension and the healthy control patients. There was no significant difference in NT-proBNP levels between patients with mild and severe preeclampsia (p = 0.17)., Conclusion: In patients with mild and severe preeclampsia, NT-proBNP levels were elevated. This may reflect ventricular stress and/or subclinical cardiac dysfunction associated with preeclampsia.

Aim: To evaluate the usefulness of serum albumin level as a marker of severity in pregnancy-related hypertension., Methods: Of 454 patients with pregnancy-related hypertension who were admitted to Kyungpook National University Hospital between May 1999 and April 2008, the medical records and laboratory tests of 354 patients who met the inclusion criteria for the current study were reviewed. A comparison of the characteristics of each hypertension group and the correlation between serum albumin levels and the time to delivery, 24-h urine protein, and/or pregnancy outcomes were statistically analyzed using SPSS 12.0 (SPSS Korea, Korea)., Results: Serum albumin level had a negative correlation with 24-h urine protein (Pearson's correlation coefficient = -0.481) and a positive correlation with time to delivery (= 0.389). Serum albumin ≤3.0 g/dL was highly associated with severe proteinuria (>2 g/day). There were significant differences in maternal or perinatal morbidity as a function of serum albumin level. If serum albumin level fell below 2.5 g/dL, the risks of ascites, hemolysis elevated liver enzyme low platelet (HELLP) syndrome and perinatal mortality significantly increased (odds ratio [OR] and 95% confidence interval [CI]: 3.5 [1.5-8.1], 12 [3.1-45], and 6.1 [1.7-22], respectively)., Conclusion: Serum albumin level in pregnancy-related hypertension is a significant determinant of disease severity and may be considered as a useful marker for predicting time to delivery, severe proteinuria, and pregnancy outcomes., (© 2010 The Authors. Journal of Obstetrics and Gynaecology Research © 2010 Japan Society of Obstetrics and Gynecology.)

Objectives: To evaluate the feasibility, safety, and patients' satisfaction of laparoendoscopic single-site surgery (LESS) with a 2-mm miniport using a standard trocar and instruments., Methods: Between November 2008 and October 2009, we performed LESS for benign gynecologic conditions with a 2-mm miniport in 61 patients. Only 1 case was converted to conventional laparoscopic surgery using three ports to perform an appendectomy. The level of satisfaction of the patients was surveyed with five scales ("very satisfied," "satisfied," "not sure," "unsatisfied," and "very unsatisfied")., Results: The mean operative time was 46.6 +/- 20.7 minutes, and the mean blood loss was 8.9 +/- 7.4 mL. The length of the hospital stay postoperatively averaged 1.8 +/- 0.9 days. No complications that required treatment occurred. Among 60 patients, 52 patients (87%) responded to the survey. Thirteen patients (25%) were "very satisfied," 29 patients (56%) were "satisfied," 8 patients (15%) were "not sure," and 2 patients (4%) were "unsatisfied." Forty-two patients (81%) had a positive perception of the surgery. Forty-nine patients (94%) responded that they were satisfied with the cosmetic outcome., Conclusion: LESS with a 2-mm miniport is a feasible and safe treatment modality for benign gynecologic diseases without incurring additional costs. Moreover, the cosmetic results were excellent.

Purpose: To evaluate cord blood amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels according to the mode of delivery., Method: Between 1 March and 31 May 2007, 106 blood samples were drawn from the umbilical vein at the time of delivery. Eighty-four NT-proBNP levels [63 term (34 cesarean sections and 29 vaginal deliveries) and 21 preterm births] were analyzed with respect to gestational age, birth weight, Apgar score, newborn gender, and cord blood pH., Results: There was no statistical significance on comparison of the mean NT-proBNP values between the cesarean and vaginal delivery groups (801.9+/-537.7 vs. 724.3+/-542.4 pg/ml, respectively; P=0.572). The correlation of NT-proBNP with gestational age, birth weight, and cord blood pH was -0.616, -0.585, and -0.202, respectively. The mean values for NT-proBNP levels were compared according to the newborn gender (male vs. female; P=0.926), and Apgar score at 1 min [>6 (N=71) vs.

Objectives: To determine the clinical effect of nonperitonization and laparoscopic lymphadenectomy using bipolar electrocautery after radical hysterectomy for cervical cancer compared with peritonization and open lymphadenectomy using monopolar electrocautery., Materials and Methods: This was a retrospective study of 180 patients who underwent a radical hysterectomy and pelvic lymph node dissection (PLND) for cervical cancer from August 1998 to August 2007. The patients were composed of the Peritonization + Laparotomy group (group A; n = 98, 196 PLND) and the Nonperitonization + Laparoscopy group (group B; n = 82, 164 PLND). Group B left the peritoneum in front of the PLND open. Two closed-suction drains were placed at each side of the PLND., Results: Group B statistically showed a lesser total amount of lymphatic drainage (P = 0.001), shorter duration of inserted drains (P < 0.001), and shorter length of hospital stay (P < 0.001), compared with group A. The formation of lymphocysts occurred in 30 patients (41 lymphocysts) of group A and 5 patients (5 lymphocysts) of group B. Lymphocyst formation of group B had a statistically lower incidence than that of group A (P < 0.001). Lymphocyst formation was associated with an increase in the total amount of lymphatic drainage in group A (P = 0.090) and group B (P = 0.041) and a pathologic type of adenocarcinoma in group B (P = 0.016). Surgical experiences were not correlated with lymphocyst formation., Conclusions: The omission of peritonization and laparoscopic lymphadenectomy using bipolar electrocautery in early-stage cervical cancer were more effective than peritonization and open lymphadenectomy using monopolar electrocautery in minimizing the incidence of lymphocyst formation.

This study was conducted to report 10 cases of Fitz-Hugh-Curtis Syndrome (FHCS) diagnosed with CT and 101 cases of FHCS-like lesion that suggested perihepatitis during laparoscopic surgery. We reviewed retrospectively the images of 3,674 laparoscopies for obstetrical and gynaecological diseases and analysed 10 cases of FHCS diagnosed by clinical patterns and CT. All the 10 cases showed liver capsular enhancement on CT. Among the 3,674 laparoscopies, we found 101 cases (2.7%) with FHCS like lesion. Among them, 23 cases were during laparoscopic procedure for endometriosis, 16 for gynaecological malignant tumours, 16 for benign adnexal diseases excluding endometriosis, 13 for uterine leiomyoma, 7 for pelvic inflammatory disease, 2 had peritoneal tuberculosis and 21 for other gynaecological diseases. Further consideration should be given for the causes of FHCS other than N. gonorrhoeae and C. trachomatis. Because FHCS may represent various clinical phases, other considerations and clinical classifications are necessary for treatment.

Purpose: To review pelvic actinomycosis confirmed by surgery and summarize clinical aspects., Method: The authors retrospectively reviewed 16 cases that underwent surgical procedures for pelvic actinomycosis between January 1998 and January 2006., Results: Twelve of the cases (75%) had used intrauterine contraceptive devices for a period of between 8 months and 12 years (mean duration: 5.2 years). Most of the cases presented elevated white blood cell count, neutrophil percentage, CRP value and CA 125 value. Four of the eight cases that were checked by computed tomography presented the possibility of pelvic malignancies. All patients underwent surgery. The mean duration of intravenous antibiotics was 11.8 days and that of peroral antibiotics was 4.3 months. After treatment, there were no complications or recurrences, with the exception of one case of preoperative unilateral ureter obliteration., Conclusion: In diagnosis of pelvic actinomycosis, it is not necessary to consider whether an intrauterine device was being used or not. To distinguish from pelvic malignancy, various methods (including imaging study) should be considered. As for antibiotic treatment, it is believed that shorter and high dose antibiotics therapy will be sufficient treatment.

Background: Colposcopic grading provides an objective and meaningful guide to histologic severity and neoplastic progression of squamous intraepithelial lesions of the cervix. The objective of this study was to develop a more efficient and convenient method to overcome procedural complexities involved with the traditional Reid index in prediction of high-grade squamous intraepithelial lesion (HSIL)., Methods: The Reid index uses four colposcopic signs (margin, color, vessel, and iodine staining). The proposed modified Reid index system specifically incorporates the location of the lesion within the transformation zone in place of iodine staining. Three hundred women with suspected or abnormal cytologies or abnormal cervicographic findings were evaluated by colposcopy, directed biopsy, and HPV testing by the Hybrid Capture II method, which detects high-risk HPV DNA types., Results: The sensitivity of high-risk HPV testing for detecting HSIL was 94.4%, the specificity was 65.0%, the positive predictive value was 75.5%, and the negative predictive value was 91.0%. The results of the colposcopic impression using the modified Reid index were superior to HPV testing. The sensitivity, specificity, positive predictive value, and negative predictive value of the colposcopic impression for detecting HSIL were 91.3, 92.9, 93.6, and 90.3% respectively., Conclusion: These results strongly indicate that the modified Reid index can accurately predict the histologic grade of squamous intraepithelial lesions of the cervix and can be applied easily and objectively in clinical practice without affecting the diagnostic accuracy of the traditional Reid index.

Ovarian yolk sac tumor (YST) is a malignant ovarian neoplasm differentiated from primordial germ cells that occur in young age, while endometrioid carcinoma (ECA) is a müllerian epithelial tumor that usually occurs in older patients. The coexistence of an ovarian ECA and YST component is very rare. Only 12 cases have been reported until now according to a Medline search of the English literatures. We present a case of a simultaneous ECA and a YST component in a 35-year-old woman. Exploratory laparotomy was performed. The parts of both ovaries that showed an endometrioid-like glandular pattern were positive for cytokeratin 7 and negative for AFP, but the YST component was negative for cytokeratin 7 and positive for AFP. After completion of four courses of BEP chemotherapy, two courses of taxane and carboplatin chemotherapy were added. The patient failed to respond and succumbed to the disease after 12 months of follow-up.

Background: An electronically controlled mechanical tapping device (MTD) to measure implant stability has been studied extensively for its ability to measure initial stability at the time of surgical placement and predict an implant's survival prognosis, with few reported complications., Methods: Initial stability data, measured repeatedly with a resonance frequency analysis device and the MTD, for seven of 28 implants placed in jawbones of four fresh human cadavers and the histologic images of bone-implant interfaces are presented as evidence for potential damage to the bone-implant interface using these techniques., Results: A progressive increase in mobility from stable (-1) to less stable (4) and eventually to visibly mobile (999) was observed after three measurements with the MTD. Corresponding histologic images revealed that the buccal threads in the coronal half of the implants were displaced lingually and apically from the bony indentations that were created during insertion of the self-threading implants, subsequent to repeated MTD measurements in the buccal and axial directions. The histologic images and changes in MTD values indicated that repeated MTD measurements at the time of implant placement surgery may damage the bone-implant interface, and a stable or borderline implant may become mobile after repeated MTD measurements., Conclusions: Histologic images showed potential damage to the bone-implant interface during repeated initial implant-stability measurements using the MTD. Initial implant-stability measurements using the MTD should be performed with caution, and they may be contraindicated for implants placed in low-quality bone.

The aim of this study was to determine whether elastic properties and apparent density of bone differ in different anatomical regions of the maxilla and mandible. Additional analyses assessed how elastic properties and apparent density were related. Four pairs of edentulous maxilla and mandibles were retrieved from fresh human cadavers. Bone samples from four anatomical regions (maxillary anterior, maxillary posterior, mandibular anterior, mandibular posterior) were obtained. Elastic modulus (EM) and hardness (H) were measured using the nano-indentation technique. Bone samples containing cortical and trabecular bone were used to measure composite apparent density (cAD) using Archimedes' principle. Statistical analyses used repeated measures ANOVA and Pearson correlations. Bone physical properties differed between regions of the maxilla and mandible. Generally, mandible had higher physical property measurements than maxilla. EM and H were higher in posterior than in anterior regions; the reverse was true for cAD. Posterior maxillary cAD was significantly lower than that in the three other regions.

Statement of Problem: There is confusion in the literature about how physical properties of bone vary between maxillary and mandibular regions and which physical properties affect initial implant stability., Purpose: The purpose of this study was to determine correlations between physical properties of bone and initial implant stability, and to determine how physical properties and initial stability vary among regions of jawbone., Material and Methods: Four pairs of edentulous maxillae and mandibles were retrieved from fresh human cadavers. Six implants per pair were placed in different anatomical regions (maxillary anterior, right and left maxillary posterior, mandibular anterior, right and left mandibular posterior). Immediately after surgery, initial implant stability was measured with a resonance frequency device and a tapping device. Implant surgeries and initial stability measurements were performed within 72 hours of death. Elastic modulus (EM) and hardness were measured using nano-indentation. Composite apparent density (cAD) was measured using Archimedes' principle. Bone-implant contact percentage and cortical bone thickness were recorded histomorphometrically. Mixed linear models and univariate-correlation analyses were used (alpha=.05)., Results: Generally, mandibular bone had higher initial implant stability and physical properties than maxillary bone. Initial implant stability was higher in the anterior region than in the posterior. EM was higher in the posterior region than in the anterior; the reverse was true for cAD., Conclusions: Of the properties evaluated, cAD had the highest correlation with initial implant stability (r=0.82). Both physical properties of bone and initial implant stability differed between regions of jawbone.

The study analyzes factors that affect vaginal hysterectomy to establish the indications of a vaginal approach to benign uterine disease. In a retrospective study, 174 patients underwent vaginal hysterectomy for uterine leiomyomas or adenomyosis by one gynecologist between December 2005 and December 2006. All data were compared and analyzed by X(2)- test, t-test, and multiple logistic regression. Based on a uterine weight > or = 500 g, body weight, a history of surgery, concomitant surgery (adenexectomy), penetration of the posterior cul de sac during surgery, uterine descent, and average uterine weight we determined the feasibility of vaginal hysterectomy. Based on an operative time > or = 33 min, body weight, concomitant surgery (adenexectomy), penetration of the posterior cul de sac, vertical length of the vaginal opening, uterine descent, and the uterine weight had significant effects on the success of vaginal hysterectomy. The range of indications for vaginal hysterectomy may vary greatly depending on the surgeon's experience. If experiences are accumulated gradually, together with the advantages of laparoscopically assisted hysterectomy, most abdominal hysterectomies and laparoscopic hysterectomies can be replaced by vaginal hysterectomy.

Statement of Problem: Accurate delivery of torque to implant prosthetic screws is critical to generate ideal preload in the screw joint and offer protection against screw loosening. Mechanical torque limiting devices (MTLDs) are available in 2 different styles that have not been compared for accuracy., Purpose: The purpose of this study was to determine the accuracy of friction-style and spring-style MTLDs in delivering target torque values., Material and Methods: Five MTLDs from each of 6 different implant manufacturers (n=30) were selected to determine their accuracy relative to their target torque values. All MTLDs were new; 3 types were of the friction style while 3 were of the spring style. To measure the output of each MTLD, a digital torque gauge with a 3-jaw chuck to hold the driver was used. Force was applied to the MTLD until either the friction style released at a precalibrated torque value or the spring style flexed to a precalibrated limit. The peak torque value registered by the digital torque gauge was recorded and the procedure was repeated 50 times for each MTLD. Statistical analysis used repeated-measures ANOVA (alpha=.05) to assess the accuracy of the MTLDs in delivering target torque values., Results: Both the mean absolute difference (ABSDIFF) and the mean percentage deviation (PERDEV) between measured torque values and target torque values differed significantly (P<.001) for the friction-style MTLDs (3.83 Ncm, 13.74%) and for the spring-style MTLDs (0.82 Ncm, 2.36%)., Conclusions: Within the limitations of this study, MTLDs that use spring-style components are significantly more accurate than those that use friction-style components in achieving their target torque values.

Statement of Problem: Initial implant stability has been used as an indicator for future osseointegration and whether an immediate/early loading protocol should be applied. However, differences in initial stability in relation to anatomical regions of jawbone have not been studied extensively because of the risks involved with stability measurements., Purpose: The purpose of this study was to determine whether initial implant stability varies with anatomical regions of the jawbone., Material and Methods: Four pairs of edentulous maxillae and mandibles were retrieved from fresh human cadavers. Six implants (Biomet 3i) per pair were placed in different anatomical regions (maxillary anterior, right and left maxillary posterior, mandibular anterior, right and left mandibular posterior). Immediately after implant placement, initial implant stability was measured with a custom-made resonance frequency analyzer, a commercial resonance frequency analysis device (Osstell), and a mechanical tapping device (Periotest). All implant surgeries and initial stability measurements were performed within 72 hours of death to simulate a clinical setting. Repeated measures ANOVA (alpha=.05) and univariate correlation analyses were used to analyze the data., Results: Mandibular implants had significantly higher initial stability than maxillary implants. Posterior maxillary implants were least stable. Stability was less buccolingually than mesiodistally. The measurements from 3 stability measuring devices were strongly associated with each other., Conclusions: Initial implant stability varied among anatomical regions of jawbone. Rank of Periotest value and implant stability quotient (Osstell) had the highest correlation (r=-0.852).

Statement of Problem: Developments in ceramic core materials such as lithium disilicate, aluminum oxide, and zirconium oxide have allowed more widespread application of all-ceramic restorations over the past 10 years. With a plethora of ceramic materials and systems currently available for use, an overview of the scientific literature on the efficacy of this treatment therapy is indicated., Purpose: This article reviews the current literature covering all-ceramic materials and systems, with respect to survival, material properties, marginal and internal fit, cementation and bonding, and color and esthetics, and provides clinical recommendations for their use., Material and Methods: A comprehensive review of the literature was completed seeking evidence for the treatment of teeth with all-ceramic restorations. A search of English language peer-reviewed literature was undertaken using MEDLINE and PubMed with a focus on evidence-based research articles published between 1996 and 2006. A hand search of relevant dental journals was also completed. Randomized controlled trials, nonrandomized controlled studies, longitudinal experimental clinical studies, longitudinal prospective studies, and longitudinal retrospective studies were reviewed. The last search was conducted on June 12, 2007. Data supporting the clinical application of all-ceramic materials and systems was sought., Results: The literature demonstrates that multiple all-ceramic materials and systems are currently available for clinical use, and there is not a single universal material or system for all clinical situations. The successful application is dependent upon the clinician to match the materials, manufacturing techniques, and cementation or bonding procedures, with the individual clinical situation., Conclusions: Within the scope of this systematic review, there is no evidence to support the universal application of a single ceramic material and system for all clinical situations. Additional longitudinal clinical studies are required to advance the development of ceramic materials and systems.

Purpose: This study compared modified distraction osteogenesis (DO) protocol with conventional DO protocol on healing bone formation. Computer simulation was performed to understand the mechanical environment of modified DO protocol, which applies compression during the consolidation period., Materials and Methods: Fifty rats were used in this study. Twenty-five rats in the conventional DO (control) group were sacrificed at postoperative days 11, 21, 28, 35, and 49 after osteotomy. In the modified DO (experimental) group, compression was applied on day 7 after distraction (day 18 postoperatively) for 4 days during the early consolidation period and 25 rats were sacrificed on postoperative day 19, 28, 39, 46, and 53. The histologic and radiographic findings were used to compare the 2 groups. Further, computer simulation was used to predict the mechanical environment of healing bone under conventional and modified DO protocol., Results: Radiographic findings showed that the experimental group resulted in denser and wider healing bone. Histologically, the experimental group yielded more mature lamellar bone than the control group. Computer simulation showed that absolute values of tissue strains were nearly double in the control group because of the softer healing tissues. Both the experimental and control groups showed high strains at the ridge crest. Concentrated tensile strain along the distraction direction at the ridge crest might hinder bone formation at the interface, while compressive strain could facilitate the process., Conclusion: This study proposed a modified DO protocol of adding compression during the early consolidation period of conventional DO protocol. This new technique appears to provide faster and denser bone regeneration.

Background: Adenoid cystic carcinoma (ACC) is a unique tumor characterized by frequent and delayed distant metastasis (DM) with uncommon regional lymph node metastasis., Objectives: To evaluate the factors affecting DM of ACC and survival after appearance of DM., Design: A retrospective analysis of 94 cases of ACC from 1979 through 2001., Setting: Academic tertiary referral center., Results: Distant metastasis of ACC occurred in 46 patients and developed more frequently in patients with tumors of the solid histologic subtype than in patients with tubular or cribriform subtypes. Distant metastasis occurred less frequently in the minor salivary glands of the sinonasal tract than in major salivary glands or in other minor salivary glands, and development of DM was not affected by tumor stage. Disease-specific 5- and 10-year survival rates were 88% and 72% for patients without DM, respectively, and 76% and 48% for those with DM (P =.02). Regarding the site of DM and its impact on outcomes, 30 patients had lung metastasis alone; 5 patients, bone metastasis alone; and 6 patients developed both lung and bone metastasis. Median survival times after appearance of DM among patients with isolated lung metastases and those with bone metastases with or without lung involvement were 54 and 21 months, respectively (P =.04)., Conclusions: Development of DM in ACC can be predicted by solid histologic subtype and major salivary gland or oral/pharyngeal rather than sinonasal primary site. Those patients with bone involvement with or without lung metastases had worse outcomes than those with pulmonary metastasis only.

Information is scarce about Young's modulus of healing bone surrounding an implant. The purpose of this preliminary study is to quantify elastic properties of pig alveolar bone that has healed for 1 month around titanium threaded dental implants, using the nanoindentation method. Two 2-year-old Sinclair miniswine were used for the study. Nanoindentation tests perpendicular to the bucco-lingual cross section were performed on harvested implant-bone blocks using the Hysitron TriboScope III. Nomarski differential interference contrast microscopy was used to identify pyramidal indentation measurements that were from bone. Reduced moduli, averaged for all anatomical regions, were found to start low (6.17 GPa) at the interface and gradually increase (slope=0.014) to a distance of 150 microm (7.89 GPa) from the implant surface, and then flatten to a slope of 0.001 from 150 to 1500 microm (10.13 GPa). Mean reduced modulus and its relationship to distance did not differ significantly by anatomic location (e.g., coronal, middle, and apical third; P>/=0.28 for all relevant tests) at 1 month after implantation.

Background: Cyclooxygenase-2 (COX-2) has been found to be up-regulated in several types of human cancers and its role in the carcinogenic process has been proposed The aim of this study was to examine the expression of COX-2 in human squamous cell carcinoma of the head and neck (SCCHN) and to find out the effects of COX-2 inhibitors on the growth of cultured cells., Materials and Methods: We investigated the effect of indomethacin and NS-398 at various concentrations on the growth of SCCHN cell lines using cell proliferation assay, cell cycle analysis and quantification of apoptosis., Results: Immunostaining revealed a significantly increased COX-2 expression in tumor tissues compared with normal controls (p<0.05). Western blotting analysis using a COX-2 antibody, indicated that seven SCCHN cell lines tested constitutively expressed COX-2 protein. Treatment of head and neck cancer cells with NS-398 (10-200 microM) or indomethacin (50-1000 microM) for 72 hours showed a significant dose-dependent inhibition of cell growth (p<0.01) and a significant increase in the number of cells in the G0/G1-phases of the cell cycle with a concomitant reduction at the S-phase in a dose-dependent manner (p<0.05). NS-398 was more effective in cell cycle arrest and growth inhibition than indomethacin (p<0.05) and induced significant apoptosis in two out of three SCCHN cell lines tested at the concentration of 100 microM., Conclusion: Our study showed that COX-2 could be a participant in carcinogenesis of SCCHN and that COX-2 inhibitors would be a potential tool for the treatment and prevention of SCCHN.

Statement of Problem: The choice of single-molar implant design is difficult because of a lack of controlled, quantitative biomechanical analyses., Purpose: This study determined the effect of 3 single-molar implant designs on implant strains under a variety of homologous loading conditions., Material and Methods: On each implant abutment, 4 strain gauges were placed axially at 90 degrees to each other on the buccal, lingual, mesial, and distal surfaces. Effects of implant design, load location, direction, and magnitude were tested on axial and bending (buccolingual and mesiodistal) strains of 3 single-molar implant designs: (1) single, 3.75-mm (regular) diameter implant, (2) single, 5-mm (wide) diameter implant, and (3) two 3.75-mm diameter (double) implants connected through a single-molar crown. Results were analyzed with ANOVA., Results: Variations in loading conditions induced 3-dimensionally complex abutment strains on the tested implant designs. Peak absolute strains in mesiodistal direction were 6493 microepsilon for design 1 and 3958 microepsilon on design 2, and 3160 microepsilon in buccolingual direction on design 3. For all loading conditions, the single 3.75-mm diameter implant consistently experienced the largest strains compared with wide-diameter and double implant designs. Changes in centric contact location affected implant abutment strains differently among the 3 designs. Angulated force direction resulted in larger bending strains., Conclusion: For single-molar implant designs, an increase in implant number and diameter may effectively reduce experimental implant abutment strains.