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BackgroundCartilage has limited intrinsic healing capacity, motivating the application of stem cells for regenerative therapies. Therapies to treat osteochondral defects using stem cell therapy-based tissue engineering have been developed and used for more than 20 years; however, the low viability and high possibility of dispersion of injected cells to target defect sites have remained challenge. Mussel adhesive protein (MAP) receiving increasing attraction as functional biomedical materials on tissue and biomedical engineering field. Because of functional underwater adhesive ability if the bioengineered MAP, therefore it could be applied on various environment of lesion site.ObjectivesWe developed biocompatible adhesive which enables implanted chondrogenic-enhanced hASCs being strongly fixed to the lesion site of defected cartilage, and thus, the implanted cells can survive lengthily in defect site allowing cells to differentiate directly to chondrocytes.MethodsMAP was produced and purified for in vivo applications using a bacterial expression system as previously reported [1]. The cell encapsulated coacervate was formulated with two polyelectrolyte, the MAP and 723 kDa hyaluronic acid (HA). The DiD labeled cell was dispensed into the solution in which the MAP solution and the HA solution were mixed in a ratio of 7:3 (v/v). MAP formed liquid microdroplets with hyaluronic acid and subsequently gelated into microparticles, which is highly viscous and strongly adhesive.In vivo efficacy of MAP in rats - the osteochondral defects were created on the patellar groove of distal femora in rats with sharp excision. After transplantation of human adipose derived stem cells (hASCs), the fluorescents image was taken in every 7 days. Animals were allocated into two groups as follows: MAP with hASCs; fibrin with hASCs.The MAP with chondro-induced hASCs were implanted on the osteochondral defect created in the patellar groove/condyle of OA-induced rabbits. Rabbits were allocated to three different groups as follows: Group 1 - Fibrin only; Group 2 - Fibrin with hASCs (1.5 x 106 chondro-induced hASCs); Group3; MAP with hASCs. After 12 weeks of implantation, rabbits were sacrificed for analysis.ResultsThe fluorescence cell images exhibit the viability of cells under encapsulated condition in coacervate. The cell viabilities were determined with Live/Dead fluorescent staining. The implanted cells were labeled with DiD for in vivo visualization. After 35 days, fluorescent signals were more potently detected for MAP with hASCs group than Fibrin with hASCs group in osteochondral defect model. Implanted hASCs had been remained in target defect rather than diffused to other sites of the knee. Moreover, histological assessment showed that MAP with hASCs group had the best healing and covered with hyaline cartilage-like tissue. The staining image shows that MAP with hASCs group were filled with perfectly differentiated chondrocytes. Although Fibrin with hASCs group had better healing than fibrin only group, it was filled with fibrous cartilage which owes its flexibility and toughness. As MAP with hASCs group has higher possibility of differentiating to complete cartilage, Fibrin only group and Fibrin with hASCs group have failed to treat OA by rehabilitating cartilage. In order to clarify the evidence of remaining human cell proving efficacy of newly developed bioadhesive, human nuclear staining was proceeded with sectioned rabbit cartilage tissue. The results explicitly showed MAP with hASCs group have retained more human cells than Fibrin only and Fibrin with hASCs groups.ConclusionWe investigated the waterproof bioadhesive supporting transplanted cells to attach to defect lengthily in harsh environment, which prevents cells from leaked to other region of cartilage. Collectively, the newly developed bio-adhesive, MAP, could be successfully applied in OA treatment as a waterproof bioadhesive with the capability of the strong adhesion to target defect sites. Our study suggests a new effective strategy for cartilage regeneration using MAP in tissue engineering fieldsReferences[1]Biomaterials (2007) 3560-3568AcknowledgementsThis research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health & Welfare, Republic of Korea (grant number: HI20C0090) and the National Research Foundation of Korea (NRF-2020R1A2C2008266 and 2019R1I1A1A01043778).Disclosure of InterestsNone declared

Setting Tertiary referral centre, Samsung Medical Center, South Korea. Objective To evaluate the pharmacokinetic parameters and toxicities of once-daily amikacin (AMK) dosing for lung disease due to Mycobacterium abscessus. Design A retrospective review of 48 patients with M. abscessus lung disease who received once-daily AMK for 4 weeks between January 2012 and June 2015. Results With a starting dose of 15 mg/kg/day and adjustment of AMK dose according to the peak serum level (Cmax), the Cmax target of 55-65 μg/ml was achieved in 31.3% (15/48) of patients in the first week, 68.8% (33/48) in week 2, 91.7% (44/48) in week 3 and 95.8% (46/48) in week 4. Transient nephrotoxicity developed in 6.3% (3/48) of patients and ototoxicity in 25.0% (6/24), which was determined by audiogram as hearing loss, asymptomatic in five patients and tinnitus in one. Multivariate analysis revealed that the highest drug concentration 12 h after administration was significantly associated with the development of toxicities (adjusted odds ratio 1.862, P = 0.047). Conclusion Our results suggest that once-daily AMK for 4 weeks with a target Cmax of 55-65 μg/ml can be used in patients with M. abscessus lung disease, with careful monitoring of toxicity.

Disseminated superficial actinic porokeratosis (DSAP), the most common type of porokeratosis, usually presents as large numbers of lesions on sun-exposed skin. Although several treatment options including corticosteroids, keratolytics, 5-fluorouracil, imiquimod, vitamin D3 analogues, cryotherapy, curettage, laser therapy and dermabrasion may be considered, there is no evidence-based standard treatment.1-2 Patient 1 was a 26-year-old female who presented with a 2-year history of progressive scaly macules on both upper and lower extremities. This article is protected by copyright. All rights reserved.

Tertiary referral centre, Samsung Medical Center, South Korea.To evaluate the pharmacokinetic parameters and toxicities of once-daily amikacin (AMK) dosing for lung disease due to Mycobacterium abscessus.A retrospective review of 48 patients with M. abscessus lung disease who received once-daily AMK for 4 weeks between January 2012 and June 2015.With a starting dose of 15 mg/kg/day and adjustment of AMK dose according to the peak serum level (Cmax), the Cmax target of 55-65 μg/ml was achieved in 31.3% (15/48) of patients in the first week, 68.8% (33/48) in week 2, 91.7% (44/48) in week 3 and 95.8% (46/48) in week 4. Transient nephrotoxicity developed in 6.3% (3/48) of patients and ototoxicity in 25.0% (6/24), which was determined by audiogram as hearing loss, asymptomatic in five patients and tinnitus in one. Multivariate analysis revealed that the highest drug concentration 12 h after administration was significantly associated with the development of toxicities (adjusted odds ratio 1.862, P = 0.047).Our results suggest that once-daily AMK for 4 weeks with a target Cmax of 55-65 μg/ml can be used in patients with M. abscessus lung disease, with careful monitoring of toxicity.

The purpose of this work was to examine outcomes in patients with T4 nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Between 2007 and 2010, 154 patients with nonmetastatic T4 NPC were treated with IMRT to a total dose of 70 Gy in 33–35 fractions. In addition, 97 % of patients received concurrent platinum-based chemotherapy. The median follow-up time was 52.8 months. The rates of 5-year actuarial locoregional control, distant metastasis-free survival, progression free-survival, and overall survival (OS) were 81.2, 72.2, 61.9, and 78.1 %, respectively. A total of 27 patients had locoregional recurrence: 85.2 % in-field failures, 11.1 % marginal failures, and 3.7 % out-of-field failures. Fourteen patients with locoregional recurrence received aggressive treatments, including nasopharyngectomy, neck dissection, or re-irradiation, and the 5-year OS rate tended to be better (61.9 %) compared to those receiving conservative treatment (32.0 %, p = 0.051). In patients treated with 1 course of radiotherapy, grade ≥ 3 toxicities of ototoxicity, neck fibrosis, xerostomia, epistaxis, and radiographic temporal lobe necrosis occurred in 18.2, 9.8, 6.3, 2.1, and 5.6 % of patients, respectively. Increased ototoxicity, osteonecrosis, severe nasal bleeding, and temporal necrosis were observed in patients treated by re-irradiation. IMRT offers good locoregional control in patients with T4 NPC. For patients with locoregional recurrence after definitive radiotherapy, aggressive local treatment may be considered for a better outcome.

The objective of this study was to characterize serum immunoglobulins and lymphocytes subpopulations in the peripheral blood mononuclear cells (PBMCs) of Holstein calves in response to lipopolysaccharide (LPS) challenge from Escherichia coli. Fourteen calves received subcutaneous injections of E. coli LPS at 10 weeks of age, and six calves were injected with saline as a control. The concentrations of total serum IgG and the relative amount of LPS-specific IgG in calves challenged with LPS were significantly higher (p

The effects of hydrolyzed yeast supplementation on growth performance, health and immune-physiological parameters in neonatal calves challenged with vaccine were investigated. Twelve Holstein calves were started in the experiment at 2 ± 1 days of age and were studied for 35 days. Calves were randomly assigned to each of two dietary treatments, a control (CON) and hydrolyzed yeast (HY) group. The calves in the HY group received control calf starter supplemented with 0.2% HY. All calves were given calf starter ad libitum for 5 weeks starting in week 1. Calves were also given whole milk according to a step-down milking protocol. In order to induce immune responses, all calves were challenged with Hog cholera and Erysipelothrix insidiossa live vaccines by intramuscular injection at 3 weeks of age. Growth performance and feed intake were not affected by dietary treatment throughout the experimental period, except that the HY group had significantly higher (P < 0.05) milk intake than did the CON group at 3 weeks of age. Calves in the HY group showed significantly better (P < 0.05) fecal and health scores at 3 weeks compared to those in the control group. After vaccine challenge, neutropenia, lymphophilia and thrombocytopenia were observed in the CON group, but calves in the HY group did not show significant changes of leukocytes. The average concentration of serum haptoglobin in the HY group was significantly higher (P < 0.05) at 1 and 3 days post-vaccine challenge (DPVC) than that of CON group. Feeding HY supplemented calf starter resulted in a higher (P < 0.05) relative amount of bacterial and viral – specific IgA than in the CON group at 5 DPVC. Although the percentage of CD4+ T cells was significantly (P < 0.05) higher in the HY group than in the CON group at −2 DPVC, significant differences between groups after vaccine challenge was not observed during the experimental period. These results suggest that 0.2% HY supplementation in calf starter can improve the health status and immune-related serum protein production and affect blood cell composition in neonatal calves after vaccine challenge.

Adsorption equilibrium, kinetics, and column dynamics of chlorophenols [2‐chlorophenol (2‐CP) and 2,4‐dichlorophenol (2,4‐DCP)] dissolved in water were studied using a hydrophobic resin, XAD‐1600, without ion‐exchange functional groups. In addition, a hydrophilic nonionic polymer resin, XAD‐7, and an activated carbon, F400, were chosen for comparative analysis. Adsorption equilibrium data were correlated with the well‐known Langmuir, Freundlich, and Sips isotherms. The adsorption amount was in the order of F400 > XAD‐1600 > XAD‐7. Desorption from polymeric resins adsorbed with chlorophenols was conducted by using two organic solvents [methanol and isopropyl alcohol (IPA)] as desorbates. The intraparticle diffusion mechanism was assumed to be the surface diffusion or pore diffusion. It was found that the diffusivity in desorption step was considerably slower than the diffusivity in adsorption step within polymeric resins. To confirm the possibility of the resin as a sorbent for the removal of chlo...

Formation of complicated emission patterns consisting of many transverse modes and associated intensity pulsations at beat frequencies between some pairs of transverse eigenmodes in microchip solid-state lasers with laser-diode asymmetric end-pumping are reviewed. The dependence of billiard-like transverse patterns on pump power and crystal rotation (i.e. kaleidoscopic patterns) was demonstrated in a 0.3 mm thick thin-slice LiNdP4O12 laser with sheet-like end-pumping. Pump-power-dependent high-speed self-pulsations were observed. The asymmetric optical confinement resulted in the formation of transverse patterns which were totally different from normal Hermite–Gaussian resonator modes. The interference among pairs of non-orthogonal transverse eigenmode fields, whose energy levels exhibited avoided crossing with increasing pump power, was shown to result in high-speed intensity modulations. A good numerical reproduction of the observed high-speed modulations was obtained with model equations.

본 연구는 반추가축에 있어 통옥수수를 주로 이용한 조사료 무급여사료의 발효특징을 알아 보기 위하여 실시하였다. 대조구는 steam- flaked corn으로 구성된 농후사료 (80%)와 볏짚(20%)을 혼합한 사료 SFCR)와 통옥수수와 면실피로 구성된 조사료 무급여사료(WC)를 사용하였다. 실험 1은 한우 반추위 미생물을 이용하여 in vitro 시험을 2처리 3반복 시험을 배양시간 48시간 동안 실시하였고, 실험 2는 한국재래산양을 이용한 반추위 내 발효 특성을 알아보기 위하여 in vivo 시험을 2처리 4반복 실험을 15일간 실시 하였으며, in sacco 시험은 2처리 3반복으로 시험을 3일간 실시하였다. 실험 1에서 SFCR구와 WC구 모두 반추위 적정 pH를 유지하였으며 처리간에 유의성은 없었으나 배양 4시간 대에 SFCR에서 다소 낮은 경향을 나타내었다. Gas 발생량은 SFCR구에서 유의적으로 높았으며(p $NH_3$ -N 농도는 WC구에서 다소 높은 경향을 나타내었다. Total VFA농도는 8시간대까지 WC구에서 유의성있게(p $NH_3$ -N 농도는 WC구에서 유의하여 높았다(p 【These study were conducted to determine the effects of a whole or steam-flaked corn based diet on rumen microbial fermentation in vitro and ruminal metabolism in the Korean Native Goat(KNG) in vivo. The experiments consisted of two dietary treatments: control, steam-flaked corn(SFC) based diet(80%) + rice straw mixed(20%)(SFCR); 100% whole corn based diet(WC). The first experiment was conducted to investigate the effect of whole corn on ruminal metabolism in vitro for 0 to 48 h. pH values were optimally maintained during incubation time, and were not significantly different between treatments. Gas production of SFCR was significantly higher than WC(p $NH_3$ -N concentration tended to increase for WC, but not significantly different between treatments. The mean value of total volatile fatty acid concentration of WC was significantly lower than SFCR(p $NH_3$ -N concentration of WC was significantly (p】

The aims of the study were to: (1) examine levels of trismus, xerostomia and nutritional status; (2) compare levels of trismus, xerostomia and nutritional status in patients with nasopharyngeal carcinoma (NPC) receiving different types of radiation modalities; and (3) identify factors related to NPC survivors' risk status for malnutrition and existing malnutrition. A cross-sectional study with consecutive sampling was conducted. NPC survivors were recruited from otolaryngology/oncology outpatient clinics in a medical centre in Northern Taiwan. Study measures included (1) Mandibular Function Impairment Questionnaire, (2) Xerostomia Questionnaire, (3) Mini Nutrition Assessment, (4) Hospital Anxiety and Depression Scale - Depression subscale, and (5) Symptom Severity Scale. A total of 110 subjects were recruited. Those receiving intensity-modulated radiation therapy had less trismus and xerostomia than patients receiving two-dimensional radiation therapy. Patients with female gender, advanced stage, completion of treatments within 1 year, higher levels of depression, more severe trismus and higher symptom severity tended to have malnutrition or were at risk of malnutrition. Trismus and xerostomia are long-term problems in some NPC survivors and may contribute to malnutrition. To better manage a patient's trismus and xerostomia and to enhance nutritional status, clinicians should develop a patient-specific care programme based on careful assessment and targeted measures to improve oral function and insure adequate nutritional intake.

Whereas much progress has been made in the diagnosis and treatment of schizophrenia and depression in recent years, bipolar disorder continues to be frequently misunderstood, leading to its inconsistent diagnosis and treatment. In this article, we seek to identify the causes of this problem and suggest possible solutions, based on a critical review of studies concerning the nosology of bipolar disorder and the effects of antidepressant agents. Bipolar disorder appears to be underdiagnosed as well as frequently misdiagnosed as unipolar major depressive disorder. Underdiagnosis can stem from patients' impaired insight into mania and failure to involve family members in the diagnostic process and also from clinicians' inadequate understanding of manic symptoms. Underdiagnosis may also reflect disagreement about the breadth of the bipolar spectrum. We therefore propose a heuristic definition of "bipolar spectrum disorder," a diagnosis that gives greater weight to family history and antidepressant-induced manic symptoms. This diagnosis would include all forms of bipolar illness that are not type I or II . The evidence also suggests that antidepressants are probably overused and mood stabilizers underused. We consequently recommend aggressive use of mood stabilizers and less emphasis on antidepressants. In summary, the state of diagnosis and treatment in bipolar disorder is suboptimal. More diagnostic attention to the criteria for mania is necessary. In addition, the current pattern of antidepressant use in bipolar disorder does not appear to be evidence-based.

Random chaotic relaxation oscillation burst generations have been observed in laser-diode-pumped microchip multimode lasers coupled to a single-mode optical ber. Dynamical characterizations have been carried out by the singular value decomposition method and the joint time-frequency analysis, and the observed instability has been identi ed to be a random switching between stable and chaotic operation. @S1050-2947~99!50511-8#

The combination of cisplatin and 5-fluorouracil (5-FU) (PF) is the most popular regimen for treating metastatic nasopharyngeal carcinoma (NPC) but it is limited by severe stomatitis and chronic cisplatin-related toxicity. A novel approach including induction with mitomycin C, doxorubicin and cisplatin (MAP) and subsequent maintenance with weekly 5-FU and leucovorin (FL) were designed with an aim to reduce acute and chronic toxicity of PF. Thirty-two patients of NPC with measurable metastatic lesions in the liver or lung were entered into this phase II trial. Mitomycin C 8 mg m−2, doxorubicin 40 mg m−2 and cisplatin 60 mg m−2 were given on day 1 every 3 weeks as initial induction. After either four courses or remission was achieved, patients received weekly dose of 5-FU 450 mg m−2 and leucovorin 30 mg m−2 for maintenance until disease progression. With 105 courses of MAP given, 5% were accompanied by grade 3 and 0% were accompanied by grade 4 stomatitis. The dose-limiting toxicity of MAP was myelosuppression. Forty per cent of courses had grade 3 and 13% of courses had grade 4 leukopenia. No grade 3 or 4 cisplatin-related toxicity was observed. The overall response rate was 94% (95% confidence interval (CI) 84.9–100%) with a complete response rate (CR) of 6% (95% CI: 0–15.2%) and a good partial response (PR) rate of 28% (95% CI 11.7–44.6%), which was optionally defined as observance of only equivocal lesion identifiable under imaging study. Twenty-seven cases entered weekly FL maintenance phase. The median duration of maintenance with weekly FL was 38 weeks (8–91 weeks). There was no grade 3 or 4 toxicity noted during weekly FL. The median progression-free survival and overall survival were 11.6 ± 0.4 and 18.1 ± 3.6 months respectively. Six patients with a median follow-up of 19.8 months (9.6–41.0 months) were still alive and five of them had disease under control with FL. Good responders (CR and good PR) had better survival than less satisfactory responders (PR and stable disease) (P = 0.05). From Cox’s multivariate regression analysis, the only significant prognostic factor for survival was good response to MAP (P = 0.042). Liver metastasis was the only significant variable in the best subset regression model that predicted good response to MAP (CR and good PR) (P = 0.027). MAP was an effective combination for metastatic NPC with minimal stomatitis and cisplatin-related toxicity but had significant myelosuppression. Weekly FL was a maintenance therapy with minimal side-effects. The response rate and overall survival of MAP-FL were better than series previously reported even when a subset of patients with poor prognosis was selected. MAP-FL's role as neoadjuvant or adjuvant therapy is worthy of further study. © 1999 Cancer Research Campaign

Our purpose was to depict the characteristics of the global vasculature of cervical lymphadenopathies and to clarify the efficiency of Doppler spectral analysis and power Doppler sonography in the differential diagnosis.Prospectively, 289 lymph node lesions underwent Doppler flow studies and were grouped as metastasis, lymphoma, tuberculosis, and benign lymphadenopathies. Sonographic assessments included vascular pattern and vascular density (presented as vascularity index) as revealed by power Doppler sonography. Vascular resistive index and pulsatility index were assessed by at least three flow samplings. Values of both the highest and the lowest resistance were analyzed. Vascularity index, resistive index, pulsatility index, nodal size, and age were correlated.Most benign lymphadenopathies (87%), tuberculous lymphadenopathies (72%), and lymphomas (71%) revealed an avascular or hilar vascular pattern. Vascular patterns of most metastatic lymphadenopathies (90%) were of spotted (26%), peripheral (11%), or mixed (53%) type. The vascularity indexes of metastatic lymphadenopathy (mean, 0.176) and lymphoma (mean, 0.122) were significantly higher than those of tuberculous and benign lymphadenopathy (mean, 0.054 and 0.042, respectively). In vascular resistance studies, the highest pulsatility index and resistive index in metastatic lymphadenopathy statistically exceeded those of benign lymphadenopathy, whereas no difference was found in the lowest values. Negative correlation was found between the vascularity index of metastatic lesions and their lowest vascular resistance, and positive correlation was found between vascularity index and nodal size in benign lymphadenopathies.In addition to vascular resistance assessed traditionally with Doppler spectral analysis, vascular pattern and vascular density assessed with power Doppler sonography can better differentiate the nature of lymphadenopathies.

Despite a tendency for rotational abnormalities of the lower leg in children to improve spontaneously over time, some fail to correct and require corrective derotation osteotomy. In this retrospective study, we report the technique and results of the distal transverse tibial and fibular derotation osteotomy with Kirschner-wire fixation performed in 63 limbs of children with cerebral palsy, clubfoot, idiopathic tibial torsion, and myelomeningocele, as well as other less common conditions. There were no significant infections, neurologic complications, delayed or nonunions, or compartment syndromes as a result of the osteotomy. There were three (4.8%) complications, including late fracture (one), cross-union (one), and distal physeal closure (one). We conclude that transverse, same-level, distal tibial and fibular osteotomy fixated with crossed Kirschner wires is a safe, efficient, and effective surgical approach to the treatment of children with tibial torsion in a variety of clinical conditions.

Although alcohol is associated with higher upper aerodigestive tract (UADT) cancer risk, only a small fraction of alcoholics develop cancers. There is a lack of evidence proving the association of tag single nucleotide polymorphisms of alcohol-metabolizing enzymes with cancer risk. The aim of this study was to determine the association of these genetic polymorphisms with UADT cancer risk in a Chinese population. It was a hospital-based case-control candidate gene study. The databases of the International HapMap Project were searched for haplotype tag single nucleotide polymorphisms of the genes alcohol dehydrogenase (ADH)1B, ADH1C, and aldehyde dehydrogenase (ALDH)2. The genotyping was performed by the Sequenom MassARRAY system. Totally, 120 head and neck squamous cell carcinoma, 138 esophageal squamous cell carcinoma patients, and 276 age- and gender-matched subjects were enrolled between June 2008 and June 2010.Minor alleles of ADH1B (rs1229984) and ALDH2(rs671) were not only associated with the risk of UADT cancers (odds ratio [OR] [95% confidence interval, CI]: 3.53 [2.14-5.80] and 2.59 [1.79-3.75], respectively) but also potentiated the carcinogenic effects of alcohol (OR [95% CI]: 53.44 [25.21-113.29] and 70.08 [33.65-145.95], respectively). Similar effects were observed for head/neck and esophageal cancer subgroups. Multivariate logistic regression analysis identified four significant risk factors, including habitual use of cigarettes, alcohol, betel quid, and lower body mass index (P0.001). The haplotypes GAGC (OR 1.61, 95% CI 1.08-2.40, P = 0.018) and CCAATG (OR 1.69, 95% CI 1.24-2.30, P0.001) on chromosomes 4 and 12, respectively, were associated with higher cancer risk. These findings suggested that risk allele or haplotype carriers who consume alcohol and other carcinogens should be advised to undergo endoscopy screening. The information can be used to determine the degree of susceptibility of each subject and can be combined with other environmental factors, like carcinogen consumption, in the screening analysis.

The aim of this study was to investigate salivary markers related with burning mouth syndrome (BMS).Thirty female patients with BMS and twenty female control subjects were included. Unstimulated (UWS) and stimulated whole saliva samples (SWS) were collected, and their flow rates were determined. Salivary levels of cortisol, 17β-estradiol, progesterone, dehydroepiandrosterone (DHEA), and enzymatic activity of α-amylase were determined. Salivary transferrin level was measured to determine the level of blood contamination in saliva samples. The levels of all analytes in UWS were significantly correlated with those of SWS. The levels of 17β-estradiol, progesterone, and DHEA in UWS were significantly correlated with age. Age-matched comparisons revealed that the patient group had significantly higher levels of cortisol in UWS and of 17β-estradiol in SWS. When the patients were divided into older (≥60years) and younger (60years) groups, the older group showed a significantly lower level of progesterone in UWS. There were no significant relationships between treatment efficacy and levels of salivary analytes.In conclusion, patients with BMS showed significantly higher levels of cortisol in UWS and of 17β-estradiol in SWS compared with controls.

Giant congenital melanocytic naevi (GCMN) are known risk factors for the development of melanoma. However, melanoma risk among Asians is rarely evaluated.To evaluate the clinical characteristics and risk of melanoma development from GCMN in Koreans, we performed a nationwide retrospective cohort study in Korea. GCMN were defined as those comprising ≥5% body surface area in children or measuring ≥20cm in adults.In total, 131 patients with GCMN were enrolled, with a mean age of 10·3years (range: birth-70years).The posterior trunk was the most common site (67, 51·1%), followed by lateral trunk, anterior trunk, legs, both anterior and posterior trunk, buttocks, and arms. Satellite naevi were present in 69 cases (52·7%), and axial areas were more commonly involved in patients with satellite naevi than in those without satellite lesions. Atypical features such as rete ridge elongation and bridges were seen, and, among these, pagetoid spread and ballooning cell changes were more common in patients4years old. Proliferative nodules were found in three cases. Melanomas had developed in three of 131 patients (2·3%; a 6-year-old girl, a 14-year-old girl and a 70-year-old man), and the incidence rate was 990 per 100000 person-years. Melanomas in these three patients consisted of two cutaneous melanomas and one extracutaneous meningeal melanoma.We should be aware of melanoma development from GCMN, and lifelong follow-up is required due to the risk of melanoma arising in GCMN.

Employing the Monte Carlo simulation technique, we have investigated several phase transitions exhibited by a coupled XY model in two dimensions. The model is based on the Hamiltonian proposed by Bruinsma and Aeppli [Phys. Rev. Lett. 48, 1625 (1982)]. The simulation results demonstrate the existence of a new type of phase transition in which two different orderings are simultaneously established through a continuous transition. The unique nature of this phase transition provides a plausible explanation for our recent high-resolution heat-capacity data near the smectic- A-hexatic-B transition of two-layer free-standing films

A total of 33 carnation cultivars cultured in Korea were screened for resistance to the southern root-knot nematode, Meloidogyne incognita. Carnations were tested by either inoculating with 5,000 eggs or by transplanting into a mixture of bedding medium and soil infested with an average of 435 second-stage juveniles/300 cm(3) soil. Cultivars, Desio, Castelaro, Kappa, Rara, Izu Pink, Target, and Antalia were highly resistant to M. incognita. Twelve cultivars were moderately resistant, and the remaining 14 cultivars were susceptible. These results were similar to those obtained when the cultivars were subjected to field populations of the condition on a carnation farm.

Dynamical instability, chaotic pulsations, and generalized bistability have been observed in a laser-diode-pumped microchip Nd:YAG laser operating in a double transition scheme in which lasing occurs on two transitions with overlapping gain profiles, F(3/2)(4)(2)? I(11/2)(4)(3) and F(3/2)(4)(1)? I(11/2)(4)(2), and simultaneously involves excited Nd atoms from different sublevels of the upper manifold. The modeling of the experimental results requires rate equations that include cross-gain coupling among oscillating modes that belong to different transitions whose population inversion densities are determined by the Boltzmann distribution.

Background: Morphine consumption after a given surgical procedure can vary considerably. Studies show that single nucleotide polymorphism involving the nucleotide position 118 at exon 1 of the μ-opioid receptor gene (OPRM1) may play a role in mediating the effects of opioids. This study was performed to correlate the A118G polymorphism at OPRM1 with morphine consumption in patients undergoing total knee arthroplasty. Methods: Post-operative pain was relieved by patient-controlled analgesia (PCA). The analgesic effect was evaluated using a visual analogue scale. Side-effects, such as sedation, nausea and vomiting, and pruritus, were recorded systematically. The genotypes were determined by sequencing polymerase chain reaction-amplified DNA. The differences in demographics and consumed morphine from the PCA device between the different genotypes were tested using one-way analysis of variance. The prevalence of side-effects from morphine and sex distribution were compared using the Kruskal–Wallis test. Results: One hundred and forty-seven patients were included in the study. Twenty-seven patients who required rescue analgesia were excluded; these patients did not differ demographically or genetically from the 120 who completed the study. Of the latter, 74 were A118 homozygous (AA), 33 were heterozygous (AG) and 13 were G118 homozygous (GG). Group GG consumed significantly more morphine (40.4 ± 22.0 mg) than group AA (25.3 ± 15.5 mg) and group AG (25.6 ± 11.7 mg) during the first 48 h post-operatively. The groups did not differ with respect to reported pain, age, sex, weight and adverse effects. Conclusions: G118 homozygotes have a poorer response to morphine for post-operative pain control than A118 homozygotes or heterozygotes. The genotype may thus influence the post-operative response to pain and cause differences in the amounts of analgesic consumed by patients after total knee arthroplasty.

We report on our successful real‐time measurement of the dynamic frequency‐shift of light by particles in Brownian motion through self‐mixing laser spectroscopy with extreme optical sensitivity. We show that the changes over time in the non‐stationary random walks of small particles suspended in water result in different averaged dynamics when the field of vision for particles seen by the laser beam (scale of the observation) is changed. At a small focal volume of the laser beam, in which the relevant diffusion broadening is observed, the averaged motion which can be represented by the motion of a “virtual” single particle, whose velocity possesses a Gaussian‐white property, constitutes stationary fluctuations, featuring random sequences of the Lorentz‐type spectrum and double‐peaked probability distribution function for displacements.

The objective of this paper was to determine if topiramate is effective as treatment for bipolar spectrum disorders in a naturalistic setting. All charts of outpatients treated with topiramate (n = 76) were reviewed, and clinical response was assessed retrospectively using the Clinical Global Impressions Scale for Improvement. Mild improvement was seen in 47% (n = 36) and moderate-to-marked improvement in 13% (n = 10). Responders received a higher mean dose (180 mg/day) than did nonresponders (83.2 mg/day, p = 0.002). Topiramate dose was also higher in those who lost weight (138.3 mg/day) than in those who did not (70 mg/day, p = 0.007). Weight loss was experienced by 50% of the sample, with a mean loss of 14.2 lbs. Side effects were reported by 82% (n = 62) of the population, including cognitive effects, sedation, parasthesias, nausea, insomnia, headache, and dizziness. Adverse effects led 36% (n = 27) of the total sample to discontinue treatment with topiramate. Topiramate led to significant weight loss in about half of this bipolar population, while also improving mood symptoms at least mildly in most patients. Topiramate response and weight loss were both dose-related, with efficacy, in particular, associated with higher doses (mean = 180 mg/day) than frequently used in current clinical practice.

This aims to confirm elastic stress distributions and load carrying capacity of intact and cracked ellipsoidal inhomogeneities. Three dimensional finite element analysis has been carried out on intact and cracked ellipsoidal inhomogeneities in an infinite body under uniaxial tension and pure shear. For the intact inhomogeneity, as well known as Eshelby’s solution, the stress distribution is uniform in the inhomogeneity and nonuniform in the surrounding matrix. On the other hand, for the cracked inhomogeneity, the stress in the region near the crack surface is considerably released and the stress distribution becomes more complex. The average stress in the inhomogeneity represents its load carrying capacity, and the difference indicates the loss of load carrying capacity due to cracking damage between the average stresses of the intact and cracked inhomogeneities.

To analyze the factors affecting overall survival after salvage surgery in patients with recurrent nasopharyngeal carcinoma at the primary site after a full course of radiotherapy.Retrospective analysis of 60 consecutive patients treated by surgical resection of the recurrent tumors, with a mean follow-up of 43.1 months (range, 19-96 months).Academic tertiary referral center.The overall survival and locoregional relapse-free survival were 56% and 60% at 2 years, respectively, and 30% and 40% at 5 years. Twenty-nine (81%) of 36 patients died with uncontrolled local disease. The T stage of the recurrent tumors appeared to be an important prognostic factor. Age, sex, pathologic findings, and disease-free interval (time between previous radiotherapy and local recurrence) were not significant prognosis-affecting factors by the log-rank test. Multivariate analysis showed that patients with recurrent tumors of undifferentiated carcinoma, sarcoma, or small cell carcinoma had unfavorable prognoses. Uncontrolled local disease and the emergence of distant metastasis predicted grave results as well. Postoperative irradiation showed some benefit to patients, but the difference was not statistically significant.The T stage of the recurrence was the prominent prognosis-affecting factor in patients with recurrent nasopharyngeal carcinoma who received salvage surgery. Patients with local recurrence should be carefully selected for the salvage surgery. We recommend this surgery for patients with rT1, rT2, or limited rT3 lesions. The results of surgical resection in terms of local control and overall survival were slightly better than those of high-dose reirradiation, with fewer late complications.

We describe a first case of successful transcatheter management of guidewire-induced distal coronary artery perforation and impending cardiac tamponade, which developed during percutaneous coronary angioplasty, with transcatheter injection of polyvinyl alcohol form. This method may be an effective alternative in the management of distal coronary artery perforation requiring surgical repair.

The purpose of this study was to examine whether tumor DNA content correlated with prognosis in nasopharyngeal carcinoma (NPC). DNA flow-cytometric analysis in fresh specimens of nasopharyngeal biopsy from 123 patients with clinical suspicion of NPC was collected initially. Histopathologic study and successful flow-cytometric analysis had 28 lymphoid hyperplasias and 87 NPCs. Seventeen NPC patients were treated elsewhere and were excluded. A total of 98 patients, including 28 lymphoid hyperplasias and 70 NPCs, formed the materials of this study. There were 34 (49%) diploid and 36 (51%) aneuploid in NPC patients. No lymphoid hyperplasias were aneuploid. The mean of S-phase fraction was higher in NPC than in lymphoid hyperplasia (P.001), indicating higher cellular activity in NPC. DNA content failed to associate with age, gender, pathology, distant metastasis, and stage, indicating that DNA content was an independent prognostic indicator and possibly a clinical parameter. The log-rank test of overall survival curves was significant for stage (P = .002) and DNA ploidy (P = .042); it was almost significant for S-phase fraction (P = .057). Because the follow-up duration was not long enough, univariate and multivariate analysis were not significant for stage, ploidy, and S-phase fraction, except for distant metastasis. It is also most likely colinearity of clinical stage and distant metastasis that explained why clinical stage could not show significance in prognosis. Interestingly, the DNA content appeared to be a potential prognostic parameter in overall survival, although it was not statistically significant (P = .052). Our data suggested that NPC patients with aneuploid DNA and high S-phase fraction tend to have poor prognosis and should be treated more aggressively, even in the early stage of the disease.

Our purpose was to weigh various sonographic parameters as predicting malignant cervical lymphadenopathy and build a reliable prediction rule.One hundred and eighty-nine cervical lymph node lesions from 125 consecutive patients were used for building the prediction model. Sonographic variables, including 15 morphologic features of B-mode, 5 vascular parameters of color Doppler mode, along with age and sex, were analyzed with multivariate logistic regression to evaluate the joint effect of a set of independent variables. A prediction rule for malignant lymphadenopathy was established, and prospective validation was assessed on a new group consisting of 100 lymph nodes from another 60 consecutive patients.The association of heterogeneous content, long transverse diameter, pathologic vascular pattern, high vascular density, and older age provided the most robust prediction value. Scoring scale was designed as 1x (age) + 2x (vascularity index) + 3x (short axis) + 4x (vascular pattern) + 4x (internal echo) according to the parameter estimates of multivariate logistic regression analysis. Cut-off value of score==10 as malignancy resulted in 89.2% sensitivity and 85.2% specificity. Prospective validation also showed satisfactory results (sensitivity, 82.9%; specificity, 86.2%).By measuring only 4 sonographic parameters and age, this prediction rule could provide the physician a nonconfusing and reliable probability reference for managing cervical lymphadenopathy.

A field experiment was conducted in a clayey soil to determine the effects of cultural practices on methane (CH4) emissions from rice fields. The factors evaluated were a) direct seeding on dry vs wet soil, b) age of transplanted seedlings (8 d old and 30 d old), and c) fall vs spring plowing. Methane emissions were measured weekly throughout the rice-growing season using a closed static chamber technique. Transplanted 8-d-old seedlings showed the highest emission of 42.4 g CH4 m-2 season-1, followed by transplanted 30-d-seedlings (40.3 g CH4 m-2 season-1), and direct seeding on wet soil (37.1 g CH4 m-2 season-1 ). Direct seeding on dry soil registered the least emission of 26.9 g CH4 m 2 season-1 . Thus transplanting 30-d-old seedlings, direct seeding on wet soil, and direct seeding on dry soil reduced CH4 emission by 5%, 13%, and 37%, respectively, when compared with transplanting 8-d-old seedlings. Methane emission under spring plowing was 42.0 g CH4 m-2 season-1 and that under fall plowing was 31.3 g CH4 m-2 season-1 . The 26% lower emission in the field plowed in spring was caused by degradation of organic matter over the winter.

To investigate the genomic imbalances associated with nasopharyngeal carcinoma (NPC), we have performed chromosome analysis by comparative genomic hybridization (CGH) on 51 tumors, including 25 primary and 26 recurrent tumors. The most common copy number increases occurred on chromosome arms 12p (59%), 1q (47%), 17q (47%), 11q (41%), and 12q (35%). The minimal overlapping regions were at 12p12-13, 1q21-22, 17q21, 17q25, 11q13, and 12q13. The most frequent losses were from chromosome arms 3p (53%), 9p (41%), 13q (41%), 14q (35%), and 11q (29%). The minimal overlapping regions were at 3p12-14, 3p25-26, 9p21-23, 13q21-32, 14q12-21, and 11q14-23. Compared with the primary cancers, no additional chromosomal change was found in the recurrent tumors; however, the most frequent gain in the recurrent NPCs was at 11q13 (53%) instead of 12p in the primary tumors. An increase of gene alterations correlated with clinical stage. Our results provide a first comprehensive view of the genomic changes associated with NPC and reveal several new sites of genomic imbalance, indicating the possible involvement of novel oncogenes/tumor suppressor genes in the carcinogenesis of NPC.

Between February 1988 and June 1995, 24 congenital dislocations of the knee joints (17 patients) were reduced with closed methods including immediate reduction, serial casting, or traction in patients from 10 min to 26 days old. At an average follow-up of 4 years and 10 months, an excellent or good result was achieved if there were no associated anomalies. Fair or poor results were the result of delayed treatment or associated musculoskeletal anomalies including arthrogryposis multiplex congenita or Larsen's syndrome. Routine check of the hip dislocation is suggested. Diagnosis with manual testing was difficult, and other methods such as radiography or sonography were suggested in combination to detect hip dysplasia. The dislocated knee should be reduced before treating the hip dislocation. Concomitant treatment of the congenital dislocation of the knee and the hip with Pavlik harness provided satisfactory results. When late, progressive, genu valgus deformity occurred because of global instability of the knee and asymmetric physeal growth, reconstruction of the medial structures of the knee and prolonged bracing provided good results.

Nasopharyngeal angiofibroma (NAF), occurring mostly in young men, is a histologically benign tumor with aggressive clinical behavior that includes repeated epistaxis and intractable nasal obstruction. This paper reviews our recent experience at National Taiwan University Hospital (NTUH), and compares the results with those of a previous study (1955-1980) at NTUH to highlight the developments in the treatment of NAF. Fifteen patients with a diagnosis of NAF from 1984 to 1997 were included, and their clinical presentations, radiographic studies, treatments, and outcomes were retrospectively analyzed. The results showed that the clinical and demographic features were similar in the two studies. The average number of patients decreased from 2.1 patients in the previous study to 1.1 patients in this study. The duration of symptoms in the current study (8 months) was shorter than that of the previous study (16 months). Previously, the treatment consisted of radiation followed by surgery if there was residual tumor. The current treatment modality is preoperative transarterial embolization followed by surgery. The estimated intraoperative blood loss was reduced from 750 mL in the first study to 400 mL in this study. The recurrence rate decreased from 11% to 7% and the absolute relapse-free rate rose from 56% to 73%. Owing to the development of modern imaging techniques, the advent of preoperative arterial embolization, and advances in surgical techniques, successful removal of highly vascular tumors has become more feasible. Preoperative selective embolization followed by excision is an effective treatment modality. This strategy, an alternative to radiotherapy, not only avoids the long-term complications induced by radiation, but also reduces the tumor recurrence rate.

Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in Taiwan. Early detection is the best way to improve survival for this disease. A prospective study was designed to assess the feasibility of a new screening method for NPC by use of polymerase chain reaction (PCR) based on the close association of NPC and Epstein-Barr virus (EBV).One hundred thirty-three different tissues from nasopharynx, nose, and sinus were investigated by use of PCR to check for the presence of EBV genome. Subsequently, from April 1996 to March 1997, 55 patients were enrolled in a prospective screening study. All patients underwent nasopharyngeal swabs before biopsy. Polymerase chain reaction detection of EBV genome was conducted on swab samples. Anti-EBV viral capsid antigen (VCA) in IgA and IgG class were checked at the same visit.The EBV genome was present in 91.4% (85/93) of NPC tissues and in 25.0% (10/40) of non-NPC tissues (p.001, chi2 test). Of the 55 swabs, 49 (89.1%) specimens obtained enough cells for PCR examination. Thirty of these 49 patients were pathologically proved NPC. The presence of EBV were 86.7% (26/30) in NPC group and 42.1% (8/19) in non-NPC group. The sensitivity and specificity were 86.7% and 57.9%, respectively, which were similar to those of serologic method (87.5% and 43.5%) when the cut-off point was set at anti-VCA IgGor = 160 and IgAor = 10. Combining both methods elevates the specificity to 84.2%.The sensitivity of this PCR screening method is similar to that of the serologic method. Combining both methods can greatly increase the specificity, indicating this new method is a good supplement to the serologic screening of this endemic disease.

Hypopharyngeal cancer has a poor prognosis and the tumor may spread submucosally to involve all the pharyngeal mucosa. Reconstruction of circumferential defects after resection of hypopharyngeal cancer is a challenge. We describe our results using a tubed fan-shaped pectoralis major myocutaneous flap and distal interdigitating anastomosis to reconstruct a circumferential pharyngeal defect following surgical resection in six patients with advanced hypopharyngeal cancer. There was no perioperative mortality in this study. Fistula formation occurred in three patients and was corrected by secondary closure in two and spontaneous healing in one. Oral intake was started 2 weeks to 2 months after surgery. Four patients died of distant metastases within 24 months of follow-up and two survived without disease. Neither locoregional recurrence nor stenosis occurred. Our results show that the tubed fan-shaped pectoralis major myocutaneous flap with distal interdigitating anastomosis is a reliable way to reconstruct circumferential pharyngeal defects, and is relatively noninvasive.

Invasion of the air passage, especially with intraluminal involvement of well-differentiated thyroid carcinoma, is rare. Establishing a patent airway before surgery is necessary, but difficult and risky. We report a case of thyroid cancer with intraluminal invasion of the trachea. A 62-year-old schizophrenic woman presented with blood-tinged sputum and dyspnea. She had undergone a thyroid lobectomy 8 years previously. Computed tomography and bronchoscopy showed a protruding mass in the upper trachea and limited movement of the bilateral vocal folds. Emergency tracheostomy was performed to relieve impending apnea. Fine-needle aspiration of the left protruding thyroid gland showed papillary carcinoma. Because the tumor diffusely infiltrated the thyroid gland and intermingled with fibrosis due to the previous thyroid operation, and because there was limited movement of bilateral vocal folds, the patient underwent total laryngectomy, total thyroidectomy, total parathyroidectomy, and tracheal resection. Neither radioactive iodine nor external irradiation were given because of anticipated poor compliance due to schizophrenia. The postoperative course was smooth and thyroid hormone and calcium were supplemented regularly. The patient has lived well and without local recurrence for more than 3 years since the operation. She can speak with an artificial larynx.

We prospectively studied the results of distal release, performed between February 1989 and December 1994 for the treatment of a contracture of the deltoid muscle, in forty patients (forty-nine shoulders). Forty-seven contractures (in thirty-eight patients) developed after multiple intramuscular injections of various medications. The two remaining contractures (in two patients) were congenital. The average age at the onset of the symptoms was thirty-two years (range, birth to fifty-eight years). The primary symptoms included pain around the neck and the shoulder girdle, dimpling of the skin, a palpable fibrous band, winging of the scapula, difficulty in combing the hair or reaching the contralateral side of the body for grooming, and inability to bring the arm adjacent to the body. The average age at the time of the operation was thirty-nine years (range, fifteen to sixty-three years). The average duration of follow-up was three years and eleven months (range, two years to six years and six months). After the distal release of the contracture, but on the same day, the patients started a physical-therapy program. Postoperatively, the pain, dimpling of the skin, palpable fibrous band, and winging of the scapula resolved in forty-eight shoulders (thirty-nine patients). Six patients (six shoulders) no longer had difficulty in combing the hair or adducting the shoulder. There were no infections or neuromuscular complications. Forty-seven (96 per cent) of the forty-nine shoulders (thirty-eight of the forty patients) had a good clinical result, and two shoulders (two patients) had a poor result. Anterosuperior subluxation of the humeral head, noted on preoperative radiographs of twenty-three shoulders (eighteen patients), was not present postoperatively. Drooping of the acromion, seen in six patients (six shoulders) in whom the contracture had developed before they were sixteen years old, improved postoperatively in five shoulders (five patients). Rotation of the scapula, seen in five shoulders (five patients), resolved after release of the contracture in all five. There were no clinical or radiographic signs of osteoarthrosis due to long-term anterior translation of the shoulder joint in the four patients (six shoulders) who had had the contracture for at least twenty years (average, twenty-three years; maximum, twenty-seven years).