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Human spinal-cord-like tissues induced from human pluripotent stem cells are typically insufficiently mature and do not mimic the morphological features of neurulation. Here, we report a three-dimensional culture system and protocol for the production of human spinal-cord-like organoids (hSCOs) recapitulating the neurulation-like tube-forming morphogenesis of the early spinal cord. The hSCOs exhibited neurulation-like tube-forming morphogenesis, cellular differentiation into the major types of spinal-cord neurons as well as glial cells, and mature synaptic functional activities, among other features of the development of the spinal cord. We used the hSCOs to screen for antiepileptic drugs that can cause neural-tube defects. hSCOs may also facilitate the study of the development of the human spinal cord and the modelling of diseases associated with neural-tube defects.

The purpose of this study is to compare ultrasonographic ovarian mass scoring systems in pregnant women.This multicenter study included women with an ovarian mass during pregnancy who were evaluated using ultrasound and underwent surgery in 11 referral hospitals. The ovarian mass was evaluated and scored using three different scoring systems(International Ovarian Tumor Analysis Assessment of Different NEoplasias in the adnexa[IOTA ADNEX], Sassone, and Lerner). The final diagnosis was made histopathologically. Receiver operating characteristic(ROC) curves were generated for each scoring system.During the study period, 236 pregnant women underwent surgery for an ovarian mass, including 223 women(94.5%) with a benign ovarian mass and 13 women(5.5%) with a malignant ovarian mass. Among 10 ultrasound image findings, six findings were different between benign and ovarian masses(maximal diameter of mass, maximal diameter of solid mass, wall thickness of mass, inner wall structure, thickness of septations, and papillarity). In all three scoring systems, the ovarian mass scores were significantly higher in malignant masses than in benign masses, with the highest area under the ROC curve(AUROC) in the Sassone scoring system(AUROC: 0.831 for Sassone, 0.710 for Lerner vs 0.709 for IOTA ADNEX; p 0.05, between the Sassone and Lerner/ IOTA ADNEX). A combined model was developed with the six different ultrasound findings, and the AUROC of the combined model was 0.883(p = not significant between the combined model and Sassone).In pregnant women, malignant ovarian tumors can be predicted with high accuracy using either the Sassone scoring system or the combined model.

OBJECTIVE To assess the effectiveness of antibiotic treatment in patients with amniotic fluid (AF) "sludge" during the second or third trimester with uterine contractions and intact membranes. METHODS A retrospective cohort study was conducted of women at 15-32 weeks of pregnancy with uterine contractions and intact membranes. Women with AF "sludge" were treated with an antibiotic regimen of ceftriaxone, clarithromycin, and metronidazole. Based on changes in AF "sludge," patients were divided into group A (disappearance of "sludge") and group B (persistent "sludge"). RESULTS Women in group A (n=30) delivered later than those in group B (n=28). Group A showed a smaller initial size of "sludge" than group B (all P

Cyclin-dependent kinase 5 (Cdk5) controls neuronal migration in the developing cortex when multipolar newborn neurons transform to become bipolar. However, by which mechanisms Cdk5 controls cell adhesion in migrating neurons are not fully understood. In this study, we examined the functional interaction between Cdk5 and N-cadherin (Ncad) in newborn neurons when they undergo the multipolar to bipolar transition in the intermediate zone (IZ). Detailed expression analysis revealed that both Cdk5 and Ncad were present in GFP-electroporated migrating neurons in the IZ. Misexpression of dominant negative Cdk5 into the embryonic brains stalled neuronal locomotion in the lower IZ in which arrested cells were round or multipolar. When Ncad was co-introduced with Cdk5DN, however, cells continue to migrate into the cortical plate (CP) and migrating neurons acquired typical bipolar morphology with a pia-directed leading process. Similarly, downregulation of CDK5 resulted in lesser aggregation ability, reversed by the expression of Ncad in vitro. Down-regulation of activity or protein level of CDK5 did not alter the total amount of NCAD proteins but lowered its surface expression in cells. Lastly, expression of CDK5 and NCAD overlapped in the IZ of the human fetal cortex, indicating that the role of Cdk5 and Ncad in neuronal migration is evolutionarily conserved.

Introduction Sonography and magnetic resonance imaging (MRI) may be helpful to obtain an accurate diagnosis of acute abdominal pain in pregnancy. Adnexal torsion presenting in the first or second trimester can be confirmed and treated through laparoscopic surgery; however laparoscopic surgery in the third trimester can be difficult owing to the large uterus, and a gridiron incision can be useful. Case Report/Case presentation An 18-year-old gravida 1, para 0 (G1P0) woman at 30 + 4 weeks of gestation presented with sudden-onset cyclic pain in the right lower quadrant. Abdominal ultrasonography showed a normal appendix, and MRI showed a normal appendix and normal ovaries. The patient’s prominent tender point was marked and compared with the MR images, which confirmed the mark as the position of the right ovary. Laparotomy was performed through a gridiron incision, and a folded right ovary was identified. The ovary was unfolded, and TachoSil® and Surgicel® were used to maintain the unfolded position. The patient’s pain resolved, and her postoperative course was uneventful. She delivered a healthy, 2540-g male baby at 35 weeks’ gestation. Discussion/Conclusions A gridiron incision was useful to treat a folded ovary in the third trimester and to evaluate the adnexa and minimize uterine manipulation.

Background Our objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.Methods We analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysisResults During the study period, 38,402 women with diagnosed myoma(s), 9,890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1-1.16, p = 0.042; and aOR 7.46, 95% CI 6.97-7.98, p < 0.001, respectively) and placenta previa (aOR 1.41, 95% CI 1.29-1.54, p = 0.042; and aOR 1.58, 95% CI 1.35-1.83, p < 0.001, respectively), compared to women without a diagnosed myoma. And the risks of uterine rupture, preterm birth, and low birth weight were significantly higher in women with previous myomectomy but not in women with diagnosed myoma(s), compared to women without a diagnosed myoma (aOR 12.78, 95% CI 6.5-25.13, p < 0.001; aOR 1.64, 95% CI 1.47-1.84, p < 0.001; and aOR 1.53, 95% CI 1.39-1.68, p < 0.001, respectively). The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy.Conclusions When a woman who might become pregnant later on is diagnosed with uterine myoma, she should be counseled about the risk of myoma(s) and myomectomy on obstetric complications, especially including the significant risk of uterine rupture in pregnancies following myomectomy.

We have been developing an in-house deterministic neutron and gamma transport solver, AETIUS, which uses an unstructured tetrahedral mesh for spatial discretization such as Attila. We make the most of the spatial discretization of AETIUS for a shutdown dose rate analysis. This is similar to the MCR2S unstructured mesh method with the exception that the deterministic solver AETIUS is used for the neutron and gamma transport calculations instead of MCNP(X). AETIUS provides neutron spectra for every unstructured tetrahedral element belonging to the activation zones. Activation calculations are then carried out using FISPACT-2007, and the resulting gamma spectra of each element are used as decay gamma sources for the AETIUS gamma transport calculation to obtain a shutdown dose map. We calculated the shutdown dose rate on the ITER port plug computational benchmark, and our results are the most similar to those of the FDS R2S method.

The discrete ordinates method (also called the SN method) has been widely used in radiation transport calculations. However, the ray effect and complicated geometry modeling are major shortcomings of the SN calculation compared to the Monte Carlo method. AETIUS is an in-house 3D neutron/photon transport code. It uses the first collision source method on a point or volume source and an unstructured tetrahedral mesh to overcome the two shortcomings mentioned above. A three-dimensional un-collided flux and first collision source code, FNSUNCL3, was previously developed for TORT in three-dimensional X-Y-Z geometry and its benchmark results on Kobayashi problems showed good agreement with the reference. We adapted the methodology used in FNSUNCL3 by modifying the volume source to several pseudo-point sources and summing the contributions from all pseudo-point sources. However, the AETIUS code uses unstructured tetrahedral mesh such that we can apply the first collision source method to any shape of volume sources. The AETIUS results for the original Kobayashi Benchmark Problems and for the Modified Kobayashi Benchmark Problem 2, are shown here to demonstrate the efficacy of using unstructured tetrahedral mesh. These new results show good agreement with reference results.

Objective To evaluate the usefulness of maternal serum c-reactive protein (CRP), lipid peroxide, and oxygen radical absorbance capacity (ORAC), to predict the interval between membrane rupture and delivery in patients with preterm premature rupture of membranes (PPROM). Methods The present prospective study included patients with singleton pregnancies experiencing PPROM at earlier than 34 weeks of pregnancy who underwent spontaneous vaginal delivery between August 1, 2010 and July 31, 2013 at Chonnam National University Hospital, Republic of Korea. Patients were categorized based on whether delivery occurred within 3 days of PPROM or after. CRP levels, lipid peroxide (using malondialdehyde levels), ORAC, protein carbonyl, and other potential risk factors were compared between the groups. Results There were 72 patients included. Maternal serum CRP levels, malondialdehyde levels, and Bishop Score were higher in patients who underwent delivery within 3 days (all P

Background: A project for building a neutron time-of-flight (nTOF) facility is progressing. We expect that the construction will start in early 2016. Before that, a detailed simulation based on the current architectural drawings was performed to optimize the performance of our facility. Materials and Methods: Currently, several parts had been modified or changed from the original design to reflect requirements such as the layout of the electron beam line, shape of the vacuum chamber producing a neutron beam, and the underground layout of the nTOF facility. Detailed analysis for these modifications has been done with MCNP simulation. Results and Discussion: An overview of our photo-neutron source and KAERI nTOF facility were introduced. The numerical simulations for heat deposition, source term, and radiation shielding of KAERI nTOF facility were performed and the results are discussed. Conclusion: We are expecting that the construction of the KAERI nTOF facility will start in early 2016, and these results will be used as basic data.

The oligosaccharides in human milk constitute a major innate immunological mechanism by which breastfed infants gain protection against infectious diarrhea. Clostridium difficile is the most important cause of nosocomial diarrhea, and the C-terminus of toxin A with its carbohydrate binding site, TcdA-f2, demonstrates specific abolishment of cytotoxicity and receptor binding activity upon diethylpyrocarbonate modification of the histidine residues in TcdA. TcdA-f2 was cloned and expressed in E. coli BL21 (DE3). A human milk oligosaccharide (HMO) mixture displayed binding with TcdA-f2 at 38.2 respond units (RU) at the concentration of 20 μg/ml, whereas the eight purified HMOs showed binding with the carbohydrate binding site of TcdA-f2 at 3.3 to 14 RU depending on their structures via a surface plasma resonance biosensor. Among them, Lacto-N-fucopentaose V (LNFPV) and Lacto-N-neohexaose (LNnH) demonstrated tight binding to TcdA-f2 with docking energy of -9.48 kcal/mol and -12.81 kcal/mol, respectively. It displayed numerous hydrogen bonding and hydrophobic interactions with amino acid residues of TcdA-f2.

Objective: The aim of this study was to identify the factors affecting massive hemorrhages in patients with placenta previa. We also made probability models and equations for massive hemorrhage. Methods: Seven hundred and sixty-four patients with placenta previa who underwent cesarean section from January 2011 to September 2019 were retrospectively reviewed. Massive hemorrhage was defined as a blood loss exceeding 1,500 mL or receiving over four units of packed red blood cells during cesarean section. Logistic regression analysis was used to create a probability model and identify the predictive factors for massive hemorrhage. Results: Two hundred and seventy-three (35.7%) patients had massive hemorrhages. Preoperative hemoglobin levels, multifetal gestation, emergent surgery, history of a previous cesarean section, location of the placenta, the presence of lacuna, placental adhesion, the type of placenta previa, and multiparity were selected predictive factors for massive hemorrhage. One hundred seventy-eight (23.3%) patients had placenta previa and a history of previous cesarean section. Among them, massive hemorrhage occurred in 101 (56.7%). The selected predictive factors for massive hemorrhage in patients with placenta previa and a history of previous cesarean section were emergent surgery, location of the placenta, the presence of lacuna, placental adhesion, and preoperative hemoglobin levels. An equation for massive hemorrhage in patients with placenta previa was created by combining variables. Conclusion: An equation for massive hemorrhage in patients with placenta previa was created by combining variables. These equations may help in managing placenta previa patients with high risk.

Neutron total cross sections of natFe, 197Au and natW have been measured at the n ELBE neutron time-of-flight facility in the energy range 0.15-8MeV with an uncertainty due to counting statistics of up to 2% and a total uncertainty due to systematic effects of 1%. The neutrons are produced with the superconducting electron accelerator ELBE using a liquid lead circuit as photo-neutron target. By periodical sample-in-sample-out measurements the transmission of the sample materials has been determined using a low-threshold plastic scintillation detector. The resulting effective total cross sections show good agreement with previously measured data that cover only part of the energy range available at n ELBE. The results have also been compared to evaluated library files and recent calculations based on a dispersive coupled channel optical model potential.

Congenital adrenal hyperplasia (CAH) during pregnancy is a rare condition. Only a few cases have been reported in the literature. CAH patients has lower pregnancy rate compared to normal women. A 27-year-old nulliparous woman, a diagnosed case of 21-hydroxylase deficient simple virilising form of classic CAH visited. She got pregnant spontaneously without any trial of assisted reproductive technology. At the age of 12, she underwent clitoral resection and vaginoplasty. She took dexamethasone or prednisolone after operation. She delivered healthy singleton female baby by cesarean section. Four years later, she delivered healthy singleton female baby by repeat cesarean section. Two female babies have shown normal external genitalia. Here, we report a case of successful pregnancy and delivery in a patient with CAH.

The discrete ordinates code under development by KAERI uses an unstructured tetrahedral mesh, and can thus be applied to solve the radiation transport in a complicated geometry. In addition, the ge...

A 37-year-old pregnant woman, para 3, was transferred to our hospital at 30 weeks of gestational age with severe acute abdomen. Ultrasonography of the abdomen confirmed that body fluid around the uterus was retained. Paracentesis was performed and she was diagnosed with hemoperitoneum. Exploratory laparotomy was performed and arterial bleeding from the posterior of left round ligament was found. Spontaneous rupture of uterine vessel in pregnancy is associated with a high rate of mortality. Unfortunately, clinical symptoms of hemoperitoneum are non-specific. For the well-being of the mother and fetus, rapid diagnosis and surgical treatment of hemoperitoneum during pregnancy is needed. Non-invasive and easy-to-implement ultrasonography can be performed periodically to help diagnose quickly.

The discrete ordinates code under development by KAERI uses an unstructured tetrahedral mesh, and thus it can be applied to solve the radiation transport in a complicated geometry. In addition, the geometry modeling process has become much easier because computational tetrahedral meshes are generated based on the CAD file by Gmsh. As our first phase of applying the code to a TBM neutronics analysis, the neutron flux distribution in the Korea HCCR TBM is compared with that of MCNPX, and visualized in a three-dimensional system domain. Visualization of the fluxes and associated reaction rates in the whole system with a single run is one of the merits of a deterministic method and is very useful for checking hot spots.

Scattering source calculations using conventional spherical harmonic expansion may require lots of computation time to treat full-coupled three-dimensional photon-electron transport in a highly anisotropic scattering medium where their scattering cross sections should be expanded with very high order (e.g., P 7 or higher) Legendre expansions. In this paper, we introduce a modified scattering kernel approach to avoid the unnecessarily repeated calculations involved with the scattering source calculation, and used it with parallel computing to effectively reduce the computation time. Its computational efficiency was tested for three-dimensional full-coupled photon-electron transport problems using our computer program which solves the multi-group discrete ordinates transport equation by using the discontinuous finite element method with unstructured tetrahedral meshes for complicated geometrical problems. The numerical tests show that we can improve speed up to 17∼42 times for the elapsed time per iteration using the modified scattering kernel, not only in the single CPU calculation but also in the parallel computing with several CPUs.

Precipitous delivery may lead to serious maternal and neonatal complications. Uterine artery pseudoaneurysm (UAP) is one of the causes of delayed postpartum hemorrhage. Here we describe 3 cases of UAP manifesting as delayed postpartum hemorrhage after precipitous delivery. The duration of the second stage of labor in cases 1, 2, and 3 was 15, 15, and 60 min, respectively. Excessive vaginal bleeding occurred 10, 9, and 31 days after delivery, respectively. Ultrasonogram and pelvic angiography revealed the UAP in each case and uterine artery embolization was performed. UAP may be a complication of precipitous delivery.

As computing power gets better and better, computer codes that use a deterministic method seem to be less useful than those using the Monte Carlo method. In addition, users do not like to think about space, angles, and energy discretization for deterministic codes. However, a deterministic method is still powerful in that we can obtain a solution of the flux throughout the problem, particularly as when particles can barely penetrate, such as in a deep penetration problem with small detection volumes. Recently, a new state-of-the-art discrete-ordinates code, ATTILA, was developed and has been widely used in several applications. ATTILA provides the capabilities to solve geometrically complex 3-D transport problems by using an unstructured tetrahedral mesh. Since 2009, we have been developing our own code by benchmarking ATTILA. AETIUS is a discrete ordinates code that uses an unstructured tetrahedral mesh such as ATTILA. For pre- and post- processing, Gmsh is used to generate an unstructured tetrahedral mesh by importing a CAD file (*.step) and visualizing the calculation results of AETIUS. Using a CAD tool, the geometry can be modeled very easily. In this paper, we describe a brief overview of AETIUS and provide numerical results from both AETIUS and a Monte Carlo code, MCNP5, in a deep penetration problem with small detection volumes. The results demonstrate the effectiveness and efficiency of AETIUS for such calculations.

Objective This study aimed to estimate the association between total and ionized magnesium, and the changes in serum magnesium and calcium levels in patients with preterm labor during magnesium sulfate (MgSO4) administration. Methods The study population included 64 women who were candidates for intravenous MgSO4 treatment for preterm labor. Serial blood samples were taken and measured total magnesium (T-Mg), ionized magnesium (I-Mg), total calcium (T-Ca), and ionized calcium (I-Ca) levels every one-week interval (1st, 2nd, 3rd). Results There was no significant difference in T-Mg and I-Mg levels during MgSO4 administration (P>0.05). There was no significant difference in T-Ca and I-Ca levels during MgSO4 administration (P>0.05). Compared before and after administration of MgSO4, T-Mg and I-Mg levels and T-Ca levels were changed allow statistically significant (P0.05). There was significant correlation between levels of I-Mg and T-Mg (I-Mg=0.395×T-Mg+0.144, P

Study Objective To assess the clinical outcomes of total mesh repair with the Prolift technique as treatment of advanced pelvic organ prolapse in elderly patients who desire uterine preservation. Design Case control series study (Canadian Task Force classification II-2). Setting Medical school–affiliated hospital. Patients Sixty-eight patients over the age of 70 years with advanced pelvic organ prolapse, Pelvic Organ Prolapse Quantification stage III (n = 59) or IV (n = 9), underwent a total Prolift procedure and were followed up for a minimum of 2 years. Interventions Transvaginal pelvic floor repairs were performed with a total Prolift system. The concurrent pelvic surgery included midurethral sling operation with a TVT-O, if indicated. The assessment included intraoperative and postoperative complications, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores. Measurements and Main Results Objective and subjective data were available for 68 patients. The anatomic success rate was 97.1% after 2 years. Complications included bladder perforation in 1 patient (1.5%), de novo stress urinary incontinence in 20 patients (29.4%), dyspareunia in 4 patients (22.2%), and vaginal erosion in 1 patient (1.5%). The Pelvic Organ Prolapse Quantification stages, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores all improved significantly after surgery. Conclusions The total Prolift procedure is an alternative surgical option that uses a minimally invasive transvaginal approach to surgically treat elderly patients with advanced pelvic organ prolapse.