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This study estimated the direct and indirect socioeconomic costs of 238 diseases and 22 injuries from a social perspective in Korea from 2007 to 2015. The socioeconomic cost of each disease group was calculated based on the Korean Standard Disease Classification System. Direct costs were estimated using health insurance claims data provided by the National Health Insurance Service. The numbers of outpatients and inpatients with the main diagnostic codes for each disease were selected as a proxy indicator for estimating patients’ medical use behavior by disease. The economic burden of disease from 2007 to 2015 showed an approximately 20% increase in total costs. From 2007 to 2015, communicable diseases (including infectious, maternal, pediatric, and nutritional diseases) accounted for 8.9-12.2% of the socioeconomic burden, while non-infectious diseases accounted for 65.7-70.7% and injuries accounted for 19.1-22.8%. The top 5 diseases in terms of the socioeconomic burden were self-harm (which took the top spot for 8 years), followed by cirrhosis of the liver, liver cancer, ischemic heart disease, and upper respiratory infections in 2007. Since 2010, the economic burden of conditions such as low back pain, falls, and acute bronchitis has been included in this ranking. This study expanded the scope of calculating the burden of disease at the national level by calculating the burden of disease in Koreans by gender and disease. These findings can be used as indicators of health equality and as useful data for establishing community-centered (or customized) health promotion policies, projects, and national health policy goals.

This study examined the effect of children's flourishing on the pandemic of obesity from various aspects such as age, gender, race, family, school, and community. By using a subsample of the 2011-2012 National Survey of Children's Health, the Flourishing scale analyses were performed with a total of 45,309 children. Childhood obesity was diagnosed by calculating the percentile of the body mass index. Hispanic Americans were more likely to be overweight (P

The purpose of this study was to examine the expectations from Adapted Physical Education services from the perspective of Asian parents (n = 8) who have children with disabilities. Data collection involved semi-structured interviews, completed in the participants’ preferred language. The data were analyzed using Braun and Clarke’s recipe for thematic analysis. Four themes emerged: (a) “overcoming” the disability in APE, (b) different perspectives on the importance of APE between mothers and fathers, (c) parents’ concern over children being “disrespectful,” and (d) communication issues. Since the culture in the United States is ethnically and socially more diversified, the significance and relevance of the results for effective, culturally sensitive APE provision is discussed. An increased understanding and involvement of Asian parents in terms of their children’s APE program will result in more culturally sensitive, effective, and relevant APE experiences.

The effect of the addition of La, an immiscible element, on the microstructures and mechanical properties of dendrite-reinforced eutectic composites was studied in the Fe-Nb binary eutectic system. The results revealed the suppression of halo formation in the microstructure and the transition of the eutectic structure. Further, the Fe-11Nb-5La alloy exhibited a large plastic strain (~15%).

Objective To assess the changes in antimullerian hormone (AMH) levels after ablation for symptomatic uterine fibroids and adenomyosis using ultrasound-guided high-intensity focused ultrasound (USgHIFU). Design A prospective study. Setting Gynaecological department in multiple hospitals in South Korea. Population Patients with uterus fibroids and adenomyosis. Methods Seventy-nine women with symptomatic uterine fibroids and adenomyosis who met the inclusion criteria were enrolled in our study between January 2014 and December 2014. All patients underwent USgHIFU ablations. Each patient was examined before and after treatment, and at 6 and 12 months after treatment by T2-weighted MRI imaging (T2WI) and T1-weighted MRI imaging (T1WI) with gadolinium injection. Symptom severity scores (SSS), Uterine Fibroid Symptom Quality of Life (UFS-QOL) questionnaire subscales, and reductions of treated volume were assessed. AMH levels before and 6 months after HIFU ablation were compared to determine whether USgHIFU ablation affected ovarian reserve. Main outcome measures HIFU treatment did not affect the ovarian function. Results HIFU treatment time (mean ± standard deviation), HIFU ablation time, and treatment energy were 73.5 ± 25.6 minutes, 9994.7 ± 386.8 seconds, and 364 713.8 ± 156 350.7 Joules, respectively. AMH levels before and 6 months after HIFU ablation were 2.11 ± 2.66 and 1.84 ± 2.57 μg/l, respectively. There was no significant difference in AMH level between the two time points (P > 0.05). Conclusions USgHIFU ablation for uterine fibroid and adenomyosis was effective without affecting ovarian reserve. Tweetable abstract HIFU ablation is a safe and effective treatment for patients with uterine fibroids and adenomyosis that does not affect ovarian function.

Objective: Numerous disasters confirm the need for critical event training in healthcare professions. However, no single discipline works in isolation and interprofessional learning is recognized as a necessary component. An interprofessional faculty group designed a learning curriculum crossing professional schools. Design: Faculty members from four healthcare schools within the university (nursing, pharmacy, allied health, and medicine) developed an interdisciplinary course merging both published cross-cutting competencies for critical event response and interprofessional education competencies. Setting: Students completed a discipline-specific online didactic course. Interdisciplinary groups then participated in a 4-hour synchronous experience. This live course featured high-fidelity medical simulations focused on resuscitation, as well as hands-on modules on decontamination and a mass casualty triage incorporating moulaged standardized patients in an active shooter scenario. Participants: Participants were senior students from allied health, medicine, nursing, and pharmacy. Main Outcome Measures: Precourse and postcourse assessments were conducted online to assess course impact on learning performance, leadership and team development, and course satisfaction. Results: Students participated were 402. Precourse and postcourse evaluations showed improvement in team participation values, critical event knowledge, and 94 percent of participants reported learning useful skills. Qualitative responses evidenced positive response; most frequent recurring comments concerned value of interprofessional experiences in team communication and desire to incorporate this kind of education earlier in their curriculum. Students demonstrated improvement in both knowledge and attitudes in a critical event response course that includes interprofessional instruction and collaboration. Further study is required to demonstrate sustained improvement as well as benefit to clinical outcomes.

Abdominal wall endometriosis (AWE) occurs in about 0.1% of people with endometriosis, and is often diagnosed postoperatively. Surgical resection is generally used to treat AWE. We successfully treated AWE with ultrasound-guided high-intensity focused ultrasound therapy (USgHIFU). A 37-year-old Korean female presented with a palpable subcutaneous nodule associated with cyclic pain and swelling during menstruation. She was recommended surgical excision three months ago. She had a history of laparoscopic surgery for endometriosis 4 years ago and was interested in less invasive methods of treatment. The 0.9 cm painful nodule was observed as a low-echoic shadow in transabdominal ultrasonography and as an iso-signal in T1 MRI images. USgHIFU treatment was performed under light sedation and completed when the hyperechoic area covered the entire lesion. HIFU treatment was effective without any postoperative complications such as blisters or skin burns. The lesion showed changes in hyper-intensity signal on T1 MRI images. Physical examination showed absence of pain or tenderness and three months later, the painful nodule shrunk, and the menstrual cyclic pain associated with the nodule disappeared. In conclusion, USgHIFU may represent an effective therapy for AWE.

This study was carried out to evaluate the performance of a inflow controller for the control of combined sewer overflows (CSOs). Because of the inflow controller could be adjusted manually by predicting the maximum amount of peak flow, the mechanical adjustment of this controller was higher than the existing fixed-type controller in field application. Standardizing the relationship between the flow and the clearance and angle of an inlet cover plate on the inflow conditions can selected to the optimum conditions for the on-site. It was concluded that BOD pollutant loading at the region in which inflow controller was installed had shown the removal efficiency rate of 42%. Key words : Combined Sewer Overflows (CSOs), Inflow Controller, Inlet Cover Plate, Peak Flow 1. Introduction 1)비점오염원은 도로노면의 협잡물, 타이어의 마모로 생겨난 먼지, 농경지에 쓰인 농약, 하수관로의 낮은 수심과 유속으로 생겨난 퇴적물 등이 있다. 합류식 하수관로의 월류수(Combined Sewer Overflows, CSOs)는 강우시 도시의 지면에서 발생하는 비점오염물질들이 유입되며, 이 비점오염물질들과 오수가 섞여 도시내 하천으로 유입된다 . 월류수는 상대적으로 고농도의 오염물을 함유하고 있으며 방류수역의 수질오염을 가중시켜 수생환경, 상수공급, 어패류의 폐사 등과 관련된 수질환경에 영향을 미치고 있다 . 이렇게 유입된 월류수는 하천 생태계 파괴, 악취 등의 문제점이 발생하며 생태계를 다시 복구하기까지 유지관리, 관로 시스템개선, 처리기술 등의 비용이 증가하여 많은 환경적 그리고 경제적 문제가 발생한다(Cho et al., 2011).상기 문제 해결을 위해 우수토실에 유입유량 조절과 토사유입 방지를 위한 장치가 설치되어 있으며, 이 장치들은 차집관로로 유입되는 오수의 수위 고저에 의한 개폐방식으로 되어 있다. 강우시 수위 고저에 의한 개폐방식의 장치들은

Aim: Concurrent chemoradiation (CCRT) is the standard treatment for locally advanced cervical cancer. This study was undertaken to evaluate the outcomes and the prognostic factors for cervical cancer after CCRT. Material and Methods: The medical records of 174 patients with International Federation of Gynecology and Obstetrics stage IB1–IVA who were treated at three affiliated hospitals of the Catholic University of Korea between January 1999 and December 2008 were reviewed and analyzed. Patients received pelvic radiotherapy with one of three regimens of cisplatin-based chemotherapy concurrently and high-dose rate brachytherapy. The radiation field was extended to include para-aortic lymph nodes, if necessary. Results: The median follow-up period was 29.5 months (range, 5–96 months). Using multivariate analysis, stage (P = 0.014), tumor size (P = 0.043), and clinical response (P = 0.001) had a significant effect on overall survival. Similarly, progression-free survival (PFS) was influenced by stage (P = 0.004), tumor size (P = 0.02), clinical response (P = 0.011), and normalized squamous cell carcinoma antigen level after CCRT (P = 0.007). The 5-year survival rates were 91.7% (standard error, 5.8%) for stages IB1–IIA, 71.5% (standard error, 7.8%) for stage IIB, 44.9% (standard error, 7.8%) for stage III, and 20.9% (standard error, 12.0%) for stage IVA. A total of 151 out of 174 patients (86.8%) completed the planned treatment. Toxicities were manageable with supportive therapy. Conclusions: Cisplatin-based CCRT is well-tolerated. Good clinical response revealed a favorable correlation to survival. A maximal effort to achieve this goal might prolong survival in patients with cervical cancer.

Tuning of microstructure by addition of austenite stabilizers effectively enhances the mechanical properties in Fe-Nb-(Ni-Mn) dendrite-ultrafine eutectic composites. The Fe93Nb7 alloy displays the improved plasticity up to 10 pct due to the introduction of a ductile α-Fe dendrite into the ultrafine eutectic matrix. Meanwhile, the Fe78Nb7Ni10Mn5 alloy, which forms an in-situ martensitic α′-Fe dendritic phase reinforced ultrafine eutectic composite exhibits excellent combination of a high fracture strength of 1.6 GPa and a large plastic strain of 11 pct. The investigations reveal that the characteristics of the modulated primary dendrites in the dendrite-ultrafine eutectic composites play an important role in manipulating the generation and propagation of shear bands, thus resulting in the improved mechanical properties and plastic deformation behavior.

Background: High fidelity medical simulators (HFMS) are accepted tools for health care instruction. The use of HFMS was incorporated into an International Trauma Life Support course, and course participants were surveyed regarding attitudes toward HFMS.Methods: Course participants, including physicians, nurses, and prehospital personnel, were given pre- and post-course questionnaires measuring their confidence in knowledge and treatment of trauma resuscitation, as well as their attitudes towards the utility and realism of immersive simulation. The participants were randomly assigned to take a course examination either before or after their simulator session.Results: Thirteen course participants of varying backgrounds and degrees of clinical experience were surveyed and tested. All surveyed areas improved following simulator training, including comfort level with simulation as a training method (17%), perception of the realism of HFMS (15%), and reported self-confidence in knowledge, experience and training in trauma care (27%). Test scores were improved in the post-simulation group as opposed to the pre-simulation group (86% pass rate in the post-simulation test group versus 50% pass rate in the pre-simulation test group).Conclusions: High fidelity medical simulation was accepted by medical professionals of different backgrounds and experience. Attitudes towards simulation and self-confidence improved after simulator sessions, as did test scores, suggesting improved comprehension and retention of course materials. Further testing is required to validate the findings of this small, observational study.

An in situ formed martensitic dendrite reinforced Fe–11Nb–10Ni–5Mn ultrafine composite was developed by copper mold casting. This new class of ultrafine composite composed of micrometer-scale martensitic α′-Fe dendrites and ultrafine-scale alternating eutectics exhibits a high fracture strength of 1.6 GPa and a large compressive plasticity up to 10.5%. These excellent mechanical properties originate from the precipitation of the martensitic α′-Fe dendrites containing numerous nanometer-scale laths which are effective to generate multiple shear banding and restrict the rapid propagation of localized shear bands.

Spontaneous aortic dissection is a rare, life-threatening cause of chest pain, and has a higher prevalence when traditional risks such as age, hypertension, dyslipidemia, or connective tissue disorders are present. However, even in the absence of risk factors, non-traumatic rupture of an aortic dissection may occur. Most are found in patients over 40 years of age. Younger victims of this disease often also suffer from other conditions such as cystic medial necrosis, connective tissue disorders such as Marfan's syndrome, or vasculitis. We present the case of an 18-year-old, previously healthy woman who was country line dancing when she began to complain of severe, cramping chest and back pain. She was hemodynamically stable on initial presentation but experienced two seizures while in the emergency department and was intubated. Subsequently, her blood pressure dropped and she developed cardiac arrest, and despite vigorous resuscitation that included blood products and emergency department thoracotomy, she was refractory to all attempts. At autopsy she was found to have a spontaneous, non-traumatic rupture of an aortic dissection. This patient had no discernable risk factors for aortic dissection or discoverable cause on necropsy. We present this case to raise awareness among physicians and review other reported cases in the literature of aortic dissection in patients under age 40 years.

Uterine cervical cancer usually spreads by local extension and through the rich lymphatic network to the retroperitoneal lymph nodes. However, brain metastasis from primary cervical cancer is extremely rare. They are usually seen late in the clinical course and have poor prognosis. We present a 48-year-old woman with squamous cell carcinoma of the cervix who developed multiple brain metastases after 30-month treatment of the primary disease. The patient received whole brain radiation therapy and steroids, and she is alive without any neurologic symptoms and signs at the 6-month follow-up after treatment of the recurrence.

Center for Non-crystalline Materials, Department of Materials Science and Engineering, Yonsei University, 134 Shinchondong Seodaemungu, Seoul 120-749, Korea Division of Applied Science, Cheongju University, 36 Naedokdong, Cheongju 360-764, Korea IFW Dresden, Institute for Complex Materials, P.O. Box 27 01 16, D-01171 Dresden, Germany TU Dresden, Institute of Materials Science, D-01062 Dresden, Germany

The present study shows that nanostructure–dendrite composites successfully synthesize in the Fe–Zr binary eutectic system, exhibiting a better combination of strength and plasticity than bulk metallic glass or nanograined materials. The composites composed of microscaled dendritic phases (Fe2Zr or α-Fe) and nanoscaled lamellar eutectic matrix (Fe2Zr + α-Fe) exhibit high compressive strength (1.8–2.6 GPa) and plasticity (2.5–12%) under compression. In particular, the plasticity can be improved when coarsened ductile dendritic phases are reinforced in the fine-scaled lamellar eutectic matrix.

Most mobile application displays use LCDs (liquid crystal displays). Such panels have various problems, including decreases in transmission and saturation. We propose an algorithm to solve these problems by using data processing without panel replacement. In general, the subtle problems in color adjustment processing are skin color conversion and color saturation. The human skin tone is a color that is typically remembered; viewers feel awkward when skin tone is converted to an unnatural color. This paper proposes as a solution a skin protection algorithm that detects human skin color tone and prevents skin color from changing. Moreover, the paper introduces an adaptive quadratic curve that reproduces natural appearances more vividly without color saturation. In addition, the system does not use field-to-field processing but pixel-to-pixel processing in real time so that incoming image display color can be controlled without interference from neighboring pixels.

The human cervical cancer oncogene HCCR-1 is overexpressed in various human cancers, and might function as a negative regulator of the p53 tumor suppressor. To determine the regulatory pathway involved in the HCCR-1 gene expression, we searched the 5' flanking region of HCCR-1 and identified HCCR-1 promoter including putative homeodomain protein binding sites. The level of HCCR-1 expression was increased during the mouse embryogenesis. Expression of phosphatidylinositol 3-kinase (PI3K) in NIH/3T3 cells activated the HCCR-1 promoter. This promoter was also activated by wild type Akt but not by dominant negative Akt in K562 cells. In addition, the level of HCCR-1 was decreased by PI3K inhibitor, LY-294002, in a dose dependent manner. Northern blot analysis revealed that the HCCR-1 gene expression was down-regulated by LY-294002. These results suggest that the HCCR-1 oncogene expression was regulated by the PI3K/Akt signaling pathway.

Methyl gallate (meGAL) is known as one of major antioxidants. To investigate whether meGAL protects human cells from oxidative stress, meGAL extracted from Korean medicinal plant, Cercis chinensis leaves, was primarily screened using cell viability assay against oxidative stress. Human umbilical vein endothelial cells (HUVECs) were treated with three different concentrations of meGAL for indicated time. After or during meGAL treatment, H(2)O(2) was added and incubated. meGAL showed free radical scavenging effect at low concentration (0.02 mM) and cell protective effect against H2O2-mediated oxidative stress. meGAL recovered viability of HUVECs damaged by H(2)O(2)-treatment, reduced the lipid peroxidation (LPO) and decreased the internal reactive oxygen species (ROS) level elevated by H(2)O(2)-treatment. Free radical scavenging effect of meGAL was proven to be very high. Differential display reverse transcription-PCR analysis showed that meGAL upregulated the levels of regulator of chromatin condensation 1, type 1 sigma receptor and phosphate carrier protein expressions, respectively. Based on structural similarity compared with meGAL, 14 chemicals were chosen and viability assay was performed. Four chemicals, haematommic acid (56.2% enhancement of viability), gallic acid (35.0%), methylorsellinic acid (23.7%), and syringic acid (20.8%), enhanced more potent cell viability than meGAL, which showed only 18.1% enhancement of cell viability. These results suggest that meGAL and four meGAL-related chemicals protect HUVECs from oxidative stress.

Purpose: The purpose of our study was to identify an unique gene that shows cancer-associated expression, evaluates its potential usefulness in cancer diagnosis, and characterizes its function related to human carcinogenesis. Experimental Design: We used the differential display reverse transcription-PCR method with normal cervical, cervical cancer and metastatic tissues, and cervical cancer cell line to identify genes overexpressed in cancers. Results: We identified a minichromosome maintenance 3 (MCM3) gene that was overexpressed in various human cancers, including leukemia, lymphoma, and carcinomas of the uterine cervix, colon, lung, stomach, kidney and breast, and malignant melanoma. Western blot and immunohistochemical analyses also revealed that MCM3 protein was elevated in most of human cancer tissues tested. We compared the MCM3 protein expression levels in human cancers with conventional proliferation markers, Ki-67 and proliferating cell nuclear antigen. MCM3 antibody was the most specific for multiple human cancers, whereas proliferating cell nuclear antigen was relatively less effective in specificity, and Ki-67 failed to detect several human cancers. The down-regulation of MCM3 protein level was examined under serum starvation in both normal and cancer cells. Interestingly, MCM3 protein was stable in MCF-7 breast cancer cells even up to 96 hours after serum starvation, whereas it was gradually degraded in normal BJ fibroblast cells. Nude mice who received injections of HEK 293 cells stably transfected with MCM3 formed tumors in 6 weeks. Conclusions: Our study indicates that determination of MCM3 expression level will facilitate the assessment of many different human malignancies in tumor diagnosis, and MCM3 is involved in multiple types of human carcino-genesis.

In an effort to understand whether HLA class I and II plays any role in the process of tumorigenesis and metastasis, we have immunohistochemically examined expression of HLA class I and II antigen by using the monoclonal antibodies (mAb) L368 (for beta2m of HLA class I), HC-10 (for HLA-B, C heavy chains), and LGII-612.14 (for HLA class II heavy chain) in 5 borderline serous malignancy (BSM), 20 serous adenocarcinomas (SA), 15 borderline mucinous malignancy (BMM), and 10 mucinous adenocarcinomas (MA) of human ovary tumor case tissues. In BSM, the distribution and intensity of HLA expressions failed to reach statistical significance. In SA, HLA class I beta2-microglobulin (beta2m), HLA-B, C heavy chains and HLA class II heavy chain antigen expressions were down-regulated. Although expressions of HLA-B, C heavy chains and class II heavy chain were down-regulated in metastatic SA, there were no differences in HLA expression levels between primary and metastatic lesions. In BMM, class II heavy chain expressions were down-regulated. In MA, beta2m, HLA-B, C heavy chains and class II heavy chain expressions were also down-regulated. Thus, we could distinguish the reduction or absence of HLA molecule expression was related to malignant potential. Loss of HLA class I and II molecules in invasive ovarian cancers raises the possibility that this could be a factor for tumor cells to retain invasiveness.

HLA expression is altered in a large variety of human cancers. We performed immunohistochemical staining on tissues from normal, preinvasive, invasive and metastatic cervical cancer tissues using anti-HLA class I or class II antibody. In tissues from normal squamous epithelium, carcinoma in situ (CIS) and microinvasive carcinoma (MIC), the expressions of HLA-B, C heavy chains and class II heavy chain were significantly decreased as disease progressed. When the expression patterns were compared between primary and metastatic squamous cell carcinoma (SCC) lesions, statistically significant down-regulation of HLA class I and class II antigen in metastatic lesions was observed. The rates of HLA-B, C heavy chains and class II heavy chain expressions were all significantly down-regulated compared to the down-regulation rate of class I beta2-microglobulin (beta2m) in invasive squamous lesions, and the expressions of class II heavy chain in metastatic lesions was decreased further than that in primary lesions. Unlike SCC, the degree of HLA class I and class II loss was not evident as disease progressed in early stage of adenocarcinoma. In invasive adenocarcinoma lesions, only the expression of HLA-B, C heavy chains was decreased and no differences were seen in HLA-B, C heavy chain expression patterns between primary and metastatic lesions. These results suggest that alterations of HLA class I and II expressions seem to occur at a particular step in cervical cancer development and depend on tissue types: when the tumor becomes invasive and starts to metastasize.

To identify the genes involved in cervical carcinogenesis, we applied the mRNA differential display (DD) method to analyze normal cervical tissue, cervical cancer, metastatic lymph node, and cervical cancer cell line. We cloned a 491-bp cDNA fragment, CC231, which was present in metastatic tissue and cervical cancer cell line, but absent in normal cervical and cervical cancer tissues. The 491 bp cDNA fragment has 98% homology to the previously published sequence, AAC-11 (antiapoptosis clone 11). The levels of AAC-11 mRNA expressions in nine normal cervical and nine primary cervical cancer tissues were low. Its expression was higher in three metastatic tissues and five cervical cancer cell lines (HeLa, CaSki, SiHa, CUMC-3, and CUMC-6). Invasion of matrigel and adhesion to laminin by AAC-11 transfected CUMC-6 cells were increased by approximately 2-fold and 4-fold, respectively. Northern blot analysis showed that matrix metalloproteinase (MMP)-2 and membrane type 1 MMP (MT1-MMP) genes were found to be expressed in high levels in AAC-11-transfected cancer cells. But MMP-2 and MT1-MMP were not expressed in cells transfected with vector alone or wild-type cells. AAC-11-transfected cells expressed an elevated level of MMP-2 protein as assessed by immunoblotting. On the contrary, tissue inhibitor of MMP (TIMP-2) expression was detectable in cells transfected with vector alone or wild-type cells, respectively. Its expression was undetectable in AAC-11 transfected cells. In cervical cancer cells transfected with AAC-11, the expression of beta-catenin was up-regulated. These suggest that overexpressions of MMP-2 and MT1-MMP, loss of TIMP-2 expression, and up-regulation of beta-catenin by AAC-11 transfection may contribute to the development of cervical cancer invasion. AAC-11 gene transfection increased cervical cancer cell colonization. The effect of AAC-11 on cultured cervical cancer cells was associated with antiapoptotic process. Approximately 50% of the AAC-11 transfected cells in serum-free medium died after 2 weeks, compared to 1 week for vector alone or wild-type cells. These results suggest that AAC-11 may serve as a candidate metastasis-related and apoptosis-inhibiting gene in human cervical cancer.

Objective. The cell cycle regulatory protein p16 (CDKN2/cyclin dependent kinase 4 inhibitor/multiple tumor suppressor-1) causes cell cycle arrest at the G1 checkpoint by inhibiting activity of cyclin D-CDK4 complexes. The purpose of this study is to assess the effect of introduction of the p16 gene into two ovarian cancer cell lines via a recombinant adenoviral vector (Ad5CMV-p16). Methods. Cells lines used were SKOV 3 , which has a p16 deletion, and OVCA420, which has normal p16. Transduction efficiency was established by infecting cells with an adenovirus containing the Escherichia coli β-galactosidase gene (Ad5CMV-β-gal) at multiplicity of infection from 0 to 1000 and staining for X-gal. Cells were infected with Ad5CMV-p16 and cell growth was assessed by counting cells every other day for up to 7 days. Western blotting was done to assess for p16 expression after infection. Fluorescence-activated cell sorting after staining with propidium iodide was done to assess the effect of p16 on the cell cycle. Results. The SKOV3 cell line was transduced with the adenovirus at a slightly lower MOI than the OVCA420 cell line. Growth of the Ad5CMV-p16-infected cells was suppressed 75–80% by cell count in both cell lines and caused morphologic changes of the cells consistent with apoptosis. The p16 protein expression was seen to increase within 24 h after introduction of the p16 gene. G1 arrest of cells occurred beginning 24 h after introduction of the p16 gene. Conclusions. These results suggest that Ad5CMV-p16 may be further studied as a potential therapeutic agent for ovarian cancer as introduction of the p16 gene into ovarian cancer cell lines causes a G1 arrest and attenuation of growth, regardless of the endogenous p16 status of the cells.

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

Concurrent chemoradiation (CCRT) is the standard treatment for locally advanced cervical cancer. This study was undertaken to evaluate the outcomes and the prognostic factors for cervical cancer after CCRT.The medical records of 174 patients with International Federation of Gynecology and Obstetrics stage IB1-IVA who were treated at three affiliated hospitals of the Catholic University of Korea between January 1999 and December 2008 were reviewed and analyzed. Patients received pelvic radiotherapy with one of three regimens of cisplatin-based chemotherapy concurrently and high-dose rate brachytherapy. The radiation field was extended to include para-aortic lymph nodes, if necessary. The median follow-up period was 29.5 months (range, 5-96 months). Using multivariate analysis, stage (P = 0.014), tumor size (P = 0.043), and clinical response (P = 0.001) had a significant effect on overall survival. Similarly, progression-free survival (PFS) was influenced by stage (P = 0.004), tumor size (P = 0.02), clinical response (P = 0.011), and normalized squamous cell carcinoma antigen level after CCRT (P = 0.007). The 5-year survival rates were 91.7% (standard error, 5.8%) for stages IB1-IIA, 71.5% (standard error, 7.8%) for stage IIB, 44.9% (standard error, 7.8%) for stage III, and 20.9% (standard error, 12.0%) for stage IVA. A total of 151 out of 174 patients (86.8%) completed the planned treatment. Toxicities were manageable with supportive therapy.Cisplatin-based CCRT is well-tolerated. Good clinical response revealed a favorable correlation to survival. A maximal effort to achieve this goal might prolong survival in patients with cervical cancer.

Objectives Noninvasive technology may assist the emergency department (ED) physician in determining the hemodynamic status in critically ill patients. The objective of our study was to show that ED physicians can accurately measure cardiac index (CI) by performing a bedside focused cardiac ultrasound examination. Methods A convenience sample of adult subjects were prospectively enrolled. Cardiac index, left ventricular outflow tract (LVOT) diameter, velocity time integral (VTI), stroke volume index, and heart rate were obtained by trained ED physicians and a certified cardiac sonographer. The primary outcome was percent of optimal LVOT diameter and VTI measurements as verified by an expert cardiologist. Results One hundred patients were enrolled, with obtainable CI measurements in 97 patients. Cardiac index, LVOT diameter, VTI, stroke volume index, and heart rate measurements by ED physician were 2.42 ± 0.70 L min −1 m −2 , 2.07 ± 0.22 cm, 18.30 ± 3.71 cm, 32.34 ± 7.92 mL beat −1 m −2 , and 75.32 ± 13.45 beats/min, respectively. Measurements of LVOT diameter by ED physicians and sonographer were optimal in 90.0% (95% confidence interval, 82.6%-94.5) and 91.3% (73.2%-97.6%) of patients, respectively. Optimal VTI measurements were obtained in 78.4% (69.2%-85.4%) and 78.3% (58.1%-90.3%) of patients, respectively. In 23 patients, the correlation ( r ) for CI between ED physician and sonographer was 0.82 (0.60-0.92), with bias and limits of agreement of −0.11 (−1.06 to 0.83) L min −1 m −2 and percent difference of 12.4% ± 10.1%. Conclusions Emergency department ED physicians can accurately measure CI using standard bedside ultrasound. A focused ultrasound cardiac examination to derive CI has potential use in the management of critical ill patients in the ED.

Disseminated peritoneal leiomyomatosis (DPL) is a rare disease characterized by multiple benign leiomyomas arising in the pelvic and abdominal cavities in women. DPL is observed particularly in reproductive age groups and often mimics carcinomatosis grossly, but with benign histology and a favorable prognosis. The possible causes could be divided into hormonal, subperitoneal mesenchymal stem cells, metaplasia, genetic or iatrogenic after morcellation of myoma during laparoscopic surgery. Management includes surgery followed by adjuvant hormonal therapy, systemic chemotherapy or aromatase inhibitor treatment in cases of nonresectable disease.We report a case of DPL occurring after 2 previous operations including myomectomy and hysterectomy. After the DPL operation, the patient was treated with a gonadotropin-releasing hormone agonist for 6 months. One year after surgery, image analysis showed no evidence of disease.This rare condition must be considered even when a patient presents with abdominal masses after myomectomy followed by hysterectomy.

Uterine cervical cancer usually spreads by local extension and through the rich lymphatic network to the retroperitoneal lymph nodes. However, brain metastasis from primary cervical cancer is extremely rare. They are usually seen late in the clinical course and have poor prognosis. We present a 48-year-old woman with squamous cell carcinoma of the cervix who developed multiple brain metastases after 30-month treatment of the primary disease. The patient received whole brain radiation therapy and steroids, and she is alive without any neurologic symptoms and signs at the 6-month follow-up after treatment of the recurrence.

Endometriosis associated with ascites is an uncommon condition, but nevertheless important because it mimics the presentation of ovarian malignancy. We present the case of a 34-year-old woman who was admitted with the acute onset of abdominal pain and distension. A pelvic sonogram showed a large amount of peritoneal fluid with echogenic material and a 10-cm complex cystic structure, which appeared to be an enlarged left ovary. The concentrations of CA125 and CA19-9 were 548.1 and 7604 IU/mL, respectively. On the second day of admission, an exploratory laparoscopy was performed, which revealed a ruptured left ovarian cyst consistent with an endometrioma. A laparoscopic left adnexectomy was therefore performed. The histological examination of the specimen confirmed the diagnosis of an endometrioma. After a 12-month follow-up period, the patient showed no recurrence of the endometrioma or peritoneal fluid accumulation. In most instances, the presence of massive ascites is associated with malignancies, tuberculosis, or a perforated viscus. The information provided in the present report is important to both gynecologists and oncologists because it shows that an ovarian cyst with ascites and highly elevated CA125 and CA19-9 levels might be benign.

Study Objective To evaluate the feasibility of single-port laparoscopic myomectomy with transumbilical morcellation and suturing. Design Continuing prospective study (Canadian Task Force classification II-3). Setting University hospital. Patients Fifteen patients who underwent single-port laparoscopic myomectomy between September 2008 and October 2009 to remove single or multiple uterine myomas, at least 1 in each patient measuring greater than 4 cm in diameter. Interventions All single-port laparoscopic myomectomy procedures were performed by a single surgeon (Dr. Y.W. Kim). Myomas were extracted transumbilically by cutting the myomas into smaller pieces with a knife or a conventional electromechanical morcellator. After making a single 1.5- to 2.0-cm umbilical incision, the single-port system, created with a wound retractor and a surgical glove, was inserted. All operations were performed using conventional rigid straight laparoscopic instruments. Laparoscopic suturing was performed in intramural myomas and some subserosal myomas. Measurements and Main Results Patient mean (SD; range) age was 38.3 (5.6; 29–49) years. The number of myomas per patient was 1.6 (1.4; 1–6). The diameter of the largest myomas was 6.1 (1.5; 4.2–9.6) cm. In 4 patients, only a knife was required for transumbilical extraction of myomas, and in 11 patients, transumbilical morcellation with an electromechanical morcellator with or without a knife was used. Transumbilical drainage tubes were inserted into the pelvic cavity in 11 of 15 patients. Operative time was 96.7 (33.8; 35–150) minutes. The decrease in postoperative hemoglobin concentration was 1.8 (1.2; 0.4–3.6) g/dL. During the operations, no patients required blood transfusion. No patients developed postoperative fever. Neither bowel injury nor urinary tract injury occurred in any patient. The postoperative hospital stay was 3.1 (0.8; 2–4) days. Conclusion Single-port transumbilical morcellation using a conventional electromechanical morcellator with or without a knife is feasible. Single-port laparoscopic myomectomy is an alternative method with cosmetic advantage.

Background The Human cervical cancer oncogene (HCCR-1) has been isolated as a human oncoprotein, and has shown strong tumorigenic features. Its potential role in tumorigenesis may result from a negative regulation of the p53 tumor suppressor gene. Results To investigate the biological function of HCCR-1 in the cell, we predicted biological features using bioinformatic tools, and have identified a LETM1 homologous domain at position 75 to 346 of HCCR-1. This domain contains proteins identified from diverse species predicted to be mitochondrial proteins. Fluorescence microscopy and fractionation experiments showed that HCCR-1 is located in mitochondria in the COS-7, MCF-7 and HEK/293 cell lines, and subcompartamentally at the outer membrane in the HEK/293 cell line. The topological structure was revealed as the NH2-terminus of HCCR-1 oriented toward the cytoplasm. We also observed that the D1-2 region, at position 1 to 110 of HCCR-1, was required and sufficient for posttranslational mitochondrial import. The function of HCCR-1 on mitochondrial membrane is to retard the intrinsic apoptosis induced by UVC and staurosporine, respectively. Conclusion Our experiments show the biological features of HCCR-1 in the cell, and suggest that uncontrolled expression of HCCR-1 may cause mitochondrial dysfunction that can result in resisting the UVC or staurosporine-induced apoptosis and progressing in the tumor formation.

This paper proposes a simple yet extremely good technique for skin color extraction in images. This technique also allows for changeable mode options so that significantly better skin detected images are able to be obtained. The correlation between Cb and Cr is analyzed, and then a novel human skin color space is created to process 1-D skin detection properly. This system uses only a distribution of Cb and Cr from human skin, which is transformed from RGB color space, so that it is able to be applied to relatively small hardware, like mobile apparatuses.

Background Basic studies of oncogenesis have demonstrated that either the elevated production of particular oncogene proteins or the occurrence of qualitative abnormalities in oncogenes can contribute to neoplastic cellular transformation. The purpose of our study was to identify an unique gene that shows cancer-associated expression, and characterizes its function related to human carcinogenesis. Methods We used the differential display (DD) RT-PCR method using normal cervical, cervical cancer, metastatic cervical tissues, and cervical cancer cell lines to identify genes overexpressed in cervical cancers and identified gremlin 1 which was overexpressed in cervical cancers. We determined expression levels of gremlin 1 using Northern blot analysis and immunohistochemical study in various types of human normal and cancer tissues. To understand the tumorigenesis pathway of identified gremlin 1 protein, we performed a yeast two-hybrid screen, GST pull down assay, and immunoprecipitation to identify gremlin 1 interacting proteins. Results DDRT-PCR analysis revealed that gremlin 1 was overexpressed in uterine cervical cancer. We also identified a human gremlin 1 that was overexpressed in various human tumors including carcinomas of the lung, ovary, kidney, breast, colon, pancreas, and sarcoma. PIG-2-transfected HEK 293 cells exhibited growth stimulation and increased telomerase activity. Gremlin 1 interacted with homo sapiens tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein, eta polypeptide (14-3-3 eta; YWHAH). YWHAH protein binding site for gremlin 1 was located between residues 61–80 and gremlin 1 binding site for YWHAH was found to be located between residues 1 to 67. Conclusion Gremlin 1 may play an oncogenic role especially in carcinomas of the uterine cervix, lung, ovary, kidney, breast, colon, pancreas, and sarcoma. Over-expressed gremlin 1 functions by interaction with YWHAH. Therefore, Gremlin 1 and its binding protein YWHAH could be good targets for developing diagnostic and therapeutic strategies against human cancers.

Coumarins comprise a group of natural phenolic compounds found in a variety of plant sources. In view of the established low toxicity, relative cheapness, presence in the diet and occurrence in various herbal remedies of coumarins, it appears prudent to evaluate their properties and applications further. The purpose of this study is to investigate cellular protective activity of coumarin compound, fraxin extracted from Weigela florida var. glabbra, under oxidative stress, to identify genes expressed differentially by fraxin and to compare antioxidative effect of fraxin with its structurally related chemicals. Of the coumarins, protective effects of fraxin against cytotoxicity induced by H2O2 were examined in human umbilical vein endothelial cells (HUVECs). Fraxin showed free radical scavenging effect at high concentration (0.5 mM) and cell protective effect against H2O2-mediated oxidative stress. Fraxin recovered viability of HUVECs damaged by H2O2-treatment and reduced the lipid peroxidation and the internal reactive oxygen species level elevated by H2O2 treatment. Differential display reverse transcription-PCR revealed that fraxin upregulated antiapoptotic genes (clusterin and apoptosis inhibitor 5) and tumor suppressor gene (ST13). Based on structural similarity comparing with fraxin, seven chemicals, fraxidin methyl ether (29.4% enhancement of viability), prenyletin (26.4%), methoxsalen (20.8%), diffratic acid (19.9%), rutoside (19.1%), xanthyletin (18.4%), and kuhlmannin (18.2%), enhanced more potent cell viability in the order in comparison with fraxin, which showed only 9.3% enhancement of cell viability. These results suggest that fraxin and fraxin-related chemicals protect HUVECs from oxidative stress.

Nowadays, many small scale distributed generation (DG) project are being introduced into power distribution systems. In this case, it is difficult to properly maintain the terminal voltage of low voltage customers within a permissible range. This paper discusses some correlations between the traditional voltage regulation method by load-tap changing transformer (LCT) and line drop compensator (LDC) and the output of DG, and also proposes a method for determining the feasible operating range of DG under the proper voltage regulation of the power distribution system. This proposed method is applied to a 22.9 kV practical power distribution system, and its validity is clarified through simulation results.

We read with great interest the leading article by Tremosini and coworkers in Gut (2012 doi:10.1136/gutjnl-2011-301951) on the prospective validation of an immunohistochemical panel (glypican 3, heat shock protein 70 and glutamine synthetase) in liver biopsies for diagnosis of very early hepatocellular carcinoma (HCC).1 In this …

The modeling of load characteristics is a difficult problem because of uncertainty of the load. This research uses artificial neural networks which can approximate the nonlinear problem to represent load characteristics. After the selection of a typical load, active and reactive power for the variation of voltage and frequency is obtained from experiments. On the basis of obtained data, the load model represented by a neural network is acquired Then the propriety is submitted by case studies.

Telomerase, a ribonucleoprotein reverse transcriptase that extends telomeres of eukaryotic chromosomes is repressed in normal somatic cells but is activated during development and neoplasia. The regulation mechanism of telomerase activity in cancer cells is not clearly known. In this report, a possible affect of PKC on telomerase activity was examined using HeLa and CUMC-6 cervical cancer cell lines. Exposure of cells to PKC inhibitor, bisindolylmaleimide I and Gö6976, and high levels of PKC activator, 12-O-tetradecanoyl phorbol 13-acetate (TPA) resulted in the inhibition of PKC activity in both cells. Telomerase activities were also inhibited by bisindolyl-maleimide I and Gö6976, respectively, in a time-dependent manner. As PKC activity changes in TPA-treated cervical cancer cells, telomerase activities were increased at low dose of TPA and decreased at high dose. The expression levels of human telomerase subunits, human telomerase RNA (hTR) were not influenced by PKC modulating drugs. In contrast, the expression of full-length human telomerase reverse transcriptase (hTERT) was decreased after exposure to bisindolylmaleimide I and Gö6976 in a time-dependent manner. hTERT expression was not affected by low dose of TPA. In contrast, high dose of TPA inhibited hTERT expression level. But the expression patterns of beta-deletion transcript of hTERT after 72 h of treatment with PKC inhibitors or high dose of TPA exposure were not discernable as compared with those of full-length hTERT transcripts to PKC modulating drugs. These results suggest that PKC-modulating drugs altered telomerase activities by affecting full-length hTERT expression profile in human cervical cancers.