Comparison of clinical and serological differences among juvenile-, adult-, and late-onset systemic lupus erythematosus in Korean patients

OBJECTIVES

We investigated whether systemic lupus erythematosus (SLE) patients could be distinguished based on the time of disease onset and, if so, whether the groups differed in their clinical and laboratory features in ethnically homogeneous Korean patients.

METHODS

We enrolled 201 SLE patients with available clinical data at the time of onset of SLE from the lupus cohort at Chonnam National University Hospital. Sociodemographic, clinical, and laboratory data, including autoantibodies, and concomitant diseases were found at the time of diagnosis of SLE by reviewing patient charts. We divided SLE patients according to age at SLE diagnosis into three groups: juvenile-onset SLE (JSLE, diagnosed at ≤ 18 years), adult-onset SLE (ASLE, diagnosed at 19-50 years), and late-onset SLE (LSLE, diagnosed at >50 years), and compared baseline demographic, clinical, and relevant laboratory findings.

RESULTS

Of the 201 patients, 27 (14.4%), 149 (74.1%), and 25 (12.4%) were JSLE, ASLE, and LSLE patients, respectively. Fever, oral ulcers, nephritis, anemia, and thrombocytopenia were more common in JSLE patients than ASLE or LSLE patients (p < 0.05, < 0.05, 0.001, < 0.05, and < 0.05, respectively). However, Sjögren's syndrome was more frequent in LSLE patients than JSLE or ASLE patients (p < 0.05). Disease activity was significantly higher in JSLE patients than in ASLE or LSLE patients (p < 0.001). Anti-dsDNA and anti-nucleosome antibodies were found more frequently in JSLE patients and less frequently in LSLE patients (p < 0.05 and 0.005, respectively) and decreased complement levels were more common in JSLE patients and less common in LSLE patients (p < 0.001, 0.001, and < 0.05, respectively).

CONCLUSIONS

Our results indicate that SLE patients present with different clinical and serological manifestations according to age at disease onset. JSLE patients have more severe disease activity and more frequent renal involvement and LSLE patients have milder disease activity, more commonly accompanied by Sjögren's syndrome, at disease onset.

Biomimetic Deposition of Hydroxyapatite by Mixed Acid Treatment of Titanium Surfaces

A simple chemical method was established for inducing bioactivity of Ti metal. In the present study, two kinds of mixed acid solutions were used to treat Ti specimens to induce Ca-P formation. Following a strong mixed acid activation process, Ca-P coatings successfully formed on the Ti surfaces in the simulated body fluid. Strong mixed acid etching was used to increase the roughness of the metal surface, because the porous and rough surfaces allow better adhesion between Ca-P coatings and substrate. Nano-scale modification of titanium surfaces can alter cellular and tissue responses, which may benefit osseointegration and dental implant therapy. Some specimens were treated with a 5 M NaOH aqueous solution, and then heat treated at 600 °C in order to form an amorphous sodium titanate layer on their surface. This treated titanium metal is believed to form a dense and uniform bone-like apatite layer on its surface in a simulated body fluid (SBF). This study proved that mixed acid treatment is not only important for surface passivation but is also another bioactive treatment for titanium surfaces, an alternative to alkali treatment. In addition, mixed acid treatment uses a lower temperature and shorter time period than alkali treatment.

Hematogenous macrophage depletion reduces the fibrotic scar and increases axonal growth after spinal cord injury

Spinal cord injury (SCI) leads to formation of a fibrotic scar that is inhibitory to axon regeneration. Recent evidence indicates that the fibrotic scar is formed by perivascular fibroblasts, but the mechanism by which they are recruited to the injury site is unknown. Using bone marrow transplantation in mouse model of spinal cord injury, we show that fibroblasts in the fibrotic scar are associated with hematogenous macrophages rather than microglia, which are limited to the surrounding astroglial scar. Depletion of hematogenous macrophages results in reduced fibroblast density and basal lamina formation that is associated with increased axonal growth in the fibrotic scar. Cytokine gene expression analysis after macrophage depletion indicates that decreased Tnfsf8, Tnfsf13 (tumor necrosis factor superfamily members) and increased BMP1-7 (bone morphogenetic proteins) expression may serve as anti-fibrotic mechanisms. Our study demonstrates that hematogenous macrophages are necessary for fibrotic scar formation and macrophage depletion results in changes in multiple cytokines that make the injury site less fibrotic and more conducive to axonal growth.

Evaluation of the bonding strength of dental zirconia with veneering porcelains

The effect of thermo-cycling treatment on the bond strength and flexural strength of porcelain veneered zirconia was evaluated. After thermo-cycling treatment between 5 degrees C to 55 degrees C, porcelain-zirconia bond strength and zirconia flexural strength was not significantly affected. In the phase analyses using XRD after thermo-cycling treatment, both the experimental group and the control group showed only tetragonal phases. That is, the porcelain-zirconia bond strength and zirconia flexural strength were not affected by low temperature degradation. So low temperature aging treatment did not reduce the flexural strength and the effect of temperature applied to the aging treatment could beignorable.

Apparent diffusion coefficient scalars correlate with near-infrared spectroscopy markers of cerebrovascular autoregulation in neonates cooled for perinatal hypoxic-ischemic injury

BACKGROUND AND PURPOSE

Neurologic morbidity remains high in neonates with perinatal hypoxic-ischemic injury despite therapeutic hypothermia. DTI provides qualitative and quantitative information about the microstructure of the brain, and a near-infrared spectroscopy index can assess cerebrovascular autoregulation. We hypothesized that lower ADC values would correlate with worse autoregulatory function.

MATERIALS AND METHODS

Thirty-one neonates with hypoxic-ischemic injury were enrolled. ADC scalars were measured in 27 neonates (age range, 4-15 days) in the anterior and posterior centrum semiovale, basal ganglia, thalamus, posterior limb of the internal capsule, pons, and middle cerebellar peduncle on MRI obtained after completion of therapeutic hypothermia. The blood pressure range of each neonate with the most robust autoregulation was identified by using a near-infrared spectroscopy index. Autoregulatory function was measured by blood pressure deviation below the range with optimal autoregulation.

RESULTS

In neonates who had MRI on day of life ≥10, lower ADC scalars in the posterior centrum semiovale (r = -0.87, P = .003, n = 9) and the posterior limb of the internal capsule (r = -0.68, P = .04, n = 9) correlated with blood pressure deviation below the range with optimal autoregulation during hypothermia. Lower ADC scalars in the basal ganglia correlated with worse autoregulation during rewarming (r = -0.71, P = .05, n = 8).

CONCLUSIONS

Blood pressure deviation from the optimal autoregulatory range may be an early biomarker of injury in the posterior centrum semiovale, posterior limb of the internal capsule, and basal ganglia. Optimizing blood pressure to support autoregulation may decrease the risk of brain injury in cooled neonates with hypoxic-ischemic injury.

Effects of precursor concentration on the properties of ZnO nanowires grown on (1-102) r-plane sapphire substrates by hydrothermal synthesis

In this study, we grew ZnO nanowires hydrothermally on (1-102) r-plane sapphire substrates in an aqueous solution which contained zinc nitrate hexahydrate and hexamethylenetetramine (HMT) at 90 °C. First, the AZO seed layer of 80 nm thickness was deposited on the r-plane sapphire substrate by a radio frequency magnetron sputter. After that, we grew the ZnO nanowires on the seed layer by changing the precursor concentration of the aqueous solution from 0.025 M to 0.01 M. When the molar concentration of the precursor was changed, the diameter, length, density and number of ZnO nanowires also changed significantly: diameter, length and density increased with increasing molar concentration but the number of ZnO nanowires decreased. The ZnO nanowires grown at the higher molar concentration tended to grow along with the c-axis direction, as revealed by atomic force microscope and X-ray diffraction peaks. Furthermore, the PL spectra measured at room-temperature revealed a UV emission of 380 nm which can be attributed to the radiative recombination of free and bound excitons (Near Band edge Emission). The NBE emission was also increased with increasing molar concentration.

ASXL1 and DNMT3A mutation in a cytogenetically normal B3 thymoma

The molecular drivers of thymoma are poorly understood. Outside of the identification of rarely occurring epidermal growth factor receptor and v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog mutations via candidate gene sequencing, mutations in common cancer genes have yet to be observed. Only a single thymoma genome sequence has been previously reported, with no mutations in known cancer genes identified. Thus, we attempted to identify somatic driver mutations in a cytogenetically normal thymoma. A stage IVB type B3 thymoma from a 47-year-old male of Asian descent with no history of myasthenia gravis or other autoimmune condition was genomically evaluated. Exome sequencing and low-pass whole-genome sequencing was performed to identify somatic point mutations, copy number changes and structural variants. Mutations in known tumor suppressors DNMT3A (p.G728D) and ASXL1 (p.E657fs), consistent with mutations of known consequence in acute myeloid leukemia, were identified. Contrary to a previous report, this finding suggests the genetic etiology of thymomas may not be fundamentally distinct from other tumor types. Rather, these findings suggest that further sequencing of cytogenetically normal thymoma samples should reveal the specific molecular drivers of thymoma.

Biomechanical evaluation of suture-holding properties of native and tissue-engineered articular cartilage

The purpose of this study was to determine suture-holding properties of tissue-engineered neocartilage relative to native articular cartilage. To this end, suture pull-out strength was quantified for native articular cartilage and for neocartilages possessing various mechanical properties. Suture-holding properties were examined in vitro and in vivo. Neocartilage from bovine chondrocytes was engineered using two sets of exogenous stimuli, resulting in neotissue of different biochemical compositions. Compressive and tensile properties and glycosaminoglycan, collagen, and pyridinoline cross-link contents were assayed (study 1). Suture pull-out strength was compared between neocartilage constructs, and bovine and leporine native cartilage. Uniaxial pull-out test until failure was performed after passing 6-0 Vicryl through each tissue (study 2). Subsequently, neocartilage was implanted into a rabbit model to examine short-term suture-holding ability in vivo (study 3). Neocartilage glycosaminoglycan and collagen content per wet weight reached 4.55 ± 1.62% and 4.21 ± 0.77%, respectively. Tensile properties for neocartilage constructs reached 2.6 ± 0.77% MPa for Young's modulus and 1.39 ± 0.63 MPa for ultimate tensile strength. Neocartilage reached ~ 33% of suture pull-out strength of native articular cartilage. Neocartilage cross-link content reached 50% of native values, and suture pull-out strength correlated positively with cross-link content (R² = 0.74). Neocartilage sutured into rabbit osteochondral defects was successfully maintained for 3 weeks. This study shows that pyridinoline cross-links in neocartilage may be vital in controlling suture pull-out strength. Neocartilage produced in vitro with one-third of native tissue pull-out strength appears sufficient for construct suturing and retention in vivo.

Evaluation of molecular profiles in calcineurin inhibitor toxicity post-kidney transplant: input to chronic allograft dysfunction

The molecular basis of calcineurin inhibitor toxicity (CNIT) in kidney transplantation (KT) and its contribution to chronic allograft dysfunction (CAD) with interstitial fibrosis (IF) and tubular atrophy (TA) were evaluated by: (1) identifying specific CNIT molecular pathways that associate with allograft injury (cross-sectional study) and (2) assessing the contribution of the identified CNIT signature in the progression to CAD with IF/TA (longitudinal study). Kidney biopsies from well-selected transplant recipients with histological diagnosis of CNIT (n = 14), acute rejection (n = 13) and CAD with IF/TA (n = 10) were evaluated. Normal allografts (n = 18) were used as controls. To test CNIT contribution to CAD progression, an independent set of biopsies (n = 122) from 61 KT patients collected at 3 and ~12 months post-KT (range = 9-18) were evaluated. Patients were classified based on 2-year post-KT graft function and histological findings as progressors (n = 30) or nonprogressors to CAD (n = 31). Molecular signatures characterizing CNIT samples were identified. Patients classified as progressors showed an overlap of 7% and 22% with the CNIT signature at 3 and at ~12 months post-KT, respectively, while the overlap was <1% and 1% in nonprogressor patients, showing CNIT at the molecular level as a nonimmunological factor involved in the progression to CAD.

Paratubal cancer found at the time of laparoscopic surgery for adnexal torsion: a case report and literature review

INTRODUCTION

Paratubal cysts are common incidental finding, but malignant paratubal cancers have rare occurrence and have not been sufficiently described and discussed in previous studies.

CASE REPORT

This report describes a case of a 70-year-old female who underwent emergent laparoscopy for adnexal torsion. A serous cystadenocarcinoma arising in a paratubal cyst and accompanied by tubal torsion was revealed by frozen section and successfully treated with laparoscopic cytoreductive surgery and adjuvant chemotherapy.

CONCLUSION

This report is the first case of paratubal cancer with bilateral tubal torsion which was diagnosed and treated with laparoscopic surgery, and the third report describing serous cystadenocarcinoma arising in a paratubal cyst. In the laparoscopic surgery for the paratubal cyst clinically presumed as accompanied with tubal torsion, surgeons should not ignore the possibility of malignancy in spite of the rare incidence of paratubal cancers and the preconception that adnexal malignancies are seldom accompanied by tubal torsion.

Immature teratoma of the parapharyngeal space presenting with airway obstruction in an infant

Teratoma is the most common germ cell tumour in childhood. Teratoma typically arises in the sacrococcygeal region, gonads and mediastinum. The head and neck region is seldom involved. Teratomas of the neck region represent one of the most unusual causes of respiratory distress during the neonatal period. We present a case of an immature teratoma in the parapharyngeal space presenting with airway obstruction in an infant. Surgeons should consider the possibility of immature teratoma in the head and neck region in the differential diagnosis of respiratory distress in an infant, even if the patient does not have an external deformity.

Improving outcomes of renal transplant recipients with behavioral adherence contracts: a randomized controlled trial

The objective of this randomized controlled trial was to assess the effects of a 1-year behavioral contract intervention on immunosuppressant therapy (IST) adherence and healthcare utilizations and costs among adult renal transplant recipients (RTRs). The sample included adult RTRs who were at least 1 year posttransplant, taking tacrolimus or cyclosporine and served by a specialty pharmacy. Pharmacy refill records were used to measure adherence and monthly questionnaires were used to measure healthcare utilizations. Direct medical costs were estimated using the 2009 Medicare Expenditure Panel Survey. Adherence was analyzed using the GLM procedure and the MIXED procedure of SAS. Rate ratios and 95% confidence intervals were estimated to quantify the rate of utilizing healthcare services relative to treatment assignment. One hundred fifty RTRs were enrolled in the study. Intervention group RTRs (n = 76) had higher adherence than control group RTRs (n = 74) over the study period (p < 0.01). And 76.1% of the intervention group compared with 42.7% of the control group was not hospitalized during the 1-year study period (RR = 1.785; 95% CI: 1.314, 2.425), resulting in cost savings. Thus, evidence supports using behavioral contracts as an effective adherence intervention that may improve healthcare outcomes and lower costs.

A phase II study of gemcitabine and cisplatin plus sorafenib in patients with advanced biliary adenocarcinomas

Background:

This study evaluated the addition of sorafenib to gemcitabine and cisplatin in biliary adenocarcinoma first-line therapy.

Methods:

Patients with advanced biliary adenocarcinomas received gemcitabine 1000 mg m⁻² and cisplatin 25 mg m⁻² on a 2 weeks on/1 week off cycle and sorafenib 400 mg twice daily. After the initial 16 patients were enrolled, the chemotherapy doses were amended in view of grade 3 and 4 hand–foot skin reaction and haematologic toxicity. Subsequently, 21 patients received gemcitabine 800 mg m⁻², cisplatin 20 mg m⁻² and sorafenib 400 mg. The primary end point was an improvement in 6-month progression-free survival (PFS6) from historical 57–77% (90% power, type I error of 10%). Pretreatment pERK, evaluated by immunostaining, was correlated with clinical outcome.

Results:

A total of 39 patients were accrued. The most common grade 3–4 toxicities noted in >10% of patients were fatigue, elevated liver function tests and haematologic toxicities including thromboemboli, hyponatraemia and hypophosphataemia. Six-month progression-free survival was 51% (95% confidence interval (CI) 34–66%). Median PFS and overall survival were 6.5 (95% CI: 3.5–8.3) and 14.4 months (95% CI: 11.6–19.2 months), respectively. No correlation was observed between pERK and outcomes.

Conclusion:

The addition of sorafenib to gemcitabine and cisplatin in biliary adenocarcinomas did not improve efficacy over historical data, and toxicity was increased.

Recurrence of subsquamous dysplasia and carcinoma after successful endoscopic and radiofrequency ablation therapy for dysplastic Barrett's esophagus

Barrett's esophagus with dysplasia is commonly treated with radiofrequency ablation (RFA). Despite its effectiveness, a concern of any ablative technique is the development of subsquamous intestinal metaplasia, which could have potential for future neoplastic progression. To date, 34 cases of subsquamous neoplasia have been described in the literature after various ablation therapies. However, only three cases of subsquamous neoplasia have been reported after successful RFA treatment of dysplastic Barrett's esophagus. In this case series, we report on four additional cases of subsquamous neoplasia detected after successful endoscopic resection and RFA for neoplastic and dysplastic Barrett's esophagus. All four patients were treated successfully with endoscopic resection of their recurrent subsquamous neoplastic and dysplastic lesions. This case series highlights the need for continued surveillance following successful treatment of dysplastic Barrett's esophagus with RFA.

Nestin expression as an indicator of cervical cancer initiation

Nestin is an intermediate filament protein expressed in proliferating cells during embryonic development of the central nervous system (CNS) and considered to be a neuronal stem cell/progenitor cell marker. This study investigated the difference of nestin expression between pre-cancer (carcinoma in situ - CIS) and cancer of cervix in 129 tissues (49 normal cervix, 41 CIS, and 39 invasive cervical cancer) through the use of a paraffin-embedded tissue array. Immunostaining was evaluated by intensity, proportion of stained cells, and pattern of expression. The expression of nestin was positive in 63.4% (26/41) for CIS and 43.6% (17/39) for invasive cervical cancer, but only 26.5% (13/49) for normal tissues (p = 0.002). Strong positive staining/large proportion staining were 53.7% (22/41) / 36.6% (15/41), 15.4% (6/39) / 61.5% (24/39) in the CIS and invasive cervical cancer tissues, respectively (p = 0.043, p < 0.001). The diffuse stain with basal layer was positive in 90.2% (37/41) for CIS, but only 24.5% (12/49) of the samples were positive in normal tissues (p < 0.001). Based on these results, the authors suggest that nestin expression seems to participate in the step of cancer initiation and could potentially be a useful marker in the early detection of cervical cancer.

QCT bone mineral density responses to 1 year of oral bisphosphonate after total knee replacement for knee osteoarthritis

Bone mineral density (BMD) declined in more than half (53.7%) of post-total knee arthroplasty (TKA) patients (44 of the 82) after 1 year of oral bisphosphonate treatment, and that this decline was significant in bilateral TKA patients.

INTRODUCTION

TKA has proven to be an extremely successful procedure in terms of improving ambulatory function. However, the effects of such improvements in ambulatory function and of bisphosphonate on axial BMD have not been established. The purpose of this study was to determine the effect of 1 year of oral bisphosphonate in postmenopausal patients that have undergone TKA and to identify factors related to BMD changes using lumbar spine quantitative computed tomography (QCT).

METHODS

Eighty-two postmenopausal women that underwent primary TKA for knee osteoarthritis and who received once-weekly oral alendronate 70 mg for 12 months after TKA were enrolled. The effect of 1 year of oral bisphosphonate treatment post-TKA and the factors related to general lumbar spine BMD changes by using QCT were determined.

RESULTS

Some 53.7% of patients (44 of the 82) experienced an average lumbar spine QCT BMD decline of -6 mg/ml (range -15 to -0.5 mg/ml) after 1 year of oral bisphosphonate treatment, whereas the remaining 38 patients (46.3%) experienced an average increase of 6.8 mg/ml (range 0.6 to 15.7 mg/ml). Logistic and linear regression analysis showed that bilateral TKA was significantly related to a BMD decline (p < 0.05). Other factors, such as, age, body mass index, number of comorbidities, and Knee Society scores were not found to be significantly related to BMD response.

CONCLUSIONS

BMD declined in more than half (53.7%) of the patients after bisphosphonate treatment, and that this decline was significant in bilateral TKA patients. We believe that reduced mobility during rehabilitation was probably responsible for these BMD reductions.

Calixazacrown ethers for copper(II) ion-selective electrode

Five novel 1,3-alternate calix[4]azacrown ethers having 2-picolyl, 3-picolyl, and benzyl unit on the nitrogen atom were synthesized and used as ionophores for transition metal-selective polymeric membrane electrodes. The electrode based on 2-picolyl armed 1,3-alternate calix [4] azacrown ether exhibited Nernstian response toward copper (II) ion over a concentration range (10(-4.5) M-10(-2.5) M). The detection limit was determined as 10(-5) M in pH 7 and the selectivity coefficients for possible interfering cations were evaluated. Anions in the sample solution strongly affected the electrode response.

Carbohydrate response element-binding protein (ChREBP) plays a pivotal role in beta cell glucotoxicity

AIMS/HYPOTHESIS

This study was aimed at the elucidation of the pathogenesis of glucotoxicity, i.e. the mechanism whereby hyperglycaemia damages pancreatic beta cells. The identification of pathways in the process may help identify targets for beta cell-protective therapy. Carbohydrate response element-binding protein (ChREBP), a transcription factor that regulates the expression of multiple hyperglycaemia-induced genes, is produced in abundance in pancreatic beta cells. We hypothesise that ChREBP plays a pivotal role in mediating beta cell glucotoxicity.

METHODS

We assessed the role of ChREBP in glucotoxicity in 832/13 beta cells, isolated mouse islets and human pancreas tissue sections using multiple complementary approaches under control and high-glucose-challenge conditions as well as in adeno-associated virus-induced beta cell-specific overexpression of Chrebp (also known as Mlxipl) in mice.

RESULTS

Under both in vitro and in vivo conditions, ChREBP activates downstream target genes, including fatty acid synthase and thioredoxin-interacting protein, leading to lipid accumulation, increased oxidative stress, reduced insulin gene transcription/secretion and enhanced caspase activity and apoptosis, processes that collectively define glucotoxicity. Immunoreactive ChREBP is enriched in the nucleuses of beta cells in pancreatic tissue sections from diabetic individuals compared with non-diabetic individuals. Finally, we demonstrate that induced beta cell-specific Chrebp overexpression is sufficient to phenocopy the glucotoxicity manifestations of hyperglycaemia in mice in vivo.

CONCLUSIONS/INTERPRETATION

These data indicate that ChREBP is a key transcription factor that mediates many of the hyperglycaemia-induced activations in a gene expression programme that underlies beta cell glucotoxicity at the molecular, cellular and whole animal levels.

Pleuropulmonary and abdominal paragonimiasis: CT and ultrasound findings

OBJECTIVES

The purpose of this study was to review radiological images of patients with Paragonimus westermani (PW) that simultaneously involved the chest and abdomen.

METHODS

Our study included four patients with serologically and histopathologically confirmed paragonimiasis. Abdomen CT (n=3) and chest CT (n=3) scans were available, and abdominal wall ultrasonography was performed in all patients. We retrospectively reviewed the clinical, radiological and histopathological findings of these patients.

RESULTS

The most common abdominal CT findings were ascites and intraperitoneal or abdominal wall nodules. Low-attenuated serpentine lesions of the liver were another common and relatively specific feature.

CONCLUSION

Radiologists should consider the possibility of PW when these abdominal CT findings are noted, especially with pleural effusion or subpleural nodules in patients with initial abdominal symptoms.

Observation of reactor electron antineutrinos disappearance in the RENO experiment

The RENO experiment has observed the disappearance of reactor electron antineutrinos, consistent with neutrino oscillations, with a significance of 4.9 standard deviations. Antineutrinos from six 2.8  GW(th) reactors at the Yonggwang Nuclear Power Plant in Korea, are detected by two identical detectors located at 294 and 1383 m, respectively, from the reactor array center. In the 229 d data-taking period between 11 August 2011 and 26 March 2012, the far (near) detector observed 17102 (154088) electron antineutrino candidate events with a background fraction of 5.5% (2.7%). The ratio of observed to expected numbers of antineutrinos in the far detector is 0.920±0.009(stat)±0.014(syst). From this deficit, we determine sin(2)2θ(13)=0.113±0.013(stat)±0.019(syst) based on a rate-only analysis.

New limits on interactions between weakly interacting massive particles and nucleons obtained with CsI(Tl) crystal detectors

New limits are presented on the cross section for weakly interacting massive particle (WIMP) nucleon scattering in the KIMS CsI(Tℓ) detector array at the Yangyang Underground Laboratory. The exposure used for these results is 24 524.3  kg·days. Nuclei recoiling from WIMP interactions are identified by a pulse shape discrimination method. A low energy background due to alpha emitters on the crystal surfaces is identified and taken into account in the analysis. The detected numbers of nuclear recoils are consistent with zero and 90% confidence level upper limits on the WIMP interaction rates are set for electron equivalent energies from 3 to 11 keV. The 90% upper limit of the nuclear recoil event rate for 3.6-5.8 keV corresponding to 2-4 keV in NaI(Tℓ) is 0.0098 counts/kg/keV/day, which is below the annual modulation amplitude reported by DAMA. This is incompatible with interpretations that enhance the modulation amplitude such as inelastic dark matter models. We establish the most stringent cross section limits on spin-dependent WIMP-proton elastic scattering for the WIMP masses greater than 20  GeV/c2.

Nerve-stimulator-guided pudendal nerve block by pararectal approach

AIM

Various techniques have been described for performing a pudendal nerve block (PNB) and have associated problems such as multiple needle injections, the need for special equipment and consumption of time. This study aimed to describe a nerve-stimulator-guided PNB using a pararectal approach and to evaluate the safety and the efficacy of that procedure.

METHOD

We conducted a prospective study of 53 patients who underwent a PNB from December 2009 to July 2010. With the index finger of the left hand inserted into anus, we guided the nerve stimulator needle along the second finger tip on the ischial spine to the site where the maximal contraction of the external anal sphincter could be felt. Once the position of the needle tip had been confirmed, the desired drug was injected. Of the 53 patients, a cohort of eight underwent manometry before and after the pudendal block.

RESULTS

A total of 53 patients underwent the nerve-stimulator-guided procedure: 13 patients for pudendal neuralgia and the other 40 patients for anorectal disease. The mean maximal resting and squeezing pressures before the block were 55 and 161 mmHg, respectively, compared with 35 and 67 mmHg after the block. The PNB took just minutes to perform, was well tolerated by the patients, and resulted in neither severe complications nor repeated attempts.

CONCLUSION

Nerve-stimulator-guided PNB using a pararectal approach proved to be easy and safe, with acceptable patient tolerance. In addition, it can be used for a variety of anorectal procedures where relaxation of anal tone is required.