Three-dimensional analysis of lip and perioral soft tissue changes after debonding of labial brackets

OBJECTIVES

To evaluate the possible soft tissue changes after debonding of labial brackets using three-dimensional (3D) images acquired by a laser scanner.

METHODS

On the same day, 3D facial scans were taken immediately before debonding (T1) and immediately after debonding (T2) from 53 patients, and follow-up scans were taken 3 months after debonding (T3) from 31 patients. To compare the scans, superimpositions were performed and shell-to-shell deviations were used for quantitative analysis.

RESULTS

Shell-to-shell deviation map showing warm colors in lip and perioral tissue represented the retrusion of soft tissue after bracket removal. Soft tissue retrusion was significant for all landmarks immediately after debonding (T1-T2) and 3 months after debonding (T1-T3). Gender, bracket type, and the lip thickness variables did not show a clinically significant influence on the amount of soft tissue retrusion at the T1-T3 period. Lip corners and vermilion borders were significantly retruded at the T1-T3 period more than other perioral areas. A negative linear relationship was found in the amount of soft tissue retrusion immediately after debonding (T1-T2) and from debonding to 3 months after debonding (T2-T3).

CONCLUSION

Three-dimensional imaging showed significant changes in lip and perioral soft tissue after debonding of labial brackets. Clinically significant changes, approximately 2 mm of retrusion, occurred in the mouth corners bilaterally. Vermilion border landmarks also demonstrated significant changes in more than 1 mm. However, it was not possible to predict the soft tissue changes. A wide range of individual variability in the response to treatment and soft tissue adaptation was noted.

Uterine angiomyolipoma with metastasis in a woman with tuberous sclerosis: a case report

Extrarenal angiomyolipomas (AMLs) have been reported at various anatomical sites such as the liver, spleen, abdominal wall, retroperitoneum, oral cavity, penis, spermatic cord, skin, and lung but are infrequently described in gynecological regions. However, only a few cases of extrarenal AML in the uterus have been reported. The authors describe a case of uterine AML in a 41-year-old woman with evidence of tuberous sclerosis. Initial diagnosis concluded with myoma based on the interpretation of imaging and other pathological parameters. However, after successful laparoscopic surgical staging, AML was diagnosed. To date, the feasibility of laparoscopic surgical diagnosis and the risks associated with this technique have not been reported. The authors briefly review the implementation of laparoscopic surgical staging to diagnose uterine AML.

Attitudes and practices of Korean gynecologists towards hormone replacement therapy in endometrial cancer survivors

PURPOSE

To investigate the attitudes of Korean gynecologists towards prescribing hormone replacement therapy (HRT) after treatment for endometrial cancer.

MATERIALS AND METHODS

A questionnaire, addressing attitudes towards HRT and treatment strategies for patients previously treated for endometrial cancer, was distributed to 163 Korean gynecologists.

RESULTS

Of the 163 gynecologists that were sent this questionnaire, 98 (60.1%) responded. Among the respondents, 81 (82.7%) had previously prescribed HRT to patients with endometrial cancer. Of the latter, 75 (92.6%) had prescribed HRT to patients with Stage I, and more than half to patients with Stage II, endometrial cancer. Of the respondents who had prescribed HRT, 33 (40.7%) did so without regard for cancer-cell type and 33 (40.7%) began patients on HRT more than two years after endometrial cancer treatment. Tibolone was the most commonly prescribed drug (61.9%). The most common reason not to prescribe HRT was fear of cancer recurrence (38.1%).

CONCLUSION

Most of the Korean gynecologists surveyed had experience prescribing HRT to endometrial cancer patients. Although HRT is not actively recommended, HRT given post-therapy to endometrial cancer patients is considered acceptable.

CCAAT/Enhancer-binding protein-homologous protein sensitizes to SU5416 by modulating p21 and PI3K/Akt signal pathway in FRO anaplastic thyroid carcinoma cells

SU5416, vascular endothelial cell growth factor receptor inhibitor, suppresses hypoxia-induced angiogenesis, growth, proliferation, and metastasis in cancer cells. CCAAT/enhancer-binding protein-homologous protein (CHOP) has pivotal roles in regulation of growth and survival. In the present study, we evaluated the effects of SU5416 on cell survival, p21, and PI3K/Akt signal pathway in FRO anaplastic thyroid carcinoma (ATC) cells. Moreover, we investigated the roles of CHOP in cell survival under condition of SU5416 treatment in FRO ATC cells. After SU5416 treatment, cell viability, PARP-1, and caspase-3 protein levels were not changed. p53 and p27 protein levels decreased while p21 protein levels increased. Phospho-Akt protein levels were not altered. In SU5416-treated situation, cell viability was not different before and after administration of either p21 siRNA or LY294002 whereas it was lessened after co-administration of p21 siRNA and LY294002. Compared to SU5416 treatment alone, cell viability was reduced with CHOP plasmid but it was unchanged with CHOP siRNA. PARP-1 and caspase-3 protein levels with CHOP plasmid were elevated whereas the protein levels with CHOP siRNA were similar. While CHOP plasmid transfection diminished p21 and phospho-Akt protein levels, CHOP siRNA transfection did not alter the protein levels. In conclusion, these results suggest that CHOP may sensitize FRO ATC cells to SU5416 thereby inhibiting cell survival by modulating p21 and PI3K/Akt signal pathway. Furthermore, these findings imply that CHOP may be a possible candidate as the chemosensitizing factor for induction of cytotoxicity in ATC cells exposed to SU5416.

Coil protection using small helical coils for wide-neck intracranial aneurysms: a novel approach

BACKGROUND AND PURPOSE

A number of remodeling or protective techniques available to treat wide-neck intracranial aneurysms are increasingly being used, provided that the shape/type of aneurysm, vessel diameter, and inherent course of the vessel are conducive to their use. The purpose of this study was to describe a novel method using coil protection for treatment of wide-neck aneurysms.

MATERIALS AND METHODS

This technique involves sequential maneuvers to the aneurysm and affected branch artery. A microcatheter is first introduced into the aneurysmal sac, and another microcatheter is introduced into the entrance of the branch artery, followed by partial deployment of a small helical coil into the branch artery. A framing coil is then placed within the aneurysmal sac, under the protection of the helical coil. After completion of the first coil insertion, the helical coil should be retrieved to confirm the stability of the framing coil. The helical coil can also serve as a filler.

RESULTS

This technique was successfully applied to 12 intracranial saccular aneurysms of the MCA bifurcation (5 patients); anterior communicating artery (3 patients); and A1 and M1 segments, distal ACA, and basilar tip (1 patient each). Selective endovascular treatment was successfully performed and resulted in excellent outcomes in all patients. There were no complications directly related to coil protection.

CONCLUSIONS

Our small study suggests that coil protection can be a safe alternative to traditional remodeling or protective techniques when those techniques have failed or are not possible due to vascular geometry. It is particularly suited for the treatment of wide-neck aneurysms arising from small and acutely angulated branching vessels.

Effects of Korean ginseng berry extract on sexual function in men with erectile dysfunction: a multicenter, placebo-controlled, double-blind clinical study

Ginseng is beneficial for many aspects of human physiology, including sexual function. In this study, we have evaluated the efficacy and safety of an extract of ginseng berry, which has a ginsenoside profile distinct from other parts of the plant, on sexual function in men with erectile dysfunction. In all, 119 men with mild-to-moderate ED participated in a multicenter, randomized, double-blind, parallel, placebo-controlled clinical study. They were administered 4 tablets of either standardized Korean ginseng berry (SKGB, 350 mg ginseng berry extract per tablet), or placebo, daily, for 8 weeks. Efficacy was assessed with the International Index of Erectile Function (IIEF)-15 and premature ejaculation diagnostic tool (PEDT) at the end of the 4th and 8th week. We observed that the total and each of the individual domain scores of IIEF-15 increased from 40.95 ± 7.05 to 46.19 ± 12.69 significantly in the SKGB by the 8th week (P<0.05). The erectile function domain of IIEF changed slightly from 17.17 ± 2.57 to 18.59 ± 5.99 in the SKGB group by the 8th week (P<0.05). In addition, PEDT scores significantly improved from 9.14 ± 4.57 to 7.97 ± 4.4 and 7.53 ± 4.26 in the SKGB group after 4 and 8 weeks of treatment (P<0.05). Safety markers including hormone and lipid in the blood were assessed at the end of the 4th and 8th week and they remained unchanged. Oral administration of the SKGB extract improved all domains of sexual function. It can be used as an alternative medicine to improve sexual life in men with sexual dysfunction.

Abstract P5-07-04: Aurora kinase regulates PKC-mediated MMP-9 expression and invasion in MCF-7 breast cancer cells

Aurora kinase is a novel family of serine/threonine kinases. Elevated expression of aurora kinase A and B is observed in many tumor cells, and dysregulation of aurora kinase has been linked to tumorigenesis. Therefore, a number of studies focused in their oncogene activities as anti-tumor targets. Matrix metalloproteinase-9 (MMP-9), which degrades the extracellular matrix (ECM) and it is important process for breast cancer cell invasion. MMP-9 can be stimulated by activation of various cellular signaling pathways including protein kinase C (PKC), and mitogen-activated protein kinase (MAPKs), activator protein-1 (AP-1) and nuclear factor-kappaB (NF-κB) signaling pathways. Here, we show that 12-O-tetradecanoylphorbol-13-acetate (TPA), a directly PKC activator stimulation resulted in an up-regulation and phosphorlyation of aurora kinases in MCF-7 breast cancer cells. Also, Results showed that inhibition of the aurora kinases suppressed TPA-induced MMP-9 secretion/expression and cell invasion through suppression of NF-κB, AP-1, and MAPKs in MCF-7 breast cancer cell. In conclusion, this study provides new insight into the novel role of aurora kinase for expression of MMP-9 by TPA and regulation of aurora kinase by TPA through MAPKs signaling pathway.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-07-04.

Abstract P5-04-07: Epithelial-mesenchymal transition phenotype in breast cancers is associated with clinicopathologic factors indicating aggressive biologic behavior and poor clinical outcome

Epithelial-mesenchymal transition (EMT) is defined by the loss of epithelial characteristics and the acquisition of a mesenchymal phenotype. EMT in epithelial tumors is a reversible process and expected to be involved in invasion, metastasis and chemoresistance of cancer cells. EMT-inducing factors down-regulate E-cadherin and up-regulate extracellular matrix proteins such as fibronectin. Cancer tissue may display a wide spectrum of expression phenotypes of EMT-related proteins. However, little is known about the clinical significance of the different EMT phenotypes in breast cancers. We investigated expression pattern of EMT-related proteins, E-cadherin and fibronectin in 1,498 invasive breast carcinomas by using immunohistochemistry on tissue microarrays. EMT phenotypes were divided into complete type (E-cadherin-negative and fibronectin-positive); incomplete type, including hybrid (E-cadherin-positive and fibronectin-positive) and null (E-cadherin-negative and fibronectin-negative) types; and a wild type (E-cadherin-positive and fibronectin-negative). We correlated EMT phenotype with clinicopathologic characteristics and patients survival. Loss of E-cadherin was observed in 140 (9.3%) cases and fibronectin was expressed in cancer cells of 320 (21.4%) cases. Twenty three (1.5%) cases were categorized as complete type, 414 (27.6%) as incomplete type (hybrid type, 297; null type, 117), and 1,061 (70.8%) as wild type. Complete EMT phenotype was significantly associated with advanced pT stage, lymph node metastasis, high histological grade, and triple negativity (p &lt; 0.001). Overall survival and disease-free survival rates were significantly worse in the complete type, better in the incomplete type and best in the wild type (p = 0.002 and p &lt; 0.001, respectively). In multivariate Cox proportional hazard model analysis, the complete EMT phenotype was not an independent prognostic factor for both overall and disease-free survival. In conclusion, breast cancer patients with EMT phenotype showed less favorable outcomes than those with wild type as it was strongly associated with clinicopathologic factors indicating aggressive biologic behavior.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-04-07.

Pilot study of patient and caregiver out-of-pocket costs of allogeneic hematopoietic cell transplantation

Patient/caregiver out-of pocket costs associated with hematopoietic-cell transplantation (HCT) are not well known. We conducted a pilot study to evaluate patient/caregiver out-of-pocket costs in the first 3 months after allogeneic HCT. Thirty patients were enrolled at three sites. Prior to HCT, participants completed a baseline survey regarding household income and insurance coverage. Subsequently, they maintained a paper-based diary to track daily out-of-pocket expenses for the first 3 months after HCT. Telephone interviews were conducted to followup on missing/incomplete diaries and on study completion. Twenty-five patients/caregivers completed the baseline survey. Among these, the median pre-tax household income was $66,500 (range, $30-$375,000) and 48% had to temporarily relocate close to the transplant center. Insurance coverage was managed care plan (56%), Medicaid (20%), Medicare (17%) and other (8%). Twenty-two patients/caregivers completed ≥4 diaries; the median out-of-pocket expenses were $2,440 (range, $199-$13,769). Patients/caregivers who required temporary lodging had higher out-of-pocket expenses compared to those who did not (median, $5,247 vs. $716). Patients/caregivers can incur substantial out-of-pocket costs over the first 3 months, especially if they need to temporarily relocate close to the transplant center. Our study lays the foundation for future research on early and long-term financial impact of allogeneic HCT on patients/caregivers.

Phase II study of bevacizumab with liposomal doxorubicin for patients with platinum- and taxane-resistant ovarian cancer

BACKGROUND

Suppression of neoangiogenesis and pegylated liposomal doxorubicin (PLD) each contribute to the management of platinum-resistant/refractory ovarian cancer. The aim of this study is to test the combination of bevacizumab and PLD in women with resistant or refractory ovarian cancer.

METHODS

Eligibility criteria were no more than two prior treatments with platinum-containing regimens and one additional regimen, without anthracyclines. Treatment was administered every 3 weeks (bevacizumab 15 mg/kg beginning on cycle 2 and PLD 30 mg/m(2)). The primary end point was progression-free survival (PFS) at 6 months; the secondary end points included side-effects, overall response rates (ORR) and survival (OS).

RESULTS

Forty-six patients were enrolled. The average number of courses administered was 7. The median PFS was 6.6 months (range 1-24.6 months) according to Gynecologic Cancer Intergroup Committee (GCIC) criteria and 7.8 months (range 2-13.3 months) according to Response Evaluation Criteria in Solid Tumors (RECIST). The median OS was 33.2 months (range 3-37.5+ months). The ORR was 30.2% [95% confidence interval (CI) 17.2-46.1] and the clinical benefit rate (CBR) was 86.1% (95% CI 72.1-94.7). Adverse events included mucosal and dermal erosions (30% grade 3) and asymptomatic cardiac dysfunction. Additional toxic effects included hypertension, headache, renal dysfunction and proteinuria, wound healing delay, and one episode each of central nervous system (CNS) ischemia and hemolytic uremic syndrome.

CONCLUSION

PLD with bevacizumab has improved activity in recurrent ovarian cancer with increased toxicity.

Inhibition of arachidonate release from rat peritoneal macrophage by biflavonoids

Biflavonoid is one of unique classes of naturally-occurring bioflavonoid. Previously, certain biflavonoids were found to possess the inhibitory effects on phospholipase A(2) activity and lymphocytes proliferation(1) suggesting their anti-inflammatory/immunoregulatory potential. In this study, effects of several biflavonoids on arachidonic acid release from rat peritoneal macrophages were investigated, because arachidonic acid released from the activated macrophages is one of the indices of inflammatory conditions. When resident peritoneal macrophages labeled with [(3)H]arachidonic acid were activated by phorbol 12-myristate 13-acetate (PMA) or calcium ionophore, A23187, radioactivity released in the medium was increased approximately 4.1 approximately 7.3 fold after 120 min incubation compared to the spontaneous release in the control incubation. In this condition, biflavonoids (10 uM) such as ochnaflavone, ginkgetin and isoginkgetin, showed inhibition of arachidonate release from macrophages activated by PMA (32.5 approximately 40.0% inhibition) or A23187 (21.7 approximately 41.7% inhibition). Amentoflavone showed protection only against PMA-induced arachidonate release, while apigenin, a monomer of these biflavonoids, did not show the significant inhibition up to 10 uM. Staurosporin (1 uM), a protein kinase C inhibitor, showed an inhibitory effect only against PMA-induced arachidonate release (96.8% inhibition). Inhibition of arachidonate release from the activated macrophages may contribute to an anti-inflammatory potential of biflavonoidsin vivo.

Use of conjoint analysis to assess HIV vaccine acceptability: feasibility of an innovation in the assessment of consumer health-care preferences

Engaging consumers in prospectively shaping strategies for dissemination of health-care innovations may help to ensure acceptability. We examined the feasibility of using conjoint analysis to assess future HIV vaccine acceptability among three diverse communities: a multiethnic sample in Los Angeles, CA, USA (n = 143); a Thai resident sample in Los Angeles (three groups; n = 27) and an Aboriginal peoples sample in Toronto (n = 13). Efficacy had the greatest impact on acceptability for all three groups, followed by cross-clade protection, side-effects and duration of protection in the Los Angeles sample; side-effects and duration of protection in the Thai-Los Angeles sample; and number of doses and duration of protection in the Aboriginal peoples-Toronto sample. Conjoint analysis provided insights into universal and population-specific preferences among diverse end users of future HIV vaccines, with implications for evidence-informed targeting of dissemination efforts to optimize vaccine uptake.

Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation

Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplant exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.

Personality influences quality-of-life assessments in adult patients after allogeneic hematopoietic SCT: results from a joint evaluation of the prospective German Multicenter Validation Trial and the Fred Hutchinson Cancer Research Center

The influence of personality on health related quality of life (QoL) and physical functioning in the setting of allogeneic hematopoietic SCT (alloHSCT) is unknown. We conducted a joint evaluation within two independent cohorts of alloHSCT recipients to investigate the impact of personality on reported QoL and physical functioning. Two-hundred-eight patients (median age 44 years, range 18-72) of cohort 1 and 93 patients (median age 55 years, range 19-79) of cohort 2 after alloHSCT were evaluated. Personality was assessed using the 24-adjective measure (AM), which measures the Big-Five personality domains and the Life Orientation Test-Revised (LOT-R), measuring optimism and pessimism. QoL was measured using the Functional Assessment of Cancer Therapy with bone marrow transplantation subscale (FACT-BMT), Short Form 36 (SF-36), the human activity profile (HAP), as well as the NIH criteria-based cGVHD activity assessment form and the Lee cGVHD symptom scale. Neuroticism was significantly associated with worse function measured by the HAP and FACT-BMT. Optimism significantly improved QoL captured by the FACT-BMT. Pessimism significantly impaired physical function captured by the HAP and SF-36. Extraversion was significantly associated with reduced depression and lower severity of cGVHD symptoms reported by the patient and the physician. The results suggest that personality traits and pre-treatment QoL assessments should be measured in clinical trials to facilitate the interpretation of QoL data.

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.

REPORT OF AN UNUSUAL CASE OF TRIGGER FINGER SECONDARY TO PHALANGEAL EXOSTOSIS

Trigger finger is commonly secondary to stenosing tenosynovitis. Space occupying lesions in the tendon bed, although uncommon, may prevent smooth tendon gliding. These include lipoma, anomalous muscle insertions, tumours of the tendon sheath and haemangiomas. We describe a patient who had triggering of the left middle finger at the proximal interphalangeal joint due to an exostosis blocking the flexor tendons gliding. Removal of the exostosis relieved the problem. The clinician must be aware that there are other causes for triggering. These may be identified with pertinent findings in the history and physical examination.

Assessment of daily exposure of endodontic personnel to extremely low frequency magnetic fields

AIM

To measure daily exposure levels to extremely low frequency magnetic fields (ELF MFs) in endodontic clinics.

METHODOLOGY

In total, 10 subjects (five endodontic trainees, five hygienists) participated. Each volunteer wore a 60-Hz MF measurement device on the left upper arm during working hours. Measurements were taken continuously throughout the working day except at lunch time. Separate measurements were taken for specific items of equipment at several distances.

RESULTS

The average MF exposure for the 10 personnel was 0.03±0.04micro-Tesla (μT) (range, 0.01-6.4μT). The average MF exposure of endodontic personnel was lower than that of other hospital personnel according to the literature. Furthermore, all monitored exposure levels were well below the maximum acute exposure level, 500μT, recommended by the International Committee on Non-ionizing Radiation Protection for the protection of workers against ELF MFs. However, relatively high levels of exposure occurred in an operating room and X-ray room, presumably as a result of the use of surgical equipment such as microscopes and monitors, various motors and power cables of X-ray machines with large current flows.

CONCLUSIONS

The total average MF exposure level of 0.03μT was lower than the typical background level at home. Although high levels of exposure were measured in an operating room and X-ray room, the MF exposure level to dental personnel was minimal during routine endodontic clinical work.

Pathological correlation with diffusion restriction on diffusion-weighted imaging in patients with pathological complete response after neoadjuvant chemoradiation therapy for locally advanced rectal cancer: preliminary results

OBJECTIVE

The objective of this study was to assess causative pathological factors associated with diffusion restriction on diffusion-weighted imaging (DWI) in patients who achieved pathological complete response (pCR) after treatment with neoadjuvant chemoradiation therapy (CRT) for locally advanced rectal cancer.

METHODS

In total, 43 patients with locally advanced rectal cancer (≥T3 or lymph node positive) who underwent neoadjuvant CRT, subsequent surgery and ultimately achieved pCR were enrolled. All patients underwent pre- and post-CRT 3.0 T rectal MRI with DWI. Two radiologists blinded to pathological staging reviewed pre- and post-CRT 3.0 T rectal MRI for the presence of diffusion restriction in the corresponding tumour areas on post-CRT DWI, with a third radiologist arbitrating any disagreement. The consensus of these findings was then correlated with pathological data such as intramural mucin and the degree of proctitis and mural fibrosis seen on surgical specimen. Additionally, the pre-CRT tumour volume was measured to define the effect of this variable on the degree of radiation proctitis and fibrosis, as well as the presence of intramural mucin.

RESULTS

Diffusion restriction occurred in 18 subjects (41.9%), while 25 subjects remained diffusion restriction-free (58.1%). The diffusion restriction group tended to have more severe proctitis and mural fibrosis when compared with non-diffusion restriction group (p<0.001). Intramural mucin was also more common in the diffusion restriction group (p=0.052). Higher pre-CRT tumour volumes were significantly predictive of the degree of proctitis (p=0.0247) and fibrosis (p=0.0445), but not the presence of intramural mucin (p=0.0944). Proctitis and mural fibrosis severity were also identified as independent pathological risk factors for diffusion restriction on multivariate analysis (p=0.0073 and 0.0011, respectively).

CONCLUSION

Both radiation-induced proctitis and fibrosis were significant and independent predictors of diffusion restriction in patients achieving pCR after treatment with neoadjuvant CRT for locally advanced rectal cancer, and pre-CRT tumour volume significantly affects both variables.

Development of decay energy spectroscopy using low temperature detectors

We have developed a high-resolution detection technique for measuring the energy and activity of alpha decay events using low-temperature detectors. A small amount of source material containing alpha-emitting radionuclides was enclosed in a 4π metal absorber. The energy of the alpha particles as well as that of the recoiled nuclides, low-energy electrons, and low-energy x-rays and γ-rays was converted into thermal energy of the gold absorber. A metallic magnetic calorimeter serving as a fast and sensitive thermometer was thermally attached to the metal absorber. In the present report, experimental demonstrations of Q spectroscopy were made with a new meander-type magnetic calorimeter. The thermal connection between the temperature sensor and the absorber was established with annealed gold wires. Each alpha decay event in the absorber resulted in a temperature increase of the absorber and the temperature sensor. Using the spectrum measured for a drop of (226)Ra solution in a 4π gold absorber, all of the alpha emitters in the sample were identified with a demonstration of good detector linearity. The resolution of the (226)Ra spectrum showed a 3.3 keV FWHM at its Q value together with an expected gamma escape peak at the energy shifted by its γ-ray energy.

Immunohistochemical analysis of pulpal regeneration by nestin expression in replanted teeth

AIM

To investigate dental pulp healing after tooth replantation in rats using nestin as an odontoblastic marker for immunohistochemical analysis.

METHODOLOGY

  Twenty-five maxillary right first molars from 25 female Sprague-Dawley rats, aged 4 weeks post-natally, were extracted and immediately repositioned in the original socket within 5 s. Five rats each were later killed on days 3, 5 and weeks 1, 2 and 4. The maxillae were removed en bloc and the tissue samples containing the maxillary right first molars were decalcified, sectioned, mounted and stained with anti-nestin antibody to be observed under a light microscope.

RESULTS

  At 3 days after replantation, there was a localized inflammatory reaction, but pulp revascularization and healing had begun in the root area. At 5 days after replantation, odontoblast-like cells were observed. Reparative dentine deposition was observed beneath the pulp-dentine border from 1 week after replantation, and gradually increased until 2 weeks after replantation. The presence of odontoblast-like cells and the formation of reparative dentine continued from the first week throughout the experimental period. At week four, deposition of osteodentine and cementum-like tissues were observed.

CONCLUSIONS

Pulpal mineralization after replantation initially occurred via the deposition of reparative dentine, followed by the deposition of osteodentine and cementum-like tissues in rat teeth.

Acoustic interrogation and optical visualization of ultrasound contrast agents within microcapsules

The effectiveness of localized drug delivery as a treatment for breast cancer requires sufficiently high therapeutic dose, as well as an ability to image the drug for proper spatial targeting. To balance treatment potential and imaging capabilities, we have begun to design a novel drug reservoir using microcapsules that are large in size (> 30 µm) but functionalized with microbubbles or ultrasound contrast agents (UCAs). We term these carriers as 'Acoustically Sensitive Microcapsules' (ASMs). In previous work, we have demonstrated preparation of ASM carriers and their structural changes under therapeutic ultrasound by imaging static changes. In this paper, we describe a combined optical-acoustic setup coupled with a microfluidic device to trap these carriers for imaging and sonication. Using the setup, continuous wave ultrasound (180 kPa, 2.25 MHz, 3 s) produced an average displacement of 3.5 µm in UCAs near the ASM boundary, and exhibited displacement as high as 90 µm near the center of the microcapsule. Longer exposure time and higher acoustic pressure increased UCA displacement within an ASM. These two parameters can be carefully optimized in the future to cause these UCAs to travel to the membrane boundary to help in the drug elution process.

Coagulation and inflammation in scrub typhus and murine typhus--a prospective comparative study from Laos

Scrub typhus (caused by Orientia tsutsugamushi) and murine typhus (caused by Rickettsia typhi) cause up to 28% of febrile episodes in Thailand and Laos. The current understanding of coagulation and inflammation in the pathogenesis of these clinically very similar vasculotropic diseases is limited. This study compared human in vivo changes in 15 coagulation, inflammation and endothelial activation markers in prospectively collected admission and follow-up samples of 121 patients (55 scrub typhus, 55 murine typhus, and 11 typhus-like illness) and 51 healthy controls from Laos. As compared with controls, all but one of the markers assessed were significantly affected in typhus patients; however, the activation patterns differed significantly between scrub and murine typhus patients. The levels of markers of coagulation activation and all inflammatory cytokines, except for interleukin-12, were significantly higher in patients with scrub typhus than in those with murine typhus. In patients with murine typhus, however, the levels of endothelium-derived markers were significantly higher. Anticoagulant factors were inhibited in both typhus patient groups. This is the first study demonstrating that, in scrub typhus, in vivo coagulation activation is prominent and is related to a strong proinflammatory response, whereas in murine typhus, changes in coagulant and fibrinolytic pathways are suggestive of endothelial cell perturbation. These data suggest that, although late-stage endothelial infection is common in both diseases, the in vivo pathogenic mechanisms of R. typhi and O. tsutsugamushi could differ in the early phase of infection and may contribute to disease differentiation.

P3-04-04: Patterns of Distant Metastasis According to the Molecular Subtypes of Breast Cancer; Results of 529 Breast Cancer Patients

Backgrounds; Distant metastasis from breast cancer arises from various sites. But few studies concerning factors that can predict metastasis patterns in breast cancer has been reported. In this study, we analyzed the effect of breast cancer molecular subtypes on distant metastasis patterns and tried to determine factors that predict metastasis sites.

Patients and methods; From January 1995 to January 2004 at Yeungnam university hospital, patients diagnosed with the primary invasive breast cancer and received treatments were included in this study. Patients with bilateral breast cancer or distant metastasis at diagnosis were excluded. After analyzing estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2), epidermal growth factor (EGFR) and cytokeratin (CK) 5/6 status, we classified patients into 5 categories, luminal A, luminal B, HER2−enriched, basal-like, and normal (triple negative nonbasal) breast cancers. Distant metastatic patterns of each category were analyzed.

Results; 529 patients were eligible for tissue microassay analysis and median follow-up period was 7.7 years. In this period, total 82 patients (15.5%) had locoregional relapse or distant metastasis and distant metastasis were identified in 54 patients (10.2%). Each distant metastatic rate was 10.5% (33/313) in luminal A, 8.7% (4/46) in luminal B, 10.2% (6/59) in HER2−enriched, 7.9% (7/89) in basal-like, and 18.2% (4/22) in normal subtype. Most frequent site of distant metastasis in all patients was bone and such result was consistent with Luminal A subtype. Liver metastasis was most frequent in Luminal B subtype, lung metastasis in HER2 enriched and normal subtype and brain metastasis in basal-like subtype.

P3-07-16: The Efficacy of Arm Node Preserving Surgery Using Axillary Reverse Mapping for Preventing Lymphedema in Patients with Breast Cancer

Background

Lymphedema affects over 20% of breast cancer patients undergoing axillary dissection. Axillary reverse mapping (ARM) technique to identify and preserve arm node during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) was developed to prevent lymphedema. The purpose of this study was to investigate the location and the metastatic rate of the arm node, and finally to evaluate the short term incidence of lymphedema after arm node preserving surgery.

Patients and Methods

From January 2009 to October 2010, 97 breast cancer patients who underwent ARM were enrolled. 2.5ml blue dye was injected in ipsilateral upper inner arm. After at least 20 minutes after injection, SLNB or ALND was performed in the usual manner and blue stained arm nodes and/or lymphatics were identified. We checked arm circumference at baseline and average of 8.8 months after operation in ALND cases and 13.7 months in SLNB cases. Patients were divided into two groups, arm node preserved group (70 patients in ALND, 10 patients in SLNB) and unpreserved group (13 patients in ALND, 4 patients in SLNB). The difference of arm circumference between preoperative and postoperative was checked in these groups.

Results: The mean number of identified blue stained arm nodes was 1.4±0.6. The arm nodes were found in the inferolateral side of axillary and thoracodorsal vessels in 57 patients (58.76%), the inferomedial side in 37 patients (38.14%), the superolateral side in 2 patients (2.06%), and the superomedial side in 1 patient (1.04%). In the majority of patients (92%), arm nodes were located between the lower level of the axillary vein and just below the second intercostal brachial nerve.

In arm node unpreserved group, 2 patients had metastasis in their arm node. The one had a common pathway between the arm node and the sentinel lymph node. Another did not have a common pathway, but had extranodal extension with N3 metastasis. Among ALND patients, in arm node preserved group, the difference of arm circumference between preoperative and postoperative in ipsilateral and contralateral arm was 0.27cm and 0.07cm, respectively, whereas 0.47cm and −0.03cm in unpreserved group, and one lymphedema was found after 6 months. No difference was found between arm node preserved and unpreserved group amoung SLNB patients (0.21cm and 0.39cm in in preserved group, 0.2cm and 0.02cm in unpreserved group).

Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study

Background

The effects of malaria and its treatment in the first trimester of pregnancy remain an area of concern. We aimed to assess the outcome of malaria-exposed and malaria-unexposed first-trimester pregnancies of women from the Thai–Burmese border and compare outcomes after chloroquine-based, quinine-based, or artemisinin-based treatments.

Methods

We analysed all antenatal records of women in the first trimester of pregnancy attending Shoklo Malaria Research Unit antenatal clinics from May 12, 1986, to Oct 31, 2010. Women without malaria in pregnancy were compared with those who had a single episode of malaria in the first trimester. The association between malaria and miscarriage was estimated using multivariable logistic regression.

Findings

Of 48 426 pregnant women, 17 613 (36%) met the inclusion criteria: 16 668 (95%) had no malaria during the pregnancy and 945 (5%) had a single episode in the first trimester. The odds of miscarriage increased in women with asymptomatic malaria (adjusted odds ratio 2·70, 95% CI 2·04–3·59) and symptomatic malaria (3·99, 3·10–5·13), and were similar for Plasmodium falciparum and Plasmodium vivax. Other risk factors for miscarriage included smoking, maternal age, previous miscarriage, and non-malaria febrile illness. In women with malaria, additional risk factors for miscarriage included severe or hyperparasitaemic malaria (adjusted odds ratio 3·63, 95% CI 1·15–11·46) and parasitaemia (1·49, 1·25–1·78 for each ten-fold increase in parasitaemia). Higher gestational age at the time of infection was protective (adjusted odds ratio 0·86, 95% CI 0·81–0·91). The risk of miscarriage was similar for women treated with chloroquine (92 [26%] of 354), quinine (95 [27%) of 355), or artesunate (20 [31%] of 64; p=0·71). Adverse effects related to antimalarial treatment were not observed.

Interpretation

A single episode of falciparum or vivax malaria in the first trimester of pregnancy can cause miscarriage. No additional toxic effects associated with artesunate treatment occurred in early pregnancy. Prospective studies should now be done to assess the safety and efficacy of artemisinin combination treatments in early pregnancy.

Funding

Wellcome Trust and Bill & Melinda Gates Foundation.

Proliferating tricholemmal tumour: clinicopathological aspects of a case

We report the case of a 49-year-old man who presented with an enlarging mass over his occipital scalp. The clinical impression was either a squamous cell carcinoma or an unusual adnexal tumour. A wide excision was performed with skin grafting. Gross examination revealed a large exophytic tumour mass measuring 10 cm. Histopathological examination showed a circumscribed, well-differentiated squamoproliferative lesion with a lobulated architecture. Clear cell features, pilar-type keratinisation, microcalcifications and the presence of mucinous degeneration were noted. A diagnosis of proliferating tricholemmal tumour was made. This entity incorporates a spectrum of lesions, ranging from the mostly benign proliferating tricholemmal cyst to tumours having more atypical cellular and invasive features, the latter features correlating with an increased capacity for aggressive behaviour. Management-wise, such tumours require complete excision with follow-up. As the tumours are often large in size at presentation, reconstruction is required.

Insular cortex is a trait marker for pain processing in fibromyalgia syndrome--blood oxygenation level-dependent functional magnetic resonance imaging study in Korea

OBJECTIVES

To investigate the variability in cerebral activation according to pain intensity and the association between variability in cerebral activation and clinical features in patients with fibromyalgia syndrome (FMS) using functional magnetic resonance imaging (fMRI).

METHODS

Nineteen FMS female patients and 22 age-matched healthy female controls were enrolled in this study. Changes in cerebral activation area were measured using blood oxygenation level-dependent (BOLD) contrast fMRI after application of both medium and high pressure stimuli to the left thumbnail bed.

RESULTS

We identified the insular cortex (IC) and superior temporal gyrus (STG) as regions of interest (ROIs) in this analysis. Cerebral activation at the bilateral IC in response to high pressure stimuli was significantly greater in FMS patients than it was in the controls, whereas there were no differences in BOLD signal changes in the STG regions between FMS patients and controls, irrespective of pain level. Prominent signal changes at both ROIs in FMS patients were noted between high and medium pressure (p<0.001 contralateral IC, p=0.001 for ipsilateral IC, p=0.008 for contralateral STG, and p=0.049 for ipsilateral STG). BOLD signal changes on the contralateral STG after medium stimuli were correlated with tender point count (r=0.586, p=0.013).

CONCLUSIONS

This study revealed more distinct signal variability in the ICs in FMS patients than in those of controls in response to high pressure stimuli. The IC can therefore be considered to be a region susceptible to pain perception in FMS patients.

Time-resolved measurements of PM2.5 carbonaceous aerosols at Gosan, Korea

In order to better understand the characteristics of atmospheric carbonaceous aerosol at a background site in Northeast Asia, semicontinuous organic carbon (OC) and elemental carbon (EC), and time-resolved water-soluble organic carbon (WSOC) were measured by a Sunset OC/ EC and a PILS-TOC (particle-into-liquid sampler coupled with an online total organic carbon) analyzer, respectively, at the Gosan supersite on Jeju Island, Korea, in the summer (May 28-June 17) and fall (August 24-September 30) of 2009. Hourly average OC concentration varied in the range of approximately 0.87-28.38 microgC m-3, with a mean of 4.07+/- 2.60 microgC m-3, while the hourly average EC concentration ranged approximately from 0.04 to 8.19 .microgC m-3, with a mean of 1.35 +/- 0.71 microgC m-3, from May 28 to June 17, 2009. During the fall season, OC varied in the approximate range 0.9-9.6 microgC m-3, with a mean of 2.30 +/-0.80 microgC m-3, whereas EC ranged approximately from 0.01 to 5.40 microgC m-3, with a mean of 0.66 +/- 0.38 microgC m-3. Average contributions of EC to TC and WSOC to OC were 26.0% +/- 9.7% and 20.6% +/-7.4%, and 37.6% +/- 23.5% and 57.2% +/- 22.2% during summer and fall seasons, respectively. As expected, clear diurnal variation of WSOC/OC was found in summer, varying from 0.22 during the nighttime up to 0.72 during the daytime, mainly due to the photo-oxidation process. In order to investigate the effect of air mass pathway on the characteristics of carbonaceous aerosol, 5-day back-trajectory analysis was conducted using the HYSPLIT model. The air mass pathways were classified into four types: Continental (CC), Marine (M), East Sea (ES) and Korean Peninsula (KP). The highest OC/EC ratio of 3.63 was observed when air mass originated from the Continental area (CC). The lowest OC/EC ratio of 0.79 was measured when air mass originated from the Marine area (M). A high OC concentration was occasionally observed at Gosan due to local biomass burning activities. The contribution of secondary OC to total OC varied approximately between 8.4% and 32.2% and depended on air mass type.

DNA capturing machinery through spore-displayed proteins

AIMS

The purpose of this study was to develop a general method for the facile development of a new DNA biosensor which utilizes streptavidin-displayed spores as a molecular machinery.

METHODS AND RESULTS

Fluorescence spectroscopy was used as a monitoring tool for the streptavidin displayed on the surface of Bacillus thuringiensis spores and as a diagnosis method for DNA detection. As a proof-of-concept, four pathogenic bacteria including Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli and Klebsiella pneumonia were used for the detection of pathogenic species. In addition, a set of mutant variants of Wilson's disease were also used for the detection of single nucleotide polymorphism (SNP) in this system.

CONCLUSIONS

This strategy, utilizing streptavidin-displayed spores, is capable of capturing DNA targets for the detection of pathogenic bacteria and for mutation analysis in Wilson's disease.

SIGNIFICANCE AND IMPACT OF THE STUDY

This approach could be useful as a simple platform for developing sensitive spore-based biosensors for any desired DNA targets in diagnostic applications.

Successful endosaccular coiling after a balloon occlusion test of the caudal channel of a double origin of the posterior inferior cerebellar artery originating from the aneurysm neck

Therapeutic strategies for unruptured aneurysms in elective procedures must be carefully planned with respect to safety. We describe the case of a patient who presented with an unruptured aneurysm associated with a double origin of the posterior inferior cerebellar artery (DOPICA), a rare variant of aberrant origin. A three-dimensional rotational angiogram clearly showed that the aneurysm incorporated the origin of the DOPICA caudal channel, which was more dominant than the cranial one. The aneurysm was completely obliterated using detachable coils after a balloon occlusion test (BOT) of the caudal channel was conducted to confirm the tolerance of the patient following sudden interruption of the more prominent flow coming from the caudal channel of the DOPICA. This report affirms the need to suspect anomalies associated with a DOPICA that predispose to intracranial aneurysms and highlights the potential role of a BOT in pretreatment hemodynamic evaluations of unusual aneurysms accompanying a particular developmental anomaly.

Alpha-lipoic acid inhibits endoplasmic reticulum stress-induced cell death through PI3K/Akt signaling pathway in FRTL5 thyroid cells

Alpha-lipoic acid (ALA) has been shown to modulate cell death via PI3K/Akt signal pathway in various cells. In the present study, the effects of ALA on cell death and PI3K/Akt signal pathway linked to cell death-related proteins during endoplasmic reticulum (ER) stress in FRTL5 thyroid cells were evaluated. In FRTL5 thyroid cells, cell viability increased by ALA pretreatment in tunicamycin (TN)-treated cells. When TN was treated, CCAAT/enhancer-binding protein-homologous protein (CHOP) and Bax protein levels were elevated while Bcl-2 protein levels were reduced. ALA diminished CHOP and Bax protein levels, and augmented Bcl-2 protein levels in TN-treated cells. After exposure to TN, phospho-Akt protein levels were repressed whereas total Akt protein levels were not changed. ALA increased phospho-Akt protein levels but not total Akt protein levels in both non-TN-treated and TN-treated cells. After LY294002 administration in non-TN-treated cells, cell viability was reduced, and CHOP and Bax protein levels were elevated, and Bcl-2 protein levels were reduced. The CHOP, Bcl-2 and Bax protein levels were not different after LY294002 administration in TN-treated cells. LY294002 and wortmannin decreased cell viability, and increased CHOP and Bax protein levels, and decreased Bcl-2 protein levels in ALA-pretreated and TN-treated cells. In conclusion, these results suggest that ER stress may induce cell death by modulating PI3K/Akt signal pathway linked to cell death-related proteins in FRTL5 thyroid cells. Moreover, these findings imply that ALA may ameliorate ER stress-induced cell death by activating PI3K/Akt signal pathway and attenuating changes of cell death-related proteins in FRTL5 thyroid cells.

Effects of all-trans retinoic acid on sodium/iodide symporter and CCAAT/enhancer-binding protein-homologous protein under condition of endoplasmic reticulum stress in FRTL5 thyroid cells

In thyroid cells, the effects of all- TRANS retinoic acid (ATRA) on sodium/iodide symporter (NIS) and CCAAT/enhancer-binding protein-homologous protein (CHOP) under condition of endoplasmic reticulum (ER) stress have not been evaluated. In the present study, the relationships between NIS, CHOP, and p38 MAPK, and the effects of ATRA on NIS and CHOP expression as well as on p38 MAPK activation under condition of ER stress in thyroid cells were investigated. In FRTL5 thyroid cells, NIS mRNA and protein levels decreased following tunicamycin (TN) treatment, while CHOP mRNA and protein levels increased. In addition, while CHOP mRNA levels decreased after administration of tauro-UDCA and siCHOP, NIS mRNA levels were not altered. After pretreatment with SB203580, NIS mRNA levels decreased in non-TN-treated cells but increased in TN-treated cells. In contrast, CHOP mRNA levels decreased in both non-TN-treated and TN-treated cells. Exposure to ATRA decreased NIS mRNA levels in non-TN-treated cells but increased NIS mRNA levels in TN-treated cells. ATRA decreased CHOP mRNA levels in both non-TN-treated and TN-treated cells although the response was significant only in TN-treated cells. Phospho-p38 MAPK protein levels but not total p38 MAPK protein levels increased in TN-treated cells. ATRA attenuated this increase in phopho-p38 MAPK protein levels. In conclusion, our results demonstrate that ER stress may induce reciprocal changes in NIS and CHOP expression via p38 MAPK in FRTL5 thyroid cells, and that ATRA may attenuate ER stress-induced alterations in NIS and CHOP expression by modulating the phosphorylation of p38 MAPK in FRTL5 thyroid cells.

Topical niacin cream-assisted 595-nm pulsed-dye laser treatment for facial flushing: retrospective analysis of 25 Korean patients

BACKGROUND

Flushing is defined clinically as a transient reddening of the face and other areas. Due to the transient nature of flushing, a patient may not show signs of flushing during laser treatment.

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of 595-nm pulsed-dye laser treatment of flushing or erythema after provocation of flushing by topical niacin cream.

METHODS

We retrospectively reviewed a total of 25 Korean patients with facial flushing who were treated with three sessions of 595-nm pulsed-dye laser after the application of topical niacin cream.

RESULTS

Follow-up results revealed that 12 of the 25 patients demonstrated marked (51-75%) clinical improvement of baseline facial erythema. Eight patients had moderate (26-50%) improvement and three demonstrated near total (≥ 75%) improvement. Two patients showed minimal to no (0-25%) improvement. We observed that the reactivity to topical niacin cream was markedly reduced in 64% of our patients after 595-nm pulsed-dye laser treatments. Minimal post-therapy facial oedema was noted in most of the patients, which usually resolved spontaneously within 2 days. Pronounced facial swelling was observed in four patients.

CONCLUSION

We suggest that 595-nm pulsed-dye laser treatment after provocation of flushing by topical niacin cream may provide a new treatment algorithm for facial flushing in Asians.

Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer: comparison with T2 weighted and PET/CT imaging

OBJECTIVES

To evaluate the added value of diffusion-weighted imaging (DWI) in combination with T(2) weighted imaging (T2WI) compared with T2WI alone or positron emission tomography (PET)/CT for detecting viable tumour after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced rectal cancer.

METHODS

50 consecutive patients with locally advanced rectal cancer (≥T3 or lymph node positive) who underwent neoadjuvant CRT and subsequent surgery were enrolled in this retrospective study. All patients underwent 3.0 T rectal MRI and PET/CT after completing CRT. For qualitative analysis, two radiologists independently reviewed T2WI alone and DWI with T2WI over a 1-month interval. One nuclear medicine physician reviewed PET/CT images using a five-point scale. Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting viable tumour were assessed. For quantitative analysis, the apparent diffusion coefficients (ADCs) of the lesions were measured and compared between the viable tumour group and non-viable tumour groups.

RESULTS

For detecting viable tumours, DWI with T2WI improved diagnostic accuracies (Reviewer 1 detected 90%; Reviewer 2, 86%) over T2WI alone (Reviewer 1 detected 76%, p=0.5; Reviewer 2, 64%, p=0.013) or PET/CT (48%, p<0.001). The sensitivity of DWI with T2WI (Reviewer 1 detected 98%; Reviewer 2, 91%) was significantly higher than those of T2WI alone (Reviewer 1 detected 77%; Reviewer 2, 64%) or PET-CT (43%, p<0.05). Only for Reviewer 2 was the NPV of DWI with T2WI (43%) significantly different from that of PET/CT (17%, p<0.05). The specificities and PPVs of DWI with T2WI were not improved over those of T2WI alone or of PET/CT (both p>0.05). The mean ADC of the viable tumour group (0.93 × 10(-3) mm(2) sc(-1)) was significantly lower than that of the non-viable tumour group (1.55 × 10(-3) mm(2) sc(-1), p<0.0001).

CONCLUSION

Adding DWI to T2WI is helpful for detecting viable tumours after neoadjuvant CRT compared with T2WI alone or PET/CT in patients with locally advanced rectal cancer.

Enhancing effect of pretreatment with topical niacin in the treatment of rosacea-associated erythema by 585-nm pulsed dye laser in Koreans: a randomized, prospective, split-face trial

BACKGROUND

Rosacea is a chronic dermatosis that is usually confined to the face. A pulsed dye laser (PDL) system has been proven to be effective in treating rosacea-associated erythema and telangiectasias. Niacin is a cutaneous vasodilator that can increase the chromophore through increased blood flow.

OBJECTIVES

We hypothesized that increased blood flow by pretreatment with topical niacin could enhance the effect of PDL in the treatment of rosacea.

METHODS

Eighteen Korean patients with rosacea were recruited. Three sessions of 585-nm PDL using a subpurpuragenic dose with and without pretreatment with niacin cream were performed on randomly assigned half-faces at 3-week intervals. Erythema was assessed objectively by a polarization colour imaging system, and evaluations were also made by three blinded dermatologists. Patient satisfaction was evaluated using a 10-point visual analogue scale.

RESULTS

Fifteen patients completed this study. All patients showed an improvement in erythema after three sessions of PDL treatment both with and without niacin pretreatment (P = 0·023 and P = 0·009, respectively). There was no significant difference in the improvement of objective erythema between the two sides. However, based on physician assessment the overall clinical improvement on the niacin side was significantly higher (P = 0·005), and patient satisfaction was also higher on the niacin-pretreated side (P = 0·007). There were no remarkable side-effects, with the exception of transient erythema and oedema.

CONCLUSIONS

Pretreatment with topical niacin safely enhanced the effect of 585-nm PDL treatment of rosacea-associated erythema in Koreans. Application of niacin can be helpful in overcoming the relatively lower effect of subpurpuragenic PDL in dark-skinned Asians.

Optically based-indentation technique for acute rat brain tissue slices and thin biomaterials

Currently, micro-indentation testing of soft biological materials is limited in its capability to test over long time scales due to accumulated instrumental drift errors. As a result, there is a paucity of measures for mechanical properties such as the equilibrium modulus. In this study, indentation combined with optical coherence tomography (OCT) was used for mechanical testing of thin tissue slices. OCT was used to measure the surface deformation profiles after placing spherical beads onto submerged test samples. Agarose-based hydrogels at low-concentrations (w/v, 0.3-0.6%) and acute rat brain tissue slices were tested using this technique over a 30-min time window. To establish that tissue slices maintained cell viability, allowable testing times were determined by measuring neuronal death or degeneration as a function of incubation time with Fluor-Jade C (FJC) staining. Since large deformations at equilibrium were measured, displacements of surface beads were compared with finite element elastic contact simulations to predict the equilibrium modulus, μ(∞) . Values of μ(∞) for the low-concentration hydrogels ranged from 0.07 to 1.8 kPa, and μ(∞) for acute rat brain tissue slices was 0.13 ± 0.04 kPa for the cortex and 0.09 ± 0.015 kPa for the hippocampus (for Poisson ratio = 0.35). This indentation technique offers a localized, real-time, and high resolution method for long-time scale mechanical testing of very soft materials. This test method may also be adapted for viscoelasticity, for testing of different tissues and biomaterials, and for analyzing changes in internal structures with loading.

Borderline mucinous tumor arising in a paratubal cyst: a case report

BACKGROUND

Paratubal borderline tumors (PBTs) are found incidentally at frozen section or permanant pathology, and are extremely rare. We describe the first case of a paratubal borderline mucinous tumor (PBMT).

CASE REPORT

A 20-year-old woman was referred with a complex right adnexal mass on pelvic sonogram. She underwent laparoscopic paratubal cyst enucleation. We used an endobag for cyst extraction. Cyst rupture or tearing of the endobag in the laparoscopic field was absent. Frozen section analysis was reported as a borderline mucinous tumor of low malignant potential. Currently, she has had no evidence of disease recurrence after a laparoscopic fertility-sparing staging procedure.

CONCLUSION

A proper preoperative differential diagnosis of an adnexal mass is difficult. Thus, laparoscopy is needed in large or symptomatic cysts. Although growth, torsion and malignancy are rare in paratubal cysts, the possibility of tumor seeding should be excluded with use of an endobag.

Aggressive angiomyxoma of the vulva treated by using a gonadotropin-releasing hormone agonist: a case report

A rare case of a 38-year-old woman with progesterone receptor-positive aggressive angiomyxoma is presented. She underwent local excision and was treated with a gonadotropin-releasing hormone agonist as adjuvant therapy, and is free of disease 20 months after.

Clinicopathologic analysis of extramammary Paget's disease

PURPOSE

To retrospectively analyze the clinicopathologic characteristics of patients with extramammary Paget's disease who were surgically treated in a single institution.

METHOD

The charts of 14 patients with extramammary Paget's disease were retrospectively reviewed, and the clinicopathologic data were collected and analyzed.

RESULTS

From January 1990 to July 2009, 14 patients were treated at our institution. Most patients (11/14 patients) had delayed diagnosis. Two patients (14.3%) had associated malignant neoplasms. Eight of 14 patients (57.1%) had positive surgical margins; of these patients, five patients had no evidence of recurrence. In the six patients with negative surgical margins, two patients (33.3%) developed recurrence.

CONCLUSIONS

The diagnosis of extramammary Paget's disease is commonly delayed. Because of the possible association with other malignancies before or after the diagnosis of extramammary Paget's disease, thorough examinations are recommended. Disease recurrence is common regardless of the surgical margin status, so long-term monitoring of patients is recommended.

Abstract P3-10-27: Caspase Variant as Prognostic Marker in Patients with Early Breast Cancer

Background: Since apoptosis induced by caspases may play a role in the prognosis of breast cancer, the present study analyzed the polymorphisms of caspase genes and their impact on the survival of 240 patients with early invasive ductal breast cancer.

Material and Methods: The genomic DNA was extracted from paraffin-embedded tumor-free tissue or blood, and 8 single nucleotide polymorphisms (SNPs) of 5 apoptosis-related genes in the apoptosis pathway determined using a Sequenom MassARRAY system. Results: During the median follow-up of 68.6 (range, 36.3-173.1) months, 43 relapses and 25 deaths occurred. Among the target polymorphisms, the caspase 9 gene polymorphism (CASP9 rs4645978) in a dominant model of the A allele was associated with survival in a log-rank test (P &lt; 0.05). In a multivariate analysis, the GA+AA genotype of CASP9 rs4645978 was significantly correlated with a better disease-free survival (HR = 0.250; 95% CI = 0.075 - 0.840; P = 0.025), while marginally with distant disease-free or overall survival (HR = 0.360 and 0.337; P = 0.118 and 0.158, respectively). No clinicopathologic difference was observed according to the genotypes of this polymorphism. Discussion: The CASP9 rs4645978 was identified as a possible prognostic factor of survival in patients with operated invasive breast cancer.

Figures available in online version.

Survival rate of H5N1 highly pathogenic avian influenza viruses at different temperatures

The survival rate of Korean H5N1 highly pathogenic avian influenza (HPAI) viruses was investigated at different temperatures under the laboratory conditions. The estimated survival days for a starting viral concentration of 10(6.5) 50% egg infectious dose/0.1 mL were 930, 1,042, and 3,213 d at 4 degrees C; 226, 232, and 293 d at 20 degrees C; and 51, 55, and 58 d at 30 degrees C for A/chicken/Korea/ES/03, A/chicken/Korea/IS/06, and A/chicken/Korea/Gimje/08 (Gimje/08) viruses, respectively. The stability of the Gimje/08 virus was statistically significant compared with the other 2 viruses except for the data between Gimje/08 and A/chicken/Korea/IS/06 virus at 30 degrees C. This result indicated that the survival rate of 3 Korean HPAI viruses is different at various temperatures, which might have partially influenced the large scale of HPAI outbreak in Korea in 2008.

A novel method for air drying aloe leaf slices by covering with filter papers as a shrink-proof layer

To prevent the shrinkage of aloe vera slices during air drying, a method utilizing a shrink-proof layer was developed. The sample was configured of whole leaf aloe slices, where 1 side or both sides were covered with filter papers as shrink-proof layers. After air drying by varying the air temperature and the slice thickness, the drying characteristics, as well as several quality factors of the dried aloe vera leaf slices, were analyzed. In the simulation of the drying curves, the modified Page model showed the best fitness, representing a diffusion-controlled drying mechanism. Nonetheless, there was a trace of a constant-rate drying period in the samples dried by the method. Shrinkage was greatly reduced, and the rehydration ratios increased by approximately 50%. Scanning electron microscopic analysis revealed that the surface structure of original fibrous form was well sustained. FT-IR characteristics showed that the dried samples could sustain aloe polysaccharide acetylation. Furthermore, the functional properties of the dried slices including water holding capacity, swelling, and fat absorption capability were improved, and polysaccharide retention levels increased by 20% to 30%. Therefore, we concluded that application of shrink-proof layers on aloe slices provides a novel way to overcome the shrinkage problems commonly found in air drying, thereby improving their functional properties with less cost. Practical Application: This research article demonstrates a novel air drying method using shrink-proof layers to prevent the shrinkage of aloe slices. We analyzed extensively the characteristics of shrinkage mechanism and physical properties of aloe flesh gels in this drying system. We concluded that this method can be a beneficial means to retain the functional properties of dried aloe, and a potential alternative to freeze drying, which is still costly.

Health care utilization in patients with gout

OBJECTIVE

To study health care utilization patterns in patients with gout.

METHODS

In a gout population from primary care and rheumatology clinics in 3 U.S. metropolitan cities, we collected data on gout-related utilization (primary care, rheumatology, urgent care, emergency room, and other) in the past year. We evaluated the association of comorbidities, age, gender, gout characteristics (time since last gout attack and tophi), and gout severity ratings (mean of serum uric acid, patient-rated, and physician-rated gout severity) and with emergency/urgent care and primary care utilization using regression and correlation analyses.

RESULTS

Of the 296 patients who reported visiting at least 1 type of health practitioner for gout in the past year, the percentage of patients utilizing the service at least once and annual utilization rates among utilizers were as follows: primary care physician, 60%, 3.0 ± 3.4; nurse practitioner/physician assistant, 26%, 2.7 ± 2.5; rheumatologist, 51%, 3.7 ± 5.7; urgent care, 23%, 2.1 ± 2.2; emergency room, 20%, 2.0 ± 1.7; and hospitalization, 7%, 2.1 ± 1.4. Higher overall gout severity was associated with greater use of each resource type and with overall gout-related utilization. Nonemergency/nonurgent care utilization (primary care physician, nurse practitioner, physician's assistant, and rheumatologist for gout) was the strongest predictor of gout-related emergency/urgent care utilization. Patients with more comorbidities had greater gout-related primary care utilization.

CONCLUSIONS

Overall gout severity was associated with all types of gout-related utilization. This may help to screen high utilizers for targeted behavioral and therapeutic interventions. Having a higher number of comorbid conditions was a risk factor for higher gout-related primary care utilization.

Wear performance of self-mating contact pairs of TiN and TiAlN coatings on orthopedic grade Ti-6Al-4V

Both titanium nitride (TiN) and titanium aluminum nitride (TiAlN) have shown great wear resistance potential in metallic medical devices as protective, hard thin film coatings. In the present study, the effects of TiN and TiAlN coating layers on the wear performance of Ti-6Al-4V were compared and analyzed. TiN and TiAlN coatings with a thickness of 3 microm were deposited by a cathodic vacuum arc ion plating technique on the surface of Ti-6Al-4V. Wear tests were conducted by using a pin-on-disk-type tribotester with a point contact self-mating pair in a linear reciprocal motion. A sliding distance of 20 mm per cycle at 1 Hz was used under a load of 15 N under ambient conditions with no lubricant. The wear resistance of TiN and TiAlN coatings is superior to that of uncoated Ti-6Al-4V at the early stage of sliding contact. Until a measurable amount of wear was detected, the number of sliding cycles of the TiAlN coating pair was longer than TiN. After the first detection of wear from the coating layers, the rate of wear of the TiN coating pairs was significantly higher than that of TiAlN (p < 0.05), and it was close to that of the uncoated pairs. In conclusion, the TiAlN coating is superior to TiN from the viewpoint of wear resistance under the test conditions used in this study.

Optimizing the culture of Plasmodium falciparum in hollow fiber bioreactors

The hollow fiber bioreactor (HFBR) is a cell culturing system allowing continuous perfusion of medium. It was designed to grow microorganisms in a dynamically altering medium mimicking change in the in vivo intravascular and extravascular compartments. The cell compartment (extra capillary space) and medium compartment (intra capillary space) are connected through pores of semipermeable fiber membranes. These membranes allow exchange of gas and nutrients. We have adapted this system for the ex vivo culture of Plasmodiumfalciparum at high parasite densities. A Thai P. falciparum isolate (TM036) cultured in RPMI, supplemented with 0.5% Albumax II, could be maintained continuously in the system by daily changes of a small volumes of medium. Under optimized conditions the HFBR cultures attained 8% parasitemia in 40% hematocrit, thereby providing a total parasite biomass of 6.0 x 10(9) parasitized erythrocytes. The main problem encountered was clogging of micropores in the hollow fiber system by cellular debris over time. Although 'reverse flushing' partly prevented this, a larger pore size might be needed to overcome this problem. The system opens new possibilities for the study of in vitro drug sensitivity under conditions mimicking in vivo pharmacokinetics, and the selection of anti-malarial drug resistance and associated parasite biological and genomic changes.

The influence of interfacial roughness on the coherence of structure and magnetic coupling across barriers in Fe/MgO multilayers

Single-crystal Fe/MgO multilayers are model systems in which to study magnetic tunnel junctions. We find that the interfacial roughness leads to the loss of coherence of the crystal structure. For thick MgO layers ferromagnetic (FM) ordering is found using polarized neutron reflectivity (PNR). For thin MgO layers magnetization measurements reveal the presence of antiferromagnetic (AF) interactions, but no long-range AF order is found using PNR. After cycling in a hysteresis loop, FM correlations are found at the coercive point, and this will limit the maximum tunnelling magnetoresistance.

Beneficial effect of dietary epigallocatechin-3-gallate on skin via enhancement of antioxidant capacity in both blood and skin

BACKGROUND/AIMS

Dietary antioxidants exert a photoprotective effect against UV radiation. However, the mechanism underlying the beneficial effects on skin of orally administered antioxidant is not very clear. The present study aimed to investigate the UVB-induced total antioxidant capacity (TAC) perturbation both in skin and blood and to study the beneficial mechanism of action of dietary epigallocatechin-3-gallate (EGCG).

METHOD

Female HWY/Slc hairless rats were exposed to UVB radiation for 4 weeks and skin and blood TAC were measured at weeks 0, 2, and 4. The correlation between skin and blood TAC was assessed using Pearson's correlation analysis. To investigate the effect of dietary EGCG, female HWY/Slc hairless rats were fed EGCG and exposed to UVB radiation. At the end of the 8-week experimental period, transepidermal water loss (TEWL) and epidermal thickness were measured to assess skin damage, and TAC was analyzed in both skin and blood.

RESULTS

UVB radiation significantly decreased skin and blood TAC, and there was a significant correlation between skin and blood TAC. Dietary EGCG significantly prevented UVB-induced adverse effects on epidermal thickness and TEWL, and the UVB-induced decrease in TAC recovered in both skin and blood.

CONCLUSION

These results demonstrate that there is a close relationship between skin and blood TAC and the beneficial effect of oral antioxidants on skin may possibly be mediated through significant enhancement of blood TAC.