Development of machine learning models for the surveillance of colon surgical site infections

BACKGROUND

Conventional surgical site infection (SSI) surveillance is labour-intensive. We aimed to develop machine learning (ML) models for the surveillance of SSIs for colon surgery and to assess whether the ML could improve surveillance process efficiency.

METHODS

This study included cases who underwent colon surgery at a tertiary center between 2013 and 2014. Logistic regression and four ML algorithms including random forest (RF), gradient boosting (GB), and neural networks (NNs) with or without recursive feature elimination (RFE) were first trained on the entire cohort, and then re-trained on cases selected based on a previous rule-based algorithm. We assessed model performance based on the area under the curve (AUC), sensitivity, and positive predictive value (PPV). The estimated proportion of reduction in workload for chart review based on the ML models was evaluated and compared with the conventional method.

RESULTS

At a sensitivity of 95%, the NN with RFE using 29 variables had the best performance with an AUC of 0.963 and PPV of 21.1%. When combining both the rule-based algorithm and ML algorithms, the NN with RFE using 19 variables had a higher PPV (28.9%) than with the ML algorithm alone, which could decrease the number of cases requiring chart review by 83.9% compared with the conventional method.

CONCLUSION

We demonstrated that ML can improve the efficiency of SSI surveillance for colon surgery by decreasing the burden of chart review while providing high sensitivity. In particular, the hybrid approach of ML with a rule-based algorithm showed the best performance in terms of PPV.

Erratum: Application of Three Dimensional Printed Models in Congenital Heart Surgery: Surgeon's Perspective

[This corrects the article on p. 310 in vol. 81.].

Application of Three-Dimensional Printed Models in Congenital Heart Surgery: Surgeon's Perspective

선천성 심장질환의 치료에 있어서 그 해부학적인 구조를 올바르게 이해하는 것은 아주 중요하다. 이러한 선천성 심장질환의 구조적인 특징을 이해하는데 있어서 삼차원 프린팅 모델을 이용하는 것은 아주 효과적이다. 기존에 얻어진 전산화단층촬영이나 자기공명영상 혹은 심장 초음파 검사의 자료만으로는 정확한 복잡심장기형의 특징을 이해하는 것이 어려운 경우가 있으며, 삼차원 프린팅 모델의 사용이 이러한 제한점 들을 극복하는데 도움을 줄 수 있다. 최근 들어서는 삼차원 프린팅 모델을 이용해 선천성 심장질환의 교육과 수술 전 시뮬레이션 그리고 치료의 방침을 결정하는데 많은 도움을 받고 있으며, 실제 구체적인 환아들의 예를 통해서 이를 살펴보고자 한다. 또한 향후 그 기술의 발전 방향에 대해 알아보고, 심장외과 의사의 관점에서 수술 수기의 발전이나 훈련 등 여러 방면의 이용에 대해서도 살펴보고자 한다.

An immunohistochemical study of matrix proteins in the craniofacial cartilage in midterm human fetuses

Immunohistochemical localization of collagen types I, II, and X, aggrecan, versican, dentin matrix protein (DMP)-1, martix extracellular phosphoprotein (MEPE) were performed for Meckel's cartilage, cranial base cartilage, and mandibular condylar cartilage in human midterm fetuses; staining patterns within the condylar cartilage were compared to those within other cartilaginous structures. Mandibular condylar cartilage contained aggrecan; it also had more type I collagen and a thicker hypertrophic cell layer than the other two types of cartilage; these three characteristics are similar to those of the secondary cartilage of rodents. MEPE immunoreactivity was first evident in the cartilage matrix of all types of cartilage in the human fetuses and in Meckel's cartilage of mice and rats. MEPE immunoreactivity was enhanced in the deep layer of the hypertrophic cell layer and in the cartilaginous core of the bone trabeculae in the primary spongiosa. These results indicated that MEPE is a component of cartilage matrix and may be involved in cartilage mineralization. DMP-1 immunoreactivity first became evident in human bone lacunae walls and canaliculi; this pattern of expression was comparable to the pattern seen in rodents. In addition, chondroid bone was evident in the mandibular (glenoid) fossa of the temporal bone, and it had aggrecan, collagen types I and X, MEPE, and DMP-1 immunoreactivity; these findings indicated that chondroid bone in this region has phenotypic expression indicative of both hypertrophic chondrocytes and osteocytes.

Reappraisal of the ligament of Henle (ligamentum inguinale internum mediale; Henle, 1871): a topohistological study using Korean foetuses

Ligament of Henle is one of muscle-associated connective tissues of the rectus abdominis muscle, but it has been confused with the conjoint tendon (a common aponeurosis for insertion of the inferomedial end of the obliquus internus and transversus abdominis muscles). To reconsider the inguinal connective tissue structures, we examined 20 mid-term foetuses (10 males and 10 females) at approximately 14-20 weeks of gestation (crown rump length 100-170 mm). In female horizontal sections, we consistently found the ligament of Henle asa wing-like aponeurosis extending from the lateral margin of the rectus tendon behind the superficial inguinal ring. The ligament was separated from and located behind the conjoint tendon. In all male foetuses, instead of the ligament, the conjoint tendon was evident behind the superficial ring and it winded around the posterior aspect of the spermatic cord. Therefore, although a limited number of specimens were examined, the ligament of Henle was likely to be a female-specific structure. The ligament of Henle, if developed well, may provide an arch-like structure suitable for a name "falx inguinalis" instead of the inferomedial end ofthe conjoint tendon. In addition, a covering fascia of the iliopsoas muscle joined the posterior wall of the inguinal canal in male, but not in female, specimens.

A Retrospective Clinical Study of Cervical Restorations: Longevity and Failure-Prognostic Variables

The aim of this retrospective clinical study was to compare the longevity of cervical restorations between resin composite (RC) and glass ionomer (GI) and to investigate variables predictive of their outcome. The clinical performance of the two restorative materials in function was compared using the ratings of the modified United States Public Health Service (USPHS) criteria. A total of 479 cervical restorations were included in the study. Ninety-one already-replaced restorations were reviewed from dental records. The other 388 restorations still in function were evaluated according to the modified USPHS criteria by two investigators. Longevity and prognostic variables were analyzed with the Kaplan-Meier survival analysis and multivariate Cox proportional hazard model. The clinical performances of the two materials were evaluated according to the ratings of the USPHS criteria and compared using the Pearson chi-square test and Fisher exact test. The longevity was not significantly different between RC and GI (median survival time, 10.4 ± 0.7 and 11.5 ± 1.1 years, respectively). The main reasons for failure were loss of retention (82.2%) and secondary caries (17.8%). The longevity of cervical restoration was significantly influenced by tooth group and operator group (Wald test, p<0.05), while material, gender, presence or absence of systemic diseases, arch, and reason for treatment did not affect the longevity. Contrary to the longevity, the clinical performance of RC was superior to GI in the criteria of retention, marginal discoloration, and marginal adaptation, but similar in secondary caries, wear, and postoperative sensitivity.

Development of the deep flexor tendons and lumbricalis muscle in the hand and foot: a histological study using human mid-term foetuses

To revisit foetal development of the deep flexor tendons of the hand and foot, we examined the paraffin-embedded histology of 20 mid-term foetuses at 8-15 weeks of estimated gestational age (35-118 mm crown-rump length or CRL). At 8-9 weeks, in front of the metacarpal bones, the flexor pollicis longus and flexor digitorum profundus (FDP) muscles provided a plate-like, common tendon from which the lumbricalis muscles originated. However, in the foot, we had no evidence of such a common tendon. The flexor pollicis tendon was separated from the common tendon at 9-10 weeks possibly due to mechanical stress from the laterally growing thumb. Notably, at the lumbricalis muscle origins at 10-12 weeks, the FDP and flexor digitorum longus tendons remained undifferentiated and the primitive tenocytes were dispersed from them. The dispersed cells seemed to develop into an interface tissue between the lumbricalis muscle fibre and the deep tendon. In 3 of 5 specimens at 15 weeks, we found an excess number of the FDP tendons (5-7) in the proximal side of the lumbricalis muscle origin. However, the excess tendons dispersed in the lumbricalis muscle origin. The development of the lumbricalis muscle origin might follow the tendon splitting for four fingers. However, conversely, we hypothesised that the developing lumbricalis muscles re-arranged the deep flexor tendons to provide a configuration of one deep tendon per one finger (or toe). The quadrates plantae muscle seemed not to contribute on the re-arrangement.

The assessment of impacted maxillary canine position with panoramic radiography and cone beam CT

OBJECTIVE

The aim of this study was to correlate the position of impacted maxillary canines on panoramic radiography with cone beam CT (CBCT) and analyse the labiopalatal position of canines and root resorption of permanent incisors in CBCT according to the mesiodistal position of canines on panoramic radiographs.

METHODS

This study was a retrospective radiographic review of 63 patients with 73 impacted maxillary canines. The mesiodistal position of the canine cusp tip was classified by sector location and analysed on 73 impacted canines from 63 panoramic radiographs. The labiopalatal position of the impacted canines and root resorption of permanent incisors were evaluated with CBCT. The sector location on panoramic radiographs was compared with the labiopalatal position of impacted maxillary canines on CBCT. The statistical correlation between panoramic and CBCT findings was examined using the χ(2) test and the Fisher's exact test.

RESULTS

Labially impacted canines in CBCT were more frequent in Panoramic Sectors 1, 2 and 3, mid-alveolus impacted canines were more frequent in Sector 4 and palatally impacted canines were more frequent in Sector 5. There was a statistically significant association between the panoramic sectors of the impacted canines and the labiopalatal position of the canines (p < 0.001). Root resorption of permanent incisors showed a significant difference according to sector location (p < 0.001) and was observed in Sectors 3, 4 and 5.

CONCLUSIONS

This study suggests that the labiopalatal position of impacted canines and resorption of permanent incisors might be predicted using sector location on panoramic radiography.

Clinical outcomes of multicenter domino kidney paired donation

Domino kidney paired donation (KPD) is a method by which an altruistic living nondirected donor (LND) is allocated to a pool of incompatible donor-recipient pairs (DRP) and a series of KPDs is initiated. To evaluate the feasibility and clinical outcomes of multicenter domino KPD, we retrospectively analyzed a cohort of DRPs who underwent domino KPD between February 2001 and July 2007 at one of 16 transplant centers. One hundred seventy-nine kidney transplants were performed, with 70 domino chains initiated by altruistic LND. There were 45 two-pair chains, 15 three-pair chains, 7 four-pair chains, 2 five-pair chains and 1 six-pair chain. A majority of donors were spouses (47.5%) or altruistic LNDs (39.1%). DRPs with a blood type O recipient or an AB donor comprised 45.9% of transplanted DRPs. HLA mismatch improved in transplanted donors compared to intended donors in pairs enrolled to improve HLA mismatch (3.4 +/- 0.7 vs. 4.8 +/- 1.0, p < 0.001). One-year and 5-year graft survival rates were 98.3% and 87.7%, respectively, with a median follow-up of 46 months. One-year and 5-year patient survival rates were 97.2% and 90.8%, respectively. In conclusion, multicenter domino KPD could multiply the benefits of donation from LNDs, with patients and graft survival rates comparable to those seen with conventional KPD.

Glutamine preferentially inhibits T-helper type 2 cell-mediated airway inflammation and late airway hyperresponsiveness through the inhibition of cytosolic phospholipase A(2) activity in a murine asthma model

BACKGROUND

The non-essential amino acid, l-glutamine (Gln), is abundant in the human body. Gln exhibits beneficial effects on endotoxic shock through the inhibition of cytosolic phospholipase A(2) (cPLA(2)) activity. cPLA(2) has been reported to be implicated in the pathogenesis of asthma, but the effects of Gln on asthma have not yet been defined.

OBJECTIVE

To investigate the effects of Gln on allergic bronchial inflammation and airway hyperresponsiveness (AHR), and to determine the possible action mechanisms of Gln in a murine model of asthma.

METHODS

cPLA(2) phosphorylation was assessed by immunoprecipitation and Western blotting. Smears of bronchoalveolar lavage cells were stained with Diff-Quik solution for differential cell counting. Airway levels of the proteins [T-helper type-1 (Th1) and Th2 cytokines, and mucin] were measured by ELISA. mRNA expression of cytokines was assessed by real-time RT-PCR. AHR was assessed as a change in airway resistance (RL). Histological studies were performed to assess the levels of mucin and pulmonary inflammation.

RESULTS

Systemic Gln administration inhibited cPLA(2) phosphorylation and its enzymatic activity in the lungs. Additionally, Gln effectively suppressed the key features of Th2-dependent asthmatic features, such as airway eosinophilia, mucus formation, and airway type 2 cytokine production, as well as late AHR.

CONCLUSION

Gln was found to be effective in the suppression of Th2-dependent phenotypes and late AHR, and this effect of Gln appeared to be at least partially attributable to its ability to suppress cLPA(2) activity in the airway. Our results suggest that clinical use of Gln for patients with asthma may be beneficial.

Dental Restorative Composites Fabricated from a Novel Organic Matrix without an Additional Diluent

Commercial organic matrixes of dental composites generally include diluents such as triethylene glycol dimethacrylate (TEGDMA) to reduce viscosity. However, the diluent exhibits adverse effects such as curing shrinkage and diminished mechanical properties of the dental composites. To overcome these adverse effects, organic monomers that can be used as an organic matrix may be developed. In this study, various novel organic monomers were developed by substituting alkoxy for hydroxyl groups in 2,2-bis[4-(2-hydroxy-3-methacryloyloxy propoxy)phenyl]propane (bis-GMA). Viscosities of the alkoxy-substituted monomers were decreased by increasing substituent size. The viscosity of 2,2-bis[4-(2-ethoxy-3-methacryloyloxy propoxy)phenyl]propane (bis-E-GMA) was higher than the control organic matrix (70 wt % bis-GMA and 30 wt % TEGDMA). However, those of 2,2-bis[4-(2-propoxy-3-methacryloyloxy propoxy)phenyl]propane (bis-Pr-GMA), 2,2-bis[4-(2-butoxy-3-methacryloyloxy propoxy)phenyl]propane (bis-B-GMA), and 2,2-bis[4-(2-pentoxy-3-methacryloyloxy propoxy)phenyl]propane (bis-P-GMA) were lower than the control organic matrix. To this end, these monomers could be used as organic matrixes of dental composites without an additional diluent. Among these monomers, bis-B-GMA exhibited the lowest curing shrinkage. In comparison to the control organic matrix, the curing shrinkage of the bis-B-GMA dental composite was approximately 40%. Additionally, dental composites prepared from bis-B-GMA exhibited excellent mechanical properties.

Mutation in the edd gene encoding the 6-phosphogluconate dehydratase of Pseudomonas chlororaphis O6 impairs root colonization and is correlated with reduced induction of systemic resistance

AIMS

The primary objective of this study was to determine the role of 6-phosphogluconate dehydratase in root colonization and the induction of systemic resistance by the rhizobacterium, Pseudomonas chlororaphis O6.

METHODS AND RESULTS

The edd gene encoding for 6-phosphogluconate dehydratase, which is one of the key enzymes in glucose utilization, was cloned. Transcription of the gene was higher in medium containing sugars than with organic acids. An edd mutant failed to grow on glucose but grew on organic acids. The edd mutant colonized tobacco roots at wild-type levels early after inoculation, but levels were lower by 12 days. The edd mutant failed to induce the systemic resistance in tobacco to a soft-rot pathogen at wild-type level.

CONCLUSIONS

6-Phosphogluconate dehydratase in P. chlororaphis O6 contributes to root colonization and induction of systemic resistance presumably as the consequence of its essential role in the Entner-Doudoroff (ED) pathway.

SIGNIFICANCE AND IMPACT OF THE STUDY

Metabolism of sugars through the ED pathway in P. chlororaphis O6 may be important because it facilitates the production of inducers of systemic resistance including butanediol.

Transcript accumulation from the rpoS gene encoding a stationary-phase sigma factor in Pseudomonas chlororaphis strain O6 is regulated by the polyphosphate kinase gene

Polyphosphate levels are modulated by the actions of polyphosphate kinase, encoded by ppk, and exopolyphosphatase, encoded by ppx. The genes ppk and ppx are adjacent to each other in the genome of the root colonizer, Pseudomonas chlororaphis O6. A ppk-deficient mutant was more sensitive to oxidative stress than the wild-type and the ppx mutant. Transcripts from ppx increased as cultures matured from mid- to late-logarithmic and stationary phases, whereas abundance was greater for ppk in the late-logarithmic phase than in the stationary phase. Transcript accumulation from the rpoS gene, encoding the stationary-phase sigma factor RpoS, was decreased in the mid- and late-logarithmic and stationary phases in the ppk mutant. Thus, ppk regulates rpoS transcript accumulation in P. chlororaphis 06. However, mutations in either the ppk or ppx genes had no effect on induction of systemic resistance in plants colonized by P. chlororaphis O6.

Characteristics of Novel Dental Composites Containing 2,2-Bis[4-(2-methoxy-3-methacryloyloxy propoxy) phenyl] propane as a Base Resin

Many dental restorative dental composites still utilize 2,2-bis[4-(2-hydroxy-3-methacryloyloxy propoxy) phenyl] propane (Bis-GMA) as base resin. The high viscosity of Bis-GMA necessitates dilution with dimethacrylate ethers of low viscosity such as triethylene glycol dimethacrylate (TEGDMA). However, increased amounts of the TEGDMA have adverse effects on properties such as water uptake and curing shrinkage. The viscosity of the base resin should be as low as possible to enable the preparation of dental composites with a minimum content of diluent. To overcome the disadvantage of Bis-GMA, i.e., its high viscosity caused by hydrogen bonding between hydroxyl groups, 2,2-bis[4-(2-methoxy-3-methacryloyloxy propoxy) phenyl propane (Bis-M-GMA) was prepared by substituting methoxy groups for hydroxyl groups in Bis-GMA. The viscosity of Bis-GMA was dramatically decreased from 574 (Pa.s) to 3.7 (Pa.s) by substitution of methoxy group. Consequently, the amount of TEGDMA included in the resin matrix could be minimized. Dental composites were prepared from Bis-M-GMA (or Bis-GMA) mixtures with TEGDMA filled with 75 wt % filler. Comparing the curing shrinkage of dental composite containing Bis-M-GMA with that prepared from Bis-GMA, the reduction in curing shrinkage was about 47%. Dental composites prepared from new resin matrixes also exhibited low water uptake and better properties in mechanical strength.

Dental restorative composites containing 2,2-bis-[4-(2-hydroxy-3-methacryloyloxy propoxy) phenyl] propane derivatives and spiro orthocarbonates

Various dental restorative composite resins containing 2,2-bis-[4-(2-hydroxy-3-methacryloyloxy propoxy) phenyl] propane (Bis-GMA) derivatives and spiro orthocarbonates (SOCs) were explored for minimizing the volumetric shrinkage that generally occurs during polymerization. Previous reports suggested mixing Bis-GMA with its derivative TMBis-GMA (2,2-bis[3,5-dimethyl-4-(2-hydroxy-3-methacryloyloxy propoxy) phenyl] propane) to obtain a dental composite with low volumetric shrinkage. It was hypothesized that spiro orthocarbonates would expand volumetrically during polymerization, because of their sophisticated ring-opening reactions; therefore several of them were added to the mixture of Bis-GMA and TMBis-GMA to bring about further reductions in volumetric shrinkage. It was indeed possible to reduce the extent of volumetric shrinkage of dental composites containing SOCs, and to do so without compromising these resins' mechanical properties.

A new method to measure the polymerization shrinkage kinetics of light cured composites

This study was undertaken to develop a new measurement method to determine the initial dynamic volumetric shrinkage of composite resins during polymerization, and to investigate the effect of curing light intensity on the polymerization shrinkage kinetics. The instrument was basically an electromagnetic balance that was constructed with a force transducer using a position sensitive photo detector (PSPD) and a negative feedback servo amplifier. The volumetric change of composites during polymerization was detected continuously as a buoyancy change in distilled water by means of the Archimedes' principle. Using this new instrument, the dynamic patterns of the polymerization shrinkage of seven commercial composite resins were measured. The polymerization shrinkage of the composites was 1.92 approximately 4.05 volume %. The shrinkage of a packable composite was the lowest, and that of a flowable composite was the highest. The maximum rate of polymerization shrinkage increased with increasing light intensity but the peak shrinkage rate time decreased with increasing light intensity. A strong positive relationship was observed between the square root of the light intensity and the maximum shrinkage rate. The shrinkage rate per unit time, dVol%/dt, showed that the instrument can be a valuable research method for investigating the polymerization reaction kinetics. This new shrinkage-measuring instrument has some advantages that it was insensitive to temperature changes and could measure the dynamic volumetric shrinkage in real time without complicated processes. Therefore, it can be used to characterize the shrinkage kinetics in a wide range of commercial and experimental visible-light-cure materials in relation to their composition and chemistry.

Surgical Outcome of Endoscopic Carpal Tunnel Release in 100 Patients with Carpal Tunnel Syndrome

The purpose of this study is to present the surgical outcome of endoscopic carpal tunnel release (ECTR) for the treatment of carpal tunnel syndrome (CTS). One hundred and thirty-one procedures (36 right hands, 33 left hands and 31 bilateral hands) of single portal ECTR were performed upon 100 patients (age range: 36-77 years, mean age: 52.9 years; 98 women and 2 men) with electrodiagnostically proven CTS for 2.5 years from 2001. Preoperative clinical severity and results of electrodiagnostic studies were compared with surgical outcomes at the minimal 3-month postoperative period. Among 131 cases 125 (95.4 %) with complete or significant relief of symptoms were satisfied and 6 (4.6 %) with partial or no relief of symptoms were dissatisfied. There were 2 cases of major complications (one with ulnar nerve injury and the other with ulnar artery injury) that developed in our early experience of ECTR and 1 case of recurrence. The grade of electrodiagnostic abnormalities was associated with surgical outcome but there was no statistical significance between them. The severity of clinical findings, age at onset and symptom duration were not correlated with surgical outcome. In conclusion, ECTR surgery was effective in relieving the symptoms of CTS with a low complication rate after the learning curve period. Thus, ECTR can be an alternative to the traditional open surgery and can be the first procedure for CTS with several advantages over open methods.

Gene expression analysis in cucumber leaves primed by root colonization with Pseudomonas chlororaphis O6 upon challenge-inoculation with Corynespora cassiicola

Root colonization by Pseudomonas chlororaphis O6, a non-pathogenic rhizobacterium, induced systemic resistance in cucumber against target leaf spot caused by Corynespora cassiicola. A cDNA library was constructed using mRNA extracted from cucumber leaves 12 h after inoculation with C. cassiicola, using plants colonized by O6. To identify genes involved in O6-mediated induced systemic resistance (ISR), we employed a subtractive hybridization method using mRNAs extracted from pathogen-challenged cucumber leaves of plants lacking colonization. Differential screening of the cDNA library led to the isolation of six distinct genes encoding a GTP binding protein, a 60S ribosomal protein, a hypersensitive-induced reaction protein, a ubiquitin extension protein, a pyridine nucleotide-disulfide oxidoreductase, and a signal recognition particle receptor. Expression of these genes was not induced by O6 colonization alone. Rather, transcript accumulation of these genes increased significantly faster and stronger in the O6 colonized than in non-colonized plants after challenge infection. Therefore, O6-mediated ISR may be associated with an enhanced capacity for the rapid and effective activation of cellular defence responses after challenge inoculation.

A new resin matrix for dental composite having low volumetric shrinkage

The applications of dental restorative composite resins containing 2,2 bis [4-(2-hydroxy-3-methacryloyloxy propoxy) phenyl] propane (Bis-GMA), as a base resin, and triethylene glycol dimethacrylate (TEGDMA), as a diluent, are often limited in dentistry due to the relatively large amount of volumetric shrinkage that occurs during the curing reaction. In this study, various new resin matrices were examined for use as dental composites in order to reduce the amount of volumetric shrinkage that occurs in dental composites as a result of curing. Bis-GMA derivatives were synthesized by substituting methyl groups for hydrogen on the phenyl ring. The derivatives of TEGDMA with different chain lengths or reactive groups were also examined. The molecular structural changes in the TEGDMA derivatives were not effective in reducing the level of volumetric shrinkage. The resin matrix containing a Bis-GMA derivative and TEGDMA showed a reduced amount of volumetric shrinkage in proportion to the number of methyl groups on the phenyl rings. Polymerization with a mixture of Bis-GMA, its derivatives and a diluent is a promising strategy for obtaining a polymer with a low amount of volumetric shrinkage. A comparison of the volumetric shrinkage of dental composites containing Bis-GMA, TMBis-GMA (2,2-bis[3,5-dimethyl, 4-(2-hydroxy-3-methacryloyloxy propoxy) phenyl] propane)), and TEGDMA with that prepared from a Bis-GMA and TEGDMA mixture showed that the volumetric shrinkage reduction in the new resin was approximately 50%. Furthermore, the mechanical strength of the former was higher than that of the latter.

Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery

A new homodigital neurovascular island flap for fingertip reconstruction, called a volar digital island flap, is described. The flap is perfused from the proper digital artery through the transverse palmar branch, and is drained through the tiny venules and capillaries contained in the perivascular soft tissue. Between 1997 and 2000, 25 fingers from 23 patients with defects of the middle and distal phalangeal areas were reconstructed using this flap. All flaps survived well. Patient age ranged from 17 to 65 years (average age, 32.5 years). Long-term follow-up for more than 6 months was possible in 15 fingers from 14 patients. Light touch and temperature sensation could be detected in all the flaps evaluated. The mean value of the static two-point discrimination test was 4.2 mm. Although this flap requires the sacrifice of important volar skin, it provides excellent padding and sensation for fingertip reconstruction. The authors think that this new flap is an alternative choice for coverage of fingertip defects.

Lagophthalmos surgery in leprosy: findings from a population-based survey in Korea

Lagophthalmos continues to be a serious problem in cured leprosy patients. We conducted a population-based survey of lagophthalmos surgical coverage (LSC), barriers to lagophthalmos surgery and outcome of lagophthalmos surgery in leprosy patients in South Korea. In our survey, there were 60 patients with lagophthalmos who had needed surgery (> 5 mm gap), 34 of whom had received surgery, resulting in a lagophthalmos surgery coverage of 57%. Among the 34 patients who had received lagophthalmos surgery, 18 needed further surgery. Among those who had never had surgery, none of the demographic indicators predicted surgical uptake; the primary reason given for failure to have surgery was lack of knowledge about it. Outcome of surgery (by eye) showed that 29% of eyes still had a gap of 5 mm or more. The frequency of symptoms (tearing, blurring of vision, pain, etc.) was high. Even in settings with a good eye care infrastructure, such as Korea, uptake of surgery can still be low and results may not be satisfactory to patients. There is a need for practical guidelines for leprosy control programmes in the areas of (a) patient recognition, (b) patient education, (c) monitoring the uptake of surgery, and (d) monitoring the outcome of surgery to ensure the best possible outcome.

Expression profile of nine novel genes differentially expressed in hepatitis B virus-associated hepatocellular carcinomas

Chronic hepatitis B virus (HBV) infection is known to be one of the major causes in the development of hepatocellular carcinoma (HCC), although the biomolecular mechanism(s) involved remain unclear. To identify the cellular gene(s) involved in HBV-associated hepatocarcinogenesis, we used the mRNA differential display method and examined three paired tumor and nontumor tissues, all of which had chromosomally integrated HBV-DNA through chronic infection. Using 240 different combinations of three one-base anchored oligo-dT primers and 80 arbitrary 13-mers, genes decreased or increased in expression more than twofold between each tumor tissue and its paired nontumor tissue were identified. Twenty-nine known genes and four novel genes were differentially over-expressed in the HCC tumor tissues. In contrast, 27 known genes and five novel genes were under-expressed in those tumor tissues. The nucleotide sequences of the nine novel gene fragments were determined and their expression patterns were examined in 40 HCC samples. HA61T2, PT18, HG63T1, and HG57T1 were preferentially over-expressed in 32 cases (80%, P<0.001), 24 cases (60%), 23 cases (57.5%) and 22 cases (55%) of the 40 tumor tissues, respectively. There was an increased frequency of HG57T1 over-expression in HCC patients with HBV-positive serology and low serum alpha-feto protein (AFP) levels (P<0.05). DNT10, PT8, PT19, ENT25 and HA6T4 were under-expressed in 26 cases (65%), 23 cases (57.5%), 21 cases (53%), 20 cases (50%) and 18 cases (45%) of the 40 tumor samples, respectively. There was a strong correlation of DNT10 under-expression with high serum AFP level in HCC patients, irrespective of HBV serology (P<0.01). HA6T4 was preferentially under-expressed in HCC tumors in patients with HBV-positive serology and high serum AFP levels (P<0.05). Thus, the functional analyses of the known and novel genes identified in this study should prove valuable to further understand the mechanism(s) of hepatocarcinogenesis.

Cataract in leprosy patients: cataract surgical coverage, barriers to acceptance of surgery, and outcome of surgery in a population based survey in Korea

BACKGROUND/AIMS

Cataract is the leading cause of blindness in leprosy patients. There is no population based information on the cataract surgical coverage, barriers to use of surgical services, and outcome of surgery in these patients. We sought to determine these measures of cataract programme effectiveness in a cured leprosy population in South Korea.

METHODS

The population consisted of residents of six leprosy resettlement villages in central South Korea. All residents were invited to participate in a study of eye disease and interviewed regarding use of surgical services and reasons for not using these services.

RESULTS

The cataract surgical coverage in this population was 55.4% when <6/18 was used as the cut off and increased to 78.3% when the cut off was <6/60. Barriers reported by patients included being told by the doctor that the cataract was not mature and a perception by the patient that there was no need for surgery. Among patients who had aphakic surgery, 71% were still blind in the operative eye while among patients who had pseudophakic surgery, 14% were still blind (presenting vision). Blindness in pseudophakic patients could be reduced to 3% with spectacle correction.

CONCLUSION

Cataract prevalence in leprosy patients will increase as life expectancy continues to increase. Leprosy control programmes will need to develop activities aimed at reducing the burden of cataract. Recommendations include establishing collaborative agreements with ophthalmological services to provide high quality IOL surgery to these patients, training of health staff to identify and refer patients in need of surgery, monitoring the uptake of cataract surgery among patients needing services, and monitoring the outcome of surgery to improve refractive outcome.

The development of the virtual reality system for the treatment of the fears of public speaking

The fear of public speaking is a kind of social phobias. The patients having the fear of public speaking show some symptoms like shame and timidity in the daily personal relationship. They are afraid that the other person would be puzzled, feel insulted, and they also fear that they should be underestimated for their mistakes. For the treatment of the fear of public speaking, the cognitive-behavioral therapy has been generally used. The cognitive-behavioral therapy is the method that makes the patients gradually experience some situations inducing the fears and overcome those at last. Recently, the virtual reality technology has been introduced as an alternative method for providing phobic situations. In this study, we developed the public speaking simulator and the virtual environments for the treatment of the fear of public speaking. The head-mounted display, the head-tracker and the 3 dimensional sound system were used for the immersive virtual environment. The imagery of the virtual environment consists of a seminar room and 8 virtual audiences. The patient will speak in front of these virtual audiences and the therapist can control motions, facial expressions, sounds, and voices of each virtual audience.

A new strategy of fingertip reattachment: sequential use of microsurgical technique and pocketing of composite graft

Many methods have been used to reattach amputated fingertips. Of these methods, microsurgery has been accepted as the procedure of choice because the defining characteristic of a microsurgically replanted finger is that its surival in the recipient bed is predicated on functioning intravascular circulation. Although considerable progress has been made in the techniques for microvascular replantation of amputated fingers, the replantation of an amputated fingertip is difficult because digital arteries branch into small arteries. This is in addition to digital veins that run from both sides of the nail bed to the median dorsal sides, which are difficult to separate from the immobile soft tissue. Furthermore, even with the most technically skilled microsurgeon, replantation failure often occurs, especially in severe injury cases. Therefore, the technique is not the only protection against failure, and a new strategy of fingertip reattachment is needed. From March of 1997 to December of 1999, 12 fingers of 11 patients with zone 1 or zone 2 fingertip amputations that were reattached microsurgically but were compromised were deepithelialized, reattached, and then inserted into the abdominal pocket. All had been complete amputations with crushing injuries. Approximately 3 weeks later, the fingers were depocketed and covered with a skin graft. Of the 12 fingers, 7 survived completely and 3 had partial necrosis on less than one-third the volume of the amputated part. The complete survival rate was approximately 58 percent. The results of the above 10 fingers were satisfactory from both functional and cosmetic aspects. The authors believe that this high success rate was achieved because the deepithelialized finger pulp was placed in direct contact with the deep abdominal fascia, which was equipped with plentiful vascularity, not subcutaneous fat. In addition, the pocketing was performed promptly before necrosis of the compromised fingertip occurred. From the results of this study, it is clear that this new method is useful and can raise the survival rate of an amputated fingertip.

Synthesis of phosphatidylserine in carrot cells cultured under carbon-source starvation

When carrot suspension cells were cultured on medium containing no carbon source (starvation), the levels of phosphatidylserine (PS) increased transiently 3-4 d after the initiation of starvation while levels of most other phospholipid (PL) species decreased. We previously reported that fatty acids of these PLs served as an alternative carbon source during starvation. The present study showed that cells possess two different biosynthetic pathways involving phosphatidylcholine (PC)/phosphatidylethanolamine (PE) exchange enzymes and PS synthase to synthesize PS. These activities peaked similarly 4 d after the initiation of starvation and coincided with the peak of PS level. The synthesis of serine was also significantly activated during starvation. The activity of phosphoserine aminotransferase (PSAT) which is involved in serine synthesis increased with a time course similar to that of the increase in the PS level. These observations suggest that the increase in PS level plays an important role in membranes which are degraded during starvation.

The politics of herbal drugs in Korea

Hanbang, the Korean medical practice with origins in classical Chinese texts, is a prominent part of the Korean health care system. Hanbang physicians, called hanuisas, are looked down on by biomedical doctors, but their practice has enjoyed increasing popularity for several decades. As the market for herbal preparations has become more lucrative, biomedical pharmacists have begun to participate in it. The Pharmaceutical Act in 1993 explicitly allowed pharmacists to prescribe and dispense herbal drugs. This provoked a bitter public conflict between hanuisas and pharmacists, involving street demonstrations and strikes. The hanuisas asserted that the pharmacists were unqualified to assume their traditional practice. They also agitated for recognition in the state-sponsored system of health care and for the state's support for developing Hanbang medicine. This paper attributes the conflicts concerning Hanbang to the expanding market for herbal preparations, Korean nationalism, and to the oversupply of biomedical pharmacists.

Effects of allyl mercaptan and various allium-derived compounds on cholesterol synthesis and secretion in Hep-G2 cells

The present study was undertaken to compare the effects of allyl mercaptan (AM), a major metabolite of garlic, with several garlic constituents and extracts on cytotoxicity, cholesterol synthesis and its secretion in Hep-G2 cells. The cells were grown in Dulbecco's modified Eagle's medium (DMEM) supplemented with 10% fetal bovine serum (FBS), and treated with 5, 25, 50, 125, 250 and 500 microg/ml of AM, diallyl disulfide (DD), diallyl trisulfide (DT), steam-distilled garlic oil (SD) or vinyl-dithiin oil of garlic (VD) for 4 h. At concentrations up to 50 microg/ml, no significant cytotoxic effect was found in any group, but at concentrations above 250 microg/ml, the cell viability decreased drastically in all groups compared to the control. The treatment of cells with 25 microg/ml (non-cytotoxic concentration) of AM, DD, DT, SD for 4 h significantly inhibited [3H]acetate incorporation into cholesterol compared to that of the control (P < 0.05). The secretion of cholesterol into the medium was also significantly decreased in all groups except for VD. The treatment of cells with those allium constituents had no effect on either [3H]acetate incorporation into fatty acids or [3H]glycerol incorporation into triglyceride or phospholipid.

Correction of axillary burn scar contracture with the thoracodorsal perforator-based cutaneous island flap

Axillary scar contracture is observed frequently after severe burn insult and is usually accompanied by injuries to the adjacent area. Although many therapeutic methods, including skin grafting, Z-plasties, local flaps, island flaps, and free flaps, have been established, each technique has its own advantages and disadvantages in specific situations. The decision regarding which technique to use can only be made after consideration is given to the merits of the individual case. We applied thoracodorsal perforator-based cutaneous flaps to 5 patients with axillary burn scar contractures and damaged adjacent tissues. In 1 patient both axillae were involved. Elevated flaps as large as 11 x 27 cm in size were used. All flaps survived completely even when raised in scar tissue. The donor sites were closed primarily except one, which needed a skin graft. Three patients obtained satisfactory release with more than 160 deg shoulder abduction. In 2 patients, release was incomplete with only 110 deg shoulder abduction, but neither one required a second release. The range of motion in terms of shoulder abduction was improved preoperatively (30-90 deg) to postoperatively (110-170 deg). The thoracodorsal perforator-based cutaneous flap presents a very useful reconstructive method for the treatment of axillary defects.

Microsurgical replantation of a partial ear, with leech therapy

Ear reconstruction is very difficult to perform and often results in a devastating deformity. The use of microsurgical replantation techniques has allowed very favorable aesthetic results. The authors report a case of partial ear replantation without venous repair with the use of medicinal leeches to decompress the acute venous congestion that occurred during postoperative care. Medicinal leech therapy can be very useful in partial ear replantation in cases with no venous repair.

Surgical correction of cryptotia using Medpor

Cryptotia is a congenital auricular anomaly found more commonly in Orientals than whites. The characteristics of cryptotia are the invagination of the upper part of the auricle under the temporal skin and the deformity of the auricular cartilage. The goals of the repair of cryptotia are to release the upper ear from the side of the head to restore the retroauricular groove, to correct the malposition, and to correct the cartilaginous deformity. To lengthen the skin between the superior portion of the auricle and the scalp, the authors used both the modified Z-plasty and the temporal advancement flap. We partially detached the abnormal insertion of the superior auricular muscle at the upper part of the helix to make it weak. After complete exposure of the posterior aspect of the upper auricular cartilage, the constricted intrinsic transverse and oblique muscles were cut, and everting horizontal mattress sutures were inserted on the antihelix to expand the constricted body and crus of the antihelix. Thereafter, an ultrathin Medpor sheet (0.85-mm thickness) was fixed with 6-0 nylon sutures to the posterior aspect of the corrected antihelical cartilage for lengthening and splinting the relatively shortened upper pole of the deformed cartilage. This operative method is thought to be useful in maintaining the lengthened auricular height and shape, and in preventing the relapse of ear cartilage deformities.

Down-regulation of insulin-like growth factor binding proteins and growth modulation in hepatoma cells by retinoic acid

We observed that all-trans-retinoic acid (RA) down-regulated insulin-like growth factor binding proteins (IGFBPs) in cultured human hepatoma cells (Hep 3B, PLC/PRF/5, and Hep G2); therefore, we characterized the role of this down-regulation in cell growth. Treatment with 10 micromol/L RA revealed a rapid decrease in IGFBP-3 within 2 days, and continued treatment with RA for 6 days resulted in a time-dependent stimulation of Hep 3B cell growth. However, RA treatment decreased IGFBP-1 in PLC/PRF/5 cells and in Hep G2 cells, and the growth-stimulatory activity of RA was transient and less prominent, and was finally obliterated in both cell lines. The addition of 5 ng/mL or 50 ng/mL insulin-like growth factors (IGFs) did not change the growth effects elicited by RA. The addition of IGFBP-3 (1,000 ng/mL) inhibited the growth of Hep 3B cells and counteracted the growth-stimulatory activity of RA, but not completely, suggesting that RA has direct growth-stimulatory activity and that this is enhanced by autocrine down-regulation of IGFBP-3. IGFBP-3 also inhibited the growth of PLC/PRF/5 cells and of Hep G2 cells. Treatment with phosphorylated IGFBP-1 (1,000 ng/mL) alone or with RA did not affect the growth of PLC/PRF/5 cells or Hep G2 cells. However, addition of dephosphorylated IGFBP-1, derived from in vivo dephosphorylation of the phosphorylated form, stimulated the growth of both cell lines, independent of interaction with IGF-I. From these observations, we propose that RA down-regulates IGFBPs, which in turn causes autocrine modulation of cell growth independent of IGF in hepatoma cells in vitro or in vivo. In addition, RA regulates IGFBPs at the posttranscriptional (Hep 3B cells and Hep G2 cells) or transcriptional level (PLC/PRF/5 cells) in a cell-specific manner.

Human periplakin: genomic organization in a clonally unstable region of chromosome 16p with an abundance of repetitive sequence elements

Periplakin, a member of the plakin family of proteins, has been recently characterized by cDNA cloning, and the corresponding gene, PPL, has been mapped to human chromosome 16p13.3 (Aho et al., 1998, Genomics 48: 242-247). Periplakin has also been shown to serve as an autoantigen in a malignancy-associated autoimmune blistering disease, paraneoplastic pemphigus (Mahoney et al., 1998, J. Invest. Dermatol. 111: 308-313). In this study, we have elucidated the intron-exon organization of human PPL and characterized its promoter region. The flanking 5' sequences were rich in G and C ( approximately 80%) and included multiple AP2 sites and a SP1 site, while no canonical TATA or CCAAT sequences were found. The functionality of the upstream sequences (-709 to +135) as a promoter in cultured epidermal keratinocytes was detected by a CAT reporter gene, and a limited region (-382 to +135) showed activity in cultured dermal fibroblasts, attesting to cell-type specificity of the promoter. The genomic organization, including the intron-exon borders, was determined by direct nucleotide sequencing of human genomic P1 clones. Comparative analysis of cDNA and genomic sequences revealed that PPL consists of 22 exons, with the distribution of exons in PPL being consistent with that of other plakin genes: 21 small exons, separated by large introns, encode the amino-terminal globular domain, and 1 large exon encodes the entire rod and the tail domains. Characterization of four P1 clones spanning the PPL locus revealed multiple Alu repeats, 20 of them within 33 kb of the entirely sequenced segments (0.60/kb), in addition to numerous MIR and L1 elements. These repetitive elements could lead to the clonal instability detected throughout the genomic P1 clones and may give rise to the genomic rearrangements possibly underlying the paraneoplastic pemphigus.

Effect of the fat composition of a single meal on the composition and cytotoxic potencies of lipolytically-releasable free fatty acids in postprandial plasma

Ingestion of a meal increases plasma levels of triglyceride (TG)-rich lipoproteins through the secretion of intestine-derived chylomcirons and liver-derived very low density lipoproteins (VLDL). We have determined the effects of the fat composition of a single meal on the composition of TG in TG-rich lipoproteins (VLDL + chylomicrons) and circulating and lipolytically-releasable free fatty acids (FFA) in postprandial (PP) plasma and on the cytotoxic potencies of the lipolytically-released FFA to cultured arterial wall cells. PP lipemia was induced by feeding fasted normolipidemic human subjects with a meal rich in saturated fat (SF) and another meal rich in polyunsaturated fat (PUF), or vice versa; each meal provided 65% of energy as fat, and polyunsaturated to saturated fatty acid ratios (P/S) of the SF and PUF in the meals were 0.40 and 2.49, respectively. The mean P/S of TG in TG-rich lipoproteins (1.43) and circulating FFA (1.46) in 4 h PP plasma of PUF were significantly higher than those in PP plasma of SF (0.44 and 0.59, respectively) in fasting plasma (0.52 and 0.53, respectively). In vitro lipolysis of fasting and PP serum by purified bovine milk lipoprotein lipase (LpL) resulted in a marked (8.8-12.3-fold) increase in the serum FFA level. The P/S of serum FFA in postlipolysis fasting and PP serum were consistently higher than that of FFA or that of TG associated with TG-rich lipoproteins in prelipolysis fasting and PP serum, indicating that polyunsaturated TG in VLDL and/or chylomicrons is more susceptible than saturated TG to lipolysis. When postlipolysis serum was interacted with cultured endothelial cells and mouse peritoneal macrophages (MPM), the lipolytically-released FFA in PP serum of SF and PUF disrupted the barrier function of endothelial cells and were cytotoxic to cultured MPM; FFA in postlipolysis fasting serum was not cytotoxic. FFA in postlipolysis PP serum of PUF were consistently more potent than that in postlipolysis PP serum of SF. Further study showed that all long-chain monounsaturated FFA and polyunsaturated FFA, but not saturated FFA, incorporated into lipoproteins (LDL) were cytotoxic to cultured MPM. In conclusion, despite the generally well-accepted belief that SF is more atherogenic than PUF, the present study provides in vitro evidence that the lipolytic remnant products of TG-rich lipoproteins produced after a meal rich in PUF are more injurious to arterial wall cells than those produced after a meal rich in SF.

Potencies of lipoproteins in fasting and postprandial plasma to accept additional cholesterol molecules released from cell membranes

To investigate the role of various lipoproteins in plasma to promote cholesterol efflux from cell membranes, potencies of lipoproteins in normolipidemic fasting and postprandial (PP) plasmas to accept additional cholesterol molecules from cell membranes were determined. We used red blood cells (RBCs) and lipoproteins in fresh blood as donors and acceptors of cell membrane cholesterol, respectively. When fresh fasting plasma (n=24) containing active lecithin:cholesterol acyltransferase (LCAT) and cholesteryl ester transfer proteins (CETP) was incubated with a 3-fold excess of autologous RBCs at 37 degrees C for 18 hours, plasma cholesterol levels increased by 19.6% (38.5+/-14.2 mg/dL) owing to an exclusive increase in the CE level. Very low density lipoprotein (VLDL), low density lipoprotein (LDL), and high density lipoprotein (HDL) fractions retained 48.1%, 26.3%, and 25.6% of the net cholesterol mass increase in fasting plasma, resulting in 91%, 8%, and 21% increases in their cholesterol contents, respectively. The PP plasma was 1.3-fold more potent than fasting plasma in promoting cholesterol efflux from RBCs by associating excess cholesterol with chylomicrons, resulting in a 356% increase in the cholesterol content of chylomicrons. These increases in lipoprotein cholesterol content indicate that chylomicrons were about 3.9x, 44x, and 17x more potent than fasting VLDL, LDL, and HDL, respectively, in accepting additional cholesterol molecules released from RBCs. The capacity of PP plasma to promote cholesterol efflux from RBCs was significantly correlated with plasma cholesterol levels (r=0.60, P<0.005), triglycerides (r=0.68, P<0.001), chylomicrons (r=0.90, P<0.001), VLDL (r=0.65, P<0.001), and LDL (r=0.47, P<0.025) but not with the levels of HDL (r= -0.34, P<0.20). In fasting plasma containing a low level of VLDL and HDL, isolated chylomicrons supplemented to the plasma were approximately 9x more potent than HDL in boosting the capacity of plasma to promote cholesterol efflux from RBCs. This study indicates that chylomicrons in PP plasma are the most potent ultimate acceptors of cholesterol released from cell membranes and that a low HDL level is not a factor that limits the ability of PP plasma to promote cholesterol efflux from cell membranes. Our data obtained from an in-vitro system suggest that PP chylomicrons may play a major role in promoting reverse cholesterol transport in vivo, since the transfer of cholesterol from cell membranes to chylomicrons will lead to the rapid removal of this cholesterol by the liver. HDL in vivo may promote reverse cholesterol transport by enhancing the rapid removal of chylomicrons from the circulation, since the rate of clearance of chylomicrons is positively correlated with the HDL level in plasma.

Cellular uptake of stearic, oleic, linoleic, and linolenic acid and their effects on synthesis and secretion of lipids in Hep-G2 cells

The present study was undertaken to examine the cellular uptake of stearic (18:0), oleic (18:1), linoleic (18:2), and linolenic acid (18:3), and their effects on synthesis and secretion of lipids in Hep-G2 cells. The cells were grown for 6 days in Dulbecco's modified Eagle's medium (DMEM) supplemented with 10% fetal bovine serum. On day 7, cells were incubated in a serum-free DMEM containing 0.25-1.0 mM of 18:0, 18:1, 18:2 or 18:3. The cellular uptake of these fatty acids was almost linear during the 4 hr incubation period, and no significant differences were noted among the fatty acids tested, regardless of their degree of unsaturation. The treatment of cells with 1.0 mM of these fatty acids stimulated triglyceride (TG) synthesis nearly ten-fold and phospholipid (PL) synthesis approx, two-fold compared with those of the control. The lipoprotein-TG secretion also increased and was the highest with 18:1 followed in descending order by 18:2, 18:3, and 18:0. The fatty acid treatment of cells also significantly increased the incorporation of 14C-acetate into the cellular and lipoprotein cholesterol compared with that of the control (p < 0.05). In addition, notable changes occurred in the fatty acid composition of cellular and medium lipids, which were enriched with the particular fatty acid present in the incubation medium. The findings that 18:0, 18:1, 18:2, and 18:3 were taken up by Hep-G2 cells at almost identical rates demonstrate that differences in the cellular synthesis of lipids and their secretion are attributable to the metabolic specificity of those fatty acids, rather than variable rates of their uptake.

Laboratory-scale bioremediation of oil-contaminated soil of Kuwait with soil amendment materials

A huge amount of oil-contaminated soil remains unremediated in the Kuwait desert. The contaminated oil has the potentiality to cause pollution of underground water and to effect the health of people in the neighborhood. In this study, laboratory scale bioremediation experiments were carried out. Hyponex (Hyponex, Inc.) and bark manure were added as basic nutrients for microorganisms, and twelve kinds of materials (baked diatomite, microporous glass, coconut charcoal, an oil-decomposing bacterial mixture (Formula X from Oppenheimer, Inc.), and eight kinds of surfactants) were applied to accelerate the biodegradation of oil hydrocarbons. 15% to 33% of the contaminated oil was decomposed during 43 weeks' incubation. Among the materials tested, coconut charcoal enhanced the biodegradation. On the contrary, the addition of an oil-decomposing bacterial mixture impeded the biodegradation. The effects of the other materials were very slight. The toxicity of the biodegraded compounds was estimated by the Ames test and the tea pollen tube growth test. Both of the hydrophobic (dichloromethane extracts) and hydrophilic (methanol extracts) fractions showed a very slight toxicity in the Ames test. In the tea pollen tube growth test, the hydrophobic fraction was not toxic and enhanced the growth of pollen tubes.