Diastolic/systolic blood pressure ratio for predicting febrile children with sepsis and progress to septic shock in the emergency department

OBJECTIVE

Given the scarcity of studies analyzing the clinical predictors of pediatric septic cases that would progress to septic shock, this study aimed to determine strong predictors for pediatric emergency department (PED) patients with sepsis at risk for septic shock and mortality.

METHODS

We conducted chart reviews of patients with ≥ 2 age-adjusted quick Sequential Organ Failure Assessment score (qSOFA) criteria to recognize patients with an infectious disease in two tertiary PEDs between January 1, 2021, and April 30, 2022. The age range of included patients was 1 month to 18 years. The primary outcome was development of septic shock within 48 h of PED attendance. The secondary outcome was sepsis-related 28-day mortality. Initial important variables in the PED and hemodynamics with the highest and lowest values during the first 24 h of admission were also analyzed.

RESULTS

Overall, 417 patients were admitted because of sepsis and met the eligibility criteria for the study. Forty-nine cases progressed to septic shock within 48 h after admission and 368 were discharged without progression. General demographics, laboratory data, and hemodynamics were analyzed by multivariate analysis. Only the minimum diastolic blood pressure/systolic blood pressure ratio (D/S ratio) during the first 24 h after admission remained as an independent predictor of progression to septic shock and 28-day mortality. The best cutoff values of the D/S ratio for predicting septic shock and 28-day mortality were 0.52 and 0.47, respectively.

CONCLUSIONS

The D/S ratio is a practical bedside scoring system in the PED and had good discriminative ability in predicting the progression of septic shock and in-hospital mortality in PED patients. Further validation is essential in other settings.

Ferritin as an Effective Predictor of Neurological Outcomes in Children With Acute Necrotizing Encephalopathy

BACKGROUND

Acute necrotizing encephalopathy (ANE) is a fulminant disease with poor prognosis. Cytokine storm is the important phenomenon of ANE that affects the brain and multiple organs. The study aimed to identify whether hyperferritinemia was associated with poor prognosis in patients with ANE.

METHODS

All patients with ANE had multiple symmetric lesions located in the bilateral thalami and other regions such as brainstem tegmentum, cerebral white matter, and cerebellum. Neurological outcome at discharge was evaluated by pediatric neurologists using the Pediatric Cerebral Performance Category Scale. All risk factors associated with poor prognosis were further analyzed using receiver operating characteristic curve analysis.

RESULTS

Twenty-nine patients with ANE were enrolled in the current study. Nine (31%) patients achieved a favorable neurological outcome, and 20 (69%) patients had poor neurological outcomes. results The group of poor neurological outcome had significantly higher proportion of shock on admission and brainstem involvement. Based on multivariate logistic regression analysis, ferritin, aspartate aminotransferase (AST), and ANE severity score (ANE-SS) were the predictors associated with outcomes. The appropriate cutoff value for predicting neurological outcomes in patients with ANE was 1823 ng/mL for ferritin, 78 U/L for AST, and 4.5 for ANE-SS. Besides, comparison analyses showed that higher level of ferritin and ANE-SS were significantly correlated with brainstem involvement (P < 0.05).

CONCLUSIONS

Ferritin may potentially be a prognostic factor in patients with ANE. Hyperferritinemia is associated with poor neurological outcomes in patients with ANE and ferritin levels more than 1823 ng/mL have about eightfold increased risk of poor neurological outcome.

Outcomes of and factors associated with the development of bronchopulmonary dysplasia with pulmonary hypertension in very low birth weight infants: A retrospective study in a medical center

Introduction

Bronchopulmonary dysplasia (BPD) with pulmonary hypertension (PH) leads to increased morbidity and mortality in extremely preterm infants. Recent studies have analyzed factors associated with development of PH in BPD; however, this research remains inconclusive, and controversy exists regarding the correlation between BPD and PH. This study aimed to investigate potential associated factors, clinical characteristics, and outcomes of BPD with pulmonary hypertension in very low birth weight (VLBW) preterm infants.

Methods

We conducted a retrospective study, reviewing the records of infants with gestational age (GA) <32 weeks and birth weight <1,500 g admitted to a tertiary neonatal intensive care unit between January 2020 and October 2021 who were diagnosed with moderate to severe BPD. Echocardiogram was performed at the postmenstrual age of 36 weeks or before discharge. The diagnosis of PH was based on the findings of echocardiogram. Prenatal and postnatal characteristics, demographic data, treatment details, and outcomes were collected and analyzed.

Results

A total of 139 VLBW infants with BPD were enrolled and divided into a PH group (n = 25) and a non-PH group (n = 114). The mean GA was 27.3 ± 2.3 weeks and the mean birth weight of infants with BPD was 927.3 ± 293.3 g. A multivariate logistic regression model revealed that a high positive end-expiratory pressure (PEEP) setting (OR: 2.105; 95% CI: 1.472-3.011; p < 0.001) in established BPD and surgical closure of patent ductus arteriosus (PDA; OR: 6.273; 95% CI: 1.574-24.977; p = 0.009) were associated with BPD-PH. Neonates with BPD who developed pulmonary hypertension remained hospitalized for longer (p < 0.001), received invasive mechanical ventilation support for longer (p < 0.001), had a higher incidence of retinopathy of prematurity (ROP; OR: 4.201; 95% CI: 1.561-11.304; p = 0.003), were more likely to require oxygen support at discharge (OR: 5.600; 95% CI: 2.175-14.416; p < 0.001), and were more likely to undergo tracheostomy (OR: 35.368; 95% CI: 4.03-310.43; p < 0.001).

Conclusion

PDA ligation and a higher PEEP setting were associated with BPD-PH in our cohort study. Compared with VLBW infants with BPD but without PH, infants with BPD and PH were hospitalized for longer, and also had a higher incidence of oxygen support after discharge, ROP, and tracheostomy.

Early High-Dose Methylprednisolone Therapy Is Associated with Better Outcomes in Children with Acute Necrotizing Encephalopathy

BACKGROUND

The neurologic outcomes of acute necrotizing encephalopathy (ANE) are very poor, with a mortality rate of up to 40% and fewer than 10% of patients surviving without neurologic deficits. Steroid and immunoglobulin treatments have been the most commonly used options for ANE, but their therapeutic efficacy is still controversial.

METHOD

We retrospectively reviewed the medical records of 26 children diagnosed with ANE. We also divided these patients into two groups: 21 patients with brainstem involvement and 8 patients without brainstem involvement. Pulse steroid therapy (methylprednisolone at 30 mg/kg/day for 3 days) and intravenous immunoglobulin (2 g/kg for 2-5 days) were administered to treat ANE.

RESULTS

The overall mortality rate was 42.3%, and patients who did not survive had significantly higher initial lactate and serum ferritin levels, as well as higher rates of inotropic agent use with brainstem involvement. There were no significant differences in the outcomes of pulse steroid therapy or pulse steroid plus immunoglobulin between survivors and non-survivors. When analyzing the time between symptom onset and usage of pulse steroid therapy, pulse steroid therapy used within 24 h after the onset of ANE resulted in significantly better outcomes (p = 0.039). In patients with brainstem involvement, the outcome was not correlated with pulse steroid therapy, early pulse steroid therapy, or pulse steroid therapy combined with immunoglobulin. All patients without brainstem involvement received "early pulse methylprednisolone" therapy, and 87.5% (7/8) of these patients had a good neurologic outcome.

CONCLUSION

Pulse steroid therapy (methylprednisolone at 30 mg/kg/day for 3 days) administered within 24 h after the onset of ANE may be correlated with a good prognosis. Further studies are needed to establish a consensus guideline for this fulminant disease.

Hakka migrant hometown associations: Development and social network patterns

This study sought to review the development of Hakka migrant hometown associations and to explore the social network patterns of these associations. To better understand migrant associations in different contexts, research was conducted in various countries or regions. The study examined the relationships between and among associations from an organizational perspective. Using the criteria of density and centralization, the social network patterns are classified into four network types: (1) hierarchical, (2) clique, (3) peer-to-peer, and (4) formative. According to the findings, the network characteristics of different associations enable Hakka associations to flourish in the immigration countries and preserve Hakka culture.

Prognostic Factors and Clinical Features of Neonatal Splenic Rupture/Hemorrhage: Two Cases Reports and Literature Review

Background: Neonatal splenic rupture/hemorrhage (SRH), an extremely rare and potentially fatal presentation, can spontaneously resolve without surgical treatment; However, treatment approaches remain controversial. The present study aimed to describe and analyze the clinical features and therapies of neonatal SRH and therapeutic approaches. Methods: We present the cases of two patients and review another 37 cases reported in English-literature. The literature search included all articles published in PUBMED from inception between January 1968 and December 2019. Demographic data, precipitating factors, clinical characteristics including presenting symptoms and signs, presenting time, age at SRH presentation, imaging findings, as well as treatments and outcomes were analyzed. Results: In addition to the two cases treated at our hospital, 37 neonates with SRH were reported during the study period. The rate of full-term neonates was 72% (28/39). The cause was idiopathic in most cases, and congenital coagulation disorders were underlying causes in 13% (5/39) of the cases. The most common presenting symptom and sign of neonatal SRH were pallor or anemia, followed by abdominal discoloration/distension. Additionally, 18% (7/39) of the cases presented with scrotal hematoma or swelling. The age at SRH presentation ranged between 3 h and 5 days of age. Abdominal ultrasonography or computed tomography was used as the diagnostic tool. Twenty-seven cases (69%) received surgical management. The prognosis was comparable between the neonates treated with splenectomy and those treated with non-surgical approaches. The mortality rate was 18% (7/39) in the study cohort. SRH presentation at ≤12 h of age was associated with higher mortality compared to SRH presenting time at >12 h of age (odds ratio 25.0, 95% CI 2.514-248.575, p = 0.001). Conclusion: Our literature review revealed that the mortality rate of neonatal SRH was 18% and that the mortality risk was higher in neonates presenting with SRH symptoms and signs at ≤12 h of age.

Cultural dimensions of risk perceptions: A case study on cross-strait driftage pollution in a coastal area of Taiwan

Constant exploitations of the ocean render numerous present challenges as the ocean is linked to human development. The study focused on cross-strait driftage pollution that poses a great threat to coastal environment under climate change. Several hundred packs of herbicides drifting across the Taiwan Strait were discovered along the coastline of Guanyin District of Taiwan. We compared risk perceptions of the local ethnic groups, Hakka and Fulao, residing in a coastal area of Taiwan and exposed to the herbicide coastal incident under climate change. It is of concern that society's response to every dimension of global climate change is mediated by culture. The Driver-Pressure-State-Impact-Response (DPSIR) cause-effect framework was applied in semi-structured interviews to explore coastal sensitivity and human adaptability. As a result, we indicated that despite the presence of two ethnic groups in the same place exposed to the incident they presented very different risk perceptions on both environmental degradation (ED) and adaptive capacity (AC) due to cultural values. We argued that the herbicide coastal incident involved people's risk perceptions and subsequently influenced their opinions and attitudes towards environmental problems. We concluded that the ethnic trait contributed to adaptive behaviors during environmental change. Culturally appropriate adaptations appeared to enhance risk perceptions and adaptation actions, suggesting a need for more rigorous cultural adaptation guidelines towards climate resilience when designing adaptation interventions for different ethnic groups.

Genetic diversity analysis of okra (Abelmoschus esculentus L.) by inter-simple sequence repeat (ISSR) markers

Okra (Abelmoschus esculentus L.) is not only a nutrient-rich vegetable but also an important medicinal herb. Inter-simple sequence repeat (ISSR) markers were employed to investigate the genetic diversity and differentiation of 24 okra genotypes. In this study, the PCR products were separated by electrophoresis on 8% nondenaturing polyacrylamide gel and visualized by silver staining. The 22 ISSR primers produced 289 amplified DNA fragments, and 145 (50%) fragments were polymorphic. The 289 markers were used to construct the dendrogram based on the unweighted pair-group method with arithmetic average (UPGMA) cluster analysis. The dendrogram indicated that 24 okras were clustered into 4 geographically distinct groups. The average polymorphism information content (PIC) was 0.531929, which showed that the majority of primers were informative. The high values of allele frequency, genetic diversity, and heterozygosity showed that primer-sample combinations produced measurable fragments. The mean distances ranged from 0.045455 to 0.454545. The dendrogram indicated that the ISSR markers succeeded in distinguishing most of the 24 varieties in relation to their genetic backgrounds and geographical origins.

Long-term disease-free survival in three ovarian cancer patients with a single relapse

Recurrent ovarian cancer with long-term survival is uncommon and often associated with poor prognosis. We report three cases of patients with advanced ovarian cancer who have achieved long-term disease-free survival following a single prior relapse. Case 1 relapsed with a localized bulky tumor and received a complete surgical resection and chemotherapy. Case 2 had a persistent central pelvic tumor after debulking surgery and second-line chemotherapy, and yet achieved excellent control with concurrent chemoradiation to the true pelvis. Case 3 relapsed with paraaortic lymph node metastasis and probable lung metastasis (subsequently negated by positron emission tomography) and received chemotherapy alone. These three patients have since remained disease-free for 13, 12, and seven years, respectively, since their first relapse. We conclude that select patients can obtain long-term disease-free survival after the first relapse by accurate restaging and aggressive multimodality treatment.

Successful salvage treatment of recurrent endometrial cancer with multiple lung and abdominal metastases

The prognosis of recurrent endometrial carcinoma is generally poor except for isolated vaginal or pelvic relapse without previous radiation. Recurrences associated with infield failure or distant metastasis carry a poor prognosis. We report a case of recurrent endometrial carcinoma treated with cytoreductive surgery, targeted radiation to lung metastasis defined by CT and PET and adjuvant chemo-hormone therapy followed by maintenance progestin therapy with a good outcome. This case implied that chemo-hormone therapy with targeted radiation should be evaluated in recurrent endometrial cancer with positive progesterone receptor for salvage treatment.

A major QTL on chromosome 11 influences psychostimulant and opioid sensitivity in mice

The identification of genes influencing sensitivity to stimulants and opioids is important for determining their mechanism of action and may provide fundamental insights into the genetics of drug abuse. We used a panel of C57BL/6J (B6; recipient)x A/J (donor) chromosome substitution strains (CSSs) to identify quantitative trait loci (QTL) for both open field activity and sensitivity to the locomotor stimulant response to methamphetamine (MA). Mice were injected with saline (days 1 and 2) and MA (day 3; 2 mg/kg i.p.). We analyzed the total distance traveled in the open field for 30 min following each injection. CSS-8, -11 and -16 showed reduced MA-induced locomotor activity relative to B6, whereas CSS-10 and -12 showed increased MA-induced locomotor activity. Further analysis focused on CSS-11 because it was robustly different from B6 following MA injection, but did not differ in activity following saline injection and because it also showed reduced locomotor activity in response to the mu-opioid receptor agonist fentanyl (0.2 mg/kg i.p.). Thus, CSS-11 captures QTLs for the response to both psychostimulants and opioids. Using a B6 x CSS-11 F(2) intercross, we identified a dominant QTL for the MA response on chromosome 11. We used haplotype association mapping of cis expression QTLs and bioinformatic resources to parse among genes within the 95% confidence interval of the chromosome 11 QTL. Identification of the genes underlying QTLs for response to psychostimulants and opioids may provide insights about genetic factors that modulate sensitivity to drugs of abuse.

Quadruple-bend achromatic low emittance lattice studies

A quadruple-bend achromatic (QBA) cell, defined as a supercell made of two double-bend cells with different outer and inner dipole bend angles, is found to provide a factor of 2 in lowering the beam emittance relative to the more conventional double-bend achromat. The ratio of bending angles of the inner dipoles to that of the outer dipoles is numerically found to be about 1.5-1.6 for an optimal low beam emittance in the isomagnetic condition. The QBA lattice provides an advantage over the double-bend achromat or the double-bend nonachromat in performance by providing a small natural beam emittance and some zero-dispersion straight sections. A lattice with 12 QBA cells and a preliminary dynamic aperture study serves as an example.

Craniofacial morphometric analysis of mandibular prognathism

The purpose of this study was to provide more information about the morphological characteristics of the craniofacial complex in mandibular prognathism. Forty young adult males having mandibular prognathism were compared with 40 having normal occlusion. This was conducted to carry out geometric morphometric assessments to localize alterations, using Procrustes analysis and thin-plate spline analysis, in addition to conventional cephalometric techniques. Procrustes analysis indicated that the mean craniofacial, midfacial and mandibular morphology was significantly different in prognathic subjects compared with normal controls. This finding was corroborated by the multivariate Hotelling T(2)-test of cephalometric variables. Mandibular prognathism demonstrated a shorter and slightly retropositioned maxilla, a greater total length and anterior positioning of the mandible. Thin-plate spline analysis revealed a developmental diminution of the palatomaxillary region anteroposteriorly and a developmental elongation of the mandible anteroposteriorly, leading to the appearance of a prognathic mandibular profile. In conclusion, thin-plate spline analysis seems to provide a valuable supplement for conventional cephalometric analysis because the complex patterns of craniofacial shape change are visualized suggestive by means of grid deformations.

Midfacial and mandibular morphometry of children with Class II and Class III malocclusions

There is insufficient evidence in conventional cephalometric analysis of the actual sites of putative maxillofacial change in Class II and Class III malocclusions. The purpose of this study was to provide more information about the morphological characteristics of the midfacial complex and mandible in children with Class II or III malocclusions. Seventy children with Class II, division 1 malocclusion and 70 children with Class III malocclusion were compared with 70 children with normal occlusion. This study was conducted to carry out geometric morphometric assessments to localize alterations using Procrustes analysis and thin-plate spline analysis. Procrustes analysis indicated the midfacial and mandibular morphologies differed between normal occlusion subjects and subjects with Class II or Class III malocclusion (P<0.0001). The deformations in subjects with Class II malocclusion may represent a developmental elongation of the palatomaxillary complex and a shortening of the mandible anteroposteriorly, which leads to the appearance of a protruding midface and retruding mandibular profile. In contrast, the deformations in subjects with Class III malocclusion may represent a developmental shortening of the palatomaxillary complex and elongation of the mandible anteroposteriorly, which leads to the appearance of a retrognathic midface and prognathic mandibular profile.

Geometric morphometric assessment of treatment effects of maxillary protraction combined with chin cup appliance on the maxillofacial complex

The aim of this study was to investigate the treatment effects on the maxillofacial complex by maxillary protraction combined with chin cup therapy among growing children. An effective geometric morphometric assessment of cephalometric radiographs, using Procrustes analysis and thin-plate spline analysis, was applied to evaluate shape change in the craniofacial and midfacial configurations of a treated sample of 20 children with skeletal Class III malocclusion. This was compared with matched untreated skeletal Class III controls. Marked treatment induced change involved the maxilla and the mandible. Major deformation consisted of forward advancement of the maxillary complex with negligible rotation of the palatal plane and a forward direction of growth of the mandibular condyle associated with a restriction in sagittal advancement of the chin. Considerable dentoalveolar components contributed to the correction of anterior crossbite. Further detailed study of skeletofacial remodelling in response to maxillary protraction in other skeletal components, including the cranial base and the mandibular complex that contribute to Class III skeletal discrepancies, is warranted.

Thin-plate spline (TPS) graphical analysis of the mandible on cephalometric radiographs

We describe two cases of Class III malocclusion with and without orthodontic treatment. A thin-plate spline (TPS) analysis of lateral cephalometric radiographs was used to visualize transformations of the mandible. The actual sites of mandibular skeletal change are not detectable with conventional cephalometric analysis. These case analyses indicate that specific patterns of mandibular transformation are associated with Class III malocclusion with or without orthopaedic therapy, and visualization of these deformations is feasible using TPS graphical analysis.

Functional blocking of integrin-associated protein impairs memory retention and decreases glutamate release from the hippocampus

We have previously demonstrated that integrin-associated protein is involved in memory consolidation of one-way inhibitory avoidance learning in rats and mice. In the present study, we examined the effects of functional blocking of integrin-associated protein on memory retention, long-term potentiation and glutamate release in mice as well as on cell attachment to extracellular matrix protein in primary cultures. The results indicated that integrin-associated protein monoclonal antibody miap301, when directly injected into the dentate gyrus of the hippocampus at moderate doses, significantly impairs memory retention in mice in the same one-way inhibitory avoidance task and decreases the amplitude of tetanic stimulation-induced long-term potentiation in dentate gyrus neurons. At a dose that effectively impairs both memory retention and long-term potentiation, integrin-associated protein monoclonal antibody also significantly blocks potassium chloride-induced glutamate release from the hippocampus in vivo. Results from western blot confirmed the presence of integrin-associated protein at the synaptic area. Cell adhesion experiments further revealed that integrin-associated protein monoclonal antibody markedly inhibits granular cell attachment to thrombospondin, the extracellular matrix protein known to bind integrin-associated protein, but not to collagen and laminin, the extracellular matrix proteins known to bind integrin. From these results we suggest that integrin-associated protein monoclonal antibody may impair synaptic plasticity and behavioral plasticity in mice through blockade of granular cell attachment to extracellular matrix protein and the subsequent signal transduction, and through inhibition of glutamate release from the hippocampus.

Correlation of cervical vertebra maturation with hand-wrist maturation in children

The purpose of this study was to evaluate the reliability of cervical vertebra maturation as an indicator of skeletal age during the circumpubertal period. This was determined by correlating cervical vertebra maturation to hand-wrist maturation. The vertebral skeletal age was assessed using lateral cephalometric radiographs according to maturity indicators modified from Lamparski. The hand-wrist skeletal age was evaluated in radiographs with the system developed by Fishman. The sample consisted of 503 subjects (244 boys and 259 girls), aged 8 through 18 years. The Spearman rank correlation coefficients and Wilcoxon sign rank test showed that a statistically significant relationship existed between the two assessments. Both the intra- and inter-judge tests of reliability displayed no significant differences. The results of this study indicate that skeletal age assessment made from the maturational changes of cervical vertebrae were reliable, reproducible and valid.

Characterization of the functional role of Asp141, Asp194, and Asp464 residues in the Mn2+-L-malate binding of pigeon liver malic enzyme

Pigeon liver malic enzyme was inactivated and cleaved at Asp141, Asp194, and Asp464 by the Cu2+-ascorbate system in acidic environment. Site-specific mutagenesis was performed at these putative metal-binding sites. Three point mutants, D141N, D194N, and D464N; three double mutants, D(141,194)N, D(194,464)N, and D(141,464)N; and a triple mutant, D(141,194,464)N; as well as the wild-type malic enzyme (WT) were successfully cloned and expressed in Escherichia coli cells. All recombinant enzymes, except the triple mutant, were purified to apparent homogeneity by successive Q-Sepharose and adenosine-2',5'-bisphosphate-agarose columns. The mutants showed similar apparent Km,NADP values to that of the WT. The Km,Mal value was increased in the D141N and D194N mutants. The Km,Mn value, on the other hand, was increased only in the D141N mutant by 14-fold, corresponding to approximately 1.6 kcal/mol for the Asp141-Mn2+ binding energy. Substrate inhibition by L-malate was only observed in WT, D464N, and D(141,464)N. Initial velocity experiments were performed to derive the various kinetic parameters. The possible interactions between Asp141, Asp194, and Asp464 were analyzed by the double-mutation cycles and triple-mutation box. There are synergistic weakening interactions between Asp141 and Asp194 in the metal binding that impel the D(141,194)N double mutant to an overall specificity constant [k(cat)/(Kd,Mn Km,Mal Km,NADP)] at least four orders of magnitude smaller than the WT value. This difference corresponds to an increase of 6.38 kcal/mol energy barrier for the catalytic efficiency. Mutation at Asp464, on the other hand, has partial additivity on the mutations at Asp141 and Asp194. The overall specificity constants for the double mutants D(194,464)N and D(141,464)N or the triple mutant D(141,194,464)N were decreased by only 10- to 100-fold compared to the WT. These results strongly suggest the involvement of Asp141 in the Mn2+-L-malate binding for the pigeon liver malic enzyme. The Asp194 and Asp464, which may be oxidized by nonspecific binding of Cu2+, are involved in the Mn2+-L-malate binding or catalysis indirectly by modulating the binding affinity of Asp141 with the Mn2+.

Impaired memory retention and decreased long-term potentiation in integrin-associated protein-deficient mice

Previously, we have demonstrated that integrin-associated protein (IAP) mRNA level is approximately fourfold higher in rats showing good retention performance (600 sec) than rats showing poor retention performance (< 80 sec) in an inhibitory avoidance learning paradigm. In the present study, we have used the gene-targeted IAP-deficient mice to further investigate the role of IAP involved in memory formation and hippocampal long-term potentiation (LTP) in vivo. Results revealed that there was a significant impairment in memory retention and a significant reduction in the magnitude of LTP in IAP-deficient mice when compared with the wild-type and heterozygote mice, whereas the wild-type and heterozygote animals did not show marked differences on these measures. Furthermore, the impairment in retention performance of IAP-deficient mice was not due to different sensitivities of these animals to the electric shock. When we examined locomotor activity and rotarod treadmill performance, no differences were observed among these three groups of animals either. Western blot analysis confirmed the lack of IAP protein in IAP-deficient mice, whereas IAP expression was similar in both the wild-type and heterozygote controls. These results together demonstrate that IAP plays an important role in the process of memory formation and synaptic plasticity in mice.

Ethnic dental analysis of shovel and Carabelli's traits in a Chinese population

Chinese populations differ from Caucasoids by having a high prevalence of shovel trait and a low prevalence of Carabelli's trait. This study was conducted to investigate the association between the shovel and the Carabelli's traits in a Chinese population. The research design investigated a Chinese population that resides in southern Taiwan. The ancestors of this Chinese population migrated to Taiwan from mainland China, mainly from Fukien and Kwangtung. The effects of sex and age on Carabelli's trait were controlled in this investigation, as was the association between tooth size and Carabelli's trait. Results show that males were more likely to have Carabelli's trait expressed on teeth than females. The buccolingual diameter of Carabelli's trait teeth was larger than that of teeth without the trait. After controlling for sex, age, and tooth size, the existence of the shovel trait increased the likelihood of having Carabelli's trait by a factor of five and a half, which is a significant effect.

Methods to improve a periodontally involved terminal abutment of a cantilever fixed partial denture--a finite element stress analysis

The two-dimensional plane stress finite element stress analysis was used to evaluate the stress of mandibular posterior cantilevers for compromised periodontal involved distal terminal abutments. Some commonly practiced methods to alleviate the stress from mastication of the cantilever FPDs were also evaluated. From the analysis the following was concluded: (1) The most distal terminal abutment of a cantilever FPD generally experienced a high stress concentration. (2) The cantilever FPDs require at least two abutments. Optimum stress reduction occurred with a splinting of three abutments. To increase the number of abutments to more than three, would not result in a proportional and meaningful reduction of stress in the periodontium. (3) To alter the bridge material with more rigid material or to have a longer marginal preparation of the terminal abutment are ineffective for better stress distribution.

Craniofacial pattern of young adults with various types of malocclusion

Craniofacial morphological characteristics of young adults with various malocclusions were investigated. Cephalometric radiographs of 100 Class I, 100 Class II, and 100 Class III cases were selected and subjected to counterpart analysis as described by Enlow. Results of individuals with normal occlusion revealed a mean value of 38.75 degrees for the angle of the middle cranial fossa relative to the posterior maxillary plane alignment (MCF/PM). This value was used as the basis for intrinsic alignment comparisons for all the other various parts. Classes I and II malocclusions were classified as either type A or B, depending on whether point A or B was protrusive in the functional occlusal plane (FOP). We found that type B was more common for Class I malocclusion. Further, these cases exhibited an underlying Class III character. We also noted that B groups had different structural craniofacial patterns relative to those seen in A groups. The difference between Class IA and Class IIA, or between Class IB and Class IIB was slight but quantitative. Class III and Class IIA individuals had distinctly different and essentially opposite underlying patterns. However, the composite compensatory result in Class IB case was, for the most part, effective.

The effect of shovel trait on Carabelli's trait in Taiwan Chinese and Aboriginal populations

Chinese and other Mongoloid populations differ from Caucasoids by having a high prevalence of shovel trait and a low prevalence of Carabelli's trait. This study was conducted to compare the association between the shovel and the Carabelli's traits between Chinese and aboriginal Mongoloid populations. The research is designed to sample randomly a Chinese population and an aboriginal population having low admixture with neighboring populations. The Mongoloid aboriginal group was from the Bunun tribe who resides in an isolated alpine area in Taiwan. The effects of sex and age on Carabelli's trait were controlled in this study, as was the association between tooth size and Carabelli's trait. Our results show that males had more Carabelli's trait expressed on teeth than females in both of these two Mongoloid populations. The buccolingual diameter of Carabelli's trait teeth was larger than that of teeth without the trait. After controlling for sex, age, and tooth size, the existence of the shovel trait significantly increased the likelihood of having Carabelli's trait, especially in Chinese, which implies another significant ethnic feature for Mongoloid identification.

A case of double inferior venae cavae

In this study, we present a case of double inferior venae cavae found among 252 Taiwanese cadavers that were dissected in the gross anatomy laboratory of Kaohsiung Medical College from 1978 to 1996. The lumbar portion of the normal inferior vena cava is embryologically formed by the persistence of the right supracardinal vein. Persistence of the left one gives rise to the left inferior vena cava and the persistence of the bilateral ones, the double inferior venae cavae. In this case, there is an anastomosis between the right and left inferior venae cavae. The anastomotic type of this anomaly seems to be more common than the non-anastomotic one.

Induction of superoxide dismutase and catalase activity in different rat tissues and protection from UVB irradiation after topical application of Ginkgo biloba extracts

Ginkgo biloba extract (GBE) prepared from the leaves of Ginkgo biloba with 50% diluted alcohol was found to locally induce superoxide dismutase (SOD) and catalase (CAT) enzyme activity in epidermis after topical application, and also to systemically increase the activity of both enzymes in the liver, heart and kidney of Sprague Dawley rats. Skin pretreated with 50% diluted alcohol-extracted liquid formulation was protected from exacerbation of UVB damage. Changes in the lipid structure of the skin of rats determined by ATR/FT-IR spectroscopy demonstrated penetration of active components from GBE dosage formulations.

Morphology and vibration pattern of the vocal cord after intracordal Teflon injection: long-term results

BACKGROUND

Intracordal Teflon injection has been the mainstream management for unilateral vocal cord palsy over the past three decades. In recent years, some investigators concerned about its possible adverse effects on the vibration of the injected vocal cords. It is therefore necessary to clarify the clinical significance of these concerns if Teflon injection will stay as a viable treatment.

METHODS

Twenty-one patients with unilateral vocal cord palsy, who had received Teflon injection for more than one year, were evaluated by flexible laryngovideostroboscopy, basic voice function evaluations and the patient self-assessment.

RESULTS

The morphological and vibratory patterns of the post-injection vocal cords were categorized into seven types according to the videostroboscopic findings. Type I and type II cases had relatively normal morphology and vibration (assorted as group I). Type III through type VII cases showed various kinds of morphological and vibratory abnormalities (assorted as group II). Group I and group II were significantly different in the results of basic voice function evaluations and the patient self-assessment. Group I cases who showed relatively normal morphology and vibration had mean values closer to the normal ranges. For all the patients recruited, their voices were quite stable after injection. None with initial improvement of the voice suffered deterioration.

CONCLUSIONS

The results showed that some patients had nearly normal vibration of the vocal cords years after Teflon injection. True (delayed onset, not due to improper injection) and voice-disturbing Teflon granuloma was not seen in the present study. The majority of cases with disturbed vibration were due to either improper location or an improper amount of injected Teflon. The problems were mostly induced by technical difficulties, not by Teflon-related foreign body reaction. Efforts should be made to avoid these technical errors to increase the predictability of the outcome.

A method of magnification correction for posteroanterior radiographic cephalometry

A simple method for magnification correction of width measurements from posteroanterior (PA) cephalograms is presented. Small lead markers were placed on selected landmarks of dry skulls. Lateral and PA cephalograms were obtained for each skull. Seven cephalometric width measurements were selected. Actual widths were deduced from the geometric principle of similar triangles. The magnification factor is the distance between the anode and the transporionic axis, plus or minus the corrected distance of the landmark to the transporionic axis measured from the lateral cephalogram, divided by the distances between the anode and the film. Differences between measurements made directly on the skull and corrected width measurements from the PA films were observed to be very small (< 0.50 mm) and statistically insignificant (P > 0.05). Paired measurements were of high correlation (r = +0.99). The present method of magnification correction means cephalometric width measurements can be made that are comparable in accuracy with measurements made directly on the skulls.

Sex determination by discriminant function analysis of lateral radiographic cephalometry

The present work is an attempt to develop a new method to determine sex from the skull with lateral radiographic cephalometry and discriminant function analysis. The superciliary ridges, frontal sinuses, external occipital protuberance, and mastoid processes were adopted as objects of lateral radiographic cephalometric measurements. With discriminant functions created from 18 established cephalometric variables, a total of 100 cases were classified into two sexual groups with 100% accuracy in a random sample of Taiwanese adults. Therefore, we may obtain a much greater reliability of sex determination from skulls according to this newly developed technique.

Autogenous fat intracordal injection as treatment for unilateral vocal palsy

BACKGROUND

Intracordal injection, which is less time-consuming and avoids neck incision, remains an important method to correct glottic insufficiency induced by unilateral vocal palsy. Among the various new materials proposed for intracordal injection, autogenous fat draws our attention for its availability without cost and high bio-compatibility. This article reports our preliminary experiences of intracordal injection using autogenous fat to treat glottic insufficiency induced by unilateral vocal palsy.

METHODS

Autogenous fat is collected under local anesthesia by syringe aspiration from femoral or lower abdomen. Precautions to reduce resorption are taken while collecting and processing the fat. Under the guidance of flexible laryngovideostroboscopy, Bruning syringe with a bended needle is inserted transorally to make the intracordal injection. Serial pre-operation and postoperation evaluations by flexible laryngovideostroboscopy, the patient's selfassessment on the voice, the speech pathologist's perceptual ratings on the breathiness and roughness of the patient's voice, maximum phonation time, and mean airflow rate are made.

RESULTS

A total of 19 cases were recruited for the treatment, and 17 of them completed the procedure. The clinical applicability was 89.5%. The fat injection had no obvious effect on the posterior glottic gap correction. The postoperative glottic gap estimated by the videostroboscopy, was improved in 15 of the 16 cases two weeks after operation, and in five of the seven cases who has been followed up for three months. Twelve of the 16 cases felt improved voice in two postoperative weeks, and six of the seven cases still felt the improvement three months after operation. The rate and amount of resorption varied greatly among individuals. None of the injected cords showed untoward morphological or vibratory changes up to three months after injection.

CONCLUSIONS

Intracordal injection of autogenous fat to treat unilateral vocal palsy by the method we propose is relatively simple with high clinical applicability and no extra-cost. None of the injected cords showed unfavorable changes. Most of the patients were improved after injection, at least for a short period of time. The long-term effectiveness remains to be observed. Repetition of the injection is also simple, if the voice results deteriorate due to resorption of the injected fat.

Axillary temperature in transitional newborn infants before and after tub bath

Twenty healthy newborn infants (mean 38.4 weeks gestation and 3,294 g) were studied to compare axillary temperatures before and after a deep-water tub bath. The bath was given in the mother's room in a plastic bassinet filled with 5 to 5 1/2 inches of warm water. Mean time was 4.4 hours postbirth. Mean infant temperature was 98.2 degrees F (36.8 degrees C) prebath and 98.0 degrees F (36.7 degrees C) postbath. Mean change was -0.2 degree F (-0.1 degree C) and was not significantly different. This significant absence of heat loss during tub baths suggests that infants need not be separated from their mothers and kept in nurseries under infrared warmers to prevent heat loss during their first bath.

Effects of the anabolic steroid nandrolone phenylpropionate on craniofacial growth in rats

Primary testosterone and its derivatives are anabolic steroids used in the treatment of osteoporosis and Turner syndrome. They also enhance fast-twitch muscle weight in female rats. The present study examines the effect of an anabolic steroid on craniofacial growth and development in rats. Five-week-old female Sprague-Dawley rats (125) were divided into experimental and control groups. The experimental group was injected subcutaneously with 1 mg nandrolone phenylpropionate in the interscapular region on alternate days, whereas those in the control group were injected with a vehicle, arachis oil. Rats were sacrificed at 60 and 120 days of age. Cephalometric analysis of soft X-ray cephalograms showed that chronic administration of the anabolic steroid, nandrolone phenylpropionate, resulted in: (1) about a 20% increase in body weight, (2) an increase in total skull length, (3) elongation of the maxillary and mandibular incisors, (4) an increase in the depth of the antegonial notch, and (5) downward-forward growth of the viscerocranium against the neurocranium. These results suggest that nandrolone phenylpropionate may accelerate craniofacial growth and/or induce high functional activity of the masticatory muscles in female rats.

A study of the growth changes in facial configuration

In order to explore the growth changes in facial configuration, 160 subjects (80 young adults and 80 children aged 11-12) with normal occlusion were selected for roentgenocephalometric analysis. The present study led to the following conclusions: (a) The ratios of anterior upper to anterior total facial heights, anterior lower to anterior total facial heights, and anterior upper to anterior lower facial heights in both sexes stayed constant around 45, 55, and 81 per cent, respectively. (b) The change in the ratio of the posterior total to anterior total facial heights was mainly due to the greater potentiality of the posterior part of the lower face. (c) The increases of the lower anterior and posterior dental heights were larger than that of the upper anterior and posterior dental heights, respectively. The increases of the upper and lower posterior dental heights were larger than that of the upper and lower anterior dental heights, respectively. (d) On average, the mandibular plane and the occlusal plane tended to rotate forwards with age while the cant of the sella-nasion plane, the Frankfort horizontal plane, and the palatal plane remained fairly unchanged. (e) The saddle angle, the articular angle, and the FNA angle remained relatively stable with age, while the gonial angle and the FNB angle seemed to be age-related. The decrease in the size of the gonial angle might contribute mainly to the flattening tendency of the mandibular growth coincident with general growth. (f) Both the inclination of upper incisor to palatal plane and lower incisor to mandibular plane remained reasonably constant throughout maturation.(ABSTRACT TRUNCATED AT 250 WORDS)

[A study on sexual differences of postero-anterior cephalometrics among Chinese in Taiwan with different occlusions]

The main purpose of this study is to investigate the characteristics of cranio-dento-facial morphology among Chinese in Taiwan with different occlusions by the postero-anterior cephalograms and to examine the differences between sexes in the cranio-dento-facial width as well as morphology. Our study comprised three hundred and seventy three patients with preorthodontic treatment records. They were divided into 12 groups with respect to the Angle's classification, sex, and age. Summarizing the differences of the various cephalometric analyses, 31 kinds of measurement, including 20 values of width dimension and 11 values of the width ratio, were employed. The results of using the Student t-test to study the sex differences of cranio-dento-facial width and morphology are summarized as follows: (1) The sexual dimorphism of the cranio-dento-facial width occurs as early as the age of 9-12. The deviation is augmented continuously with growth and, hence, it is more pronounced in adults. (2) Regardless of the class of occlusion or the stage of maturity, the cranio-dento-facial size of the male is significantly larger than that of the female. However, their cranio-dento-facial morphology is similar. (3) The sexual dimorphism of the cranio-dento-facial width dimensions is most pronounced in the zygoma, the mandibular angle and the condyles.

[The study of root resorption of human deciduous teeth. I. Histological observation by light microscope]

Sixty-four human non-carious deciduous teeth were used to observe the root resorption of deciduous teeth by means of light microscope. The extent of root resorption was classified into 6 grades: Res. O, Res. i, Res. 1/4, Res. 1/2, Res. 3/4, Res. Co. In the physiological root resorption of deciduous tooth, there are numerous, large multinucleated odontoclasts and mononuclear fibroblasts or macrophages residing at the Howship's lacunae. The odontoclasts resorbed hard dental tissues, including cementum, dentin. A characteristic of active or "resorbing" odontoclasts, but not in free or inactive odontoclasts is cytoplasmic projections, or brush borders, which were found near the underlying hard dental tissues. The deciduous root resorption was found to be most advanced in the apical areas. Because of the different eruption path of the permanent successors, the position of deciduous root resorption varied. Generally, the lingual surface was resorbed more extensively than the labial surface in the deciduous anterior teeth; the resorption of the furcal area and interradicular cementum surface of the roots were more advanced in the deciduous molars. Predentin can be resorbed by odontoclasts, too. However, it seems more resistant to resorption than dentin. Resorption lacunae could be observed in the root canal and pulp chamber. This means that the internal root resorption probably occur simultaneously. Periodontal fiber attachment was observed in some Howship's lacunae of the root surface. Inflammatory changes occurred in the pulp of deciduous teeth during the shedding process, especially when the deciduous root was resorbed more than one half way. The appearance of the repairing cellular cementum and periodontal fiber attachment was clearly observed in some deciduous roots.

Assessment of anteroposterior jaw relationship

Both angular and linear measurements have been proposed in the assessment of sagittal jaw relationship. Many distorting factors may influence the validity of evaluating this relationship. This article was undertaken to study the different measurements statistically and geometrically; in addition, the AF-BF distance as the absolute measurement of the anteroposterior jaw relationship is presented.

Craniofacial pattern of Class III deciduous dentition

The purpose of this study was to investigate the morphological characteristics of the cranio-dento-facial complex of children with deciduous dentition and Class III malocclusion. Forty Chinese children in Taiwan with normal occlusion and 40 with Class III malocclusion in deciduous dentition were selected for cephalometric analysis. Mandibular length was significantly greater and the mandible was situated farther forward in the Class III group. The maxilla was also slightly backward in this group, perhaps in association with the shorter maxillary length. The mandibular incisors were tipped lingually to compensate for the intermaxillary skeletal dysplasia and the maxillary incisors were tipped lingually by the retroinclined mandibular incisors.