Clinical usefulness of Mac-2 binding protein glycosylation isomer for diagnosing liver cirrhosis and significant fibrosis in patients with chronic liver disease: A retrospective single-center study

Accurate diagnosis of liver cirrhosis (LC) and significant fibrosis in patients with chronic liver disease (CLD) is important. The Mac-2 binding protein glycosylation isomer (M2BPGi) has emerged as a novel serum biomarker for liver fibrosis; however, insufficient clinical data of M2BPGi are available in patients with CLD. Therefore, we performed a retrospective cohort study to investigate the clinical usefulness of serum M2BPGi for assessing LC and significant fibrosis in CLD patients. We retrospectively reviewed the CLD patients with measured serum M2BPGi at Kosin University Gospel Hospital between January 2016 and December 2019. Multivariate logistic regression analyses were conducted to identify the independent factors associated with LC. The diagnostic power of serum M2BPGi for LC and significant fibrosis (≥F2) was evaluated and compared to that of other serum biomarkers using receiver operating characteristic curve and area under the curve (AUC). A total of 454 patients enrolled in this study. M2BPGi (adjusted odds ratio [aOR], 1.77; 95% confidence interval [CI], 1.52-2.07) and fibrosis index based on four factors (aOR, 1.23; 95% CI, 1.11-1.37) were identified as significant independent factors for LC. The AUC of M2BPGi for LC (0.866) and significant fibrosis (0.816) were comparable to those of fibrosis index based on four factors (0.860, 0.773), aspartate aminotransferase-to-platelet ratio index (0.806, 0.752), and gamma-glutamyl transpeptidase-to-platelet ratio (0.759, 0.710). The optimal cut-off values for M2BPGi for LC and significant fibrosis were 1.37 and 0.89, respectively. Serum M2BPGi levels were significantly correlated with liver stiffness measurements (ρ = 0.778). Serum M2BPGi is a reliable noninvasive method for the assessment of LC and significant fibrosis in patients with CLD.

Trampoline-related fractures of the proximal tibia in children

Background

Trampoline-related fractures of the proximal tibial metaphysis are common in children and have been linked to subsequent valgus deformity of the tibia. The purpose of this study was to investigate the characteristics of trampoline-related proximal tibial fractures in young children.

Methods

We evaluated 40 patients with proximal tibial fracture after trampolining between 2013 and 2019. The median duration of follow-up was 18 months. Standing long leg radiographs were obtained at the last follow-up to evaluate angular deformity and limb length inequality in the patients. The measurements recorded include the lower limb length, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), mechanical axis deviation (MAD), and anatomical tibio-femoral angle (aTFA). The anterior tilt angle (ATA) was measured using a lateral radiograph of the tibia.

Results

The median age at injury was 40.0 months. Using trampoline with a heavier person was the most common mechanism of injury. aTFA and MAD were found to be increased towards the valgus at the last follow-up in our patient; however, the increase was not statistically significant (p = 0.692 and p = 0.973, respectively). The anterior tilt angle was increased in the injured leg at the last follow-up. But the change was not statistically significant (p = 0.09).

Conclusions

Using trampoline with a heavier person carries the risk of trampoline-related proximal tibial fracture in young children. We did not find a significant change in limb alignment at a minimum of one year of follow-up.

Microvascular invasion may be the determining factor in selecting TACE as the initial treatment in patients with hepatocellular carcinoma

ABSTRACT

The aim of this study was to investigate factors affecting tumor necrosis with transcatheter arterial chemoembolization (TACE). Factors associated with early hepatocellular carcinoma recurrence after curative hepatectomy were also evaluated.Data of 51 patients who underwent surgery after a single session of TACE at a single university hospital were retrospectively analyzed. Factors that might affect tumor necrosis were determined by evaluating the TACE approach and by analyzing computed tomography and TACE findings, pathologic reports, and laboratory findings.In univariate analysis, microvascular invasion (MVI), radiological capsule appearance on the computed tomography, chronic hepatitis B, diabetes mellitus and serum albumin, MVI were significantly associated with tumor necrosis by TACE (P < .02). In multivariate analysis, MVI was the only statistically significant factor in TACE-induced tumor necrosis (P = .001). In univariate and multivariate analysis, MVI was the strongest factor for recurrence-free survival rate within 2 years (P = .008, P = .002).MVI could be a crucial factor in determining TACE as an initial treatment for hepatocellular carcinoma. MVI is also a strong indicator of recurrence within 2 years after curative hepatic resection.

[Gallbladder Perforation after Transarterial Chemoembolization in a Patient with a Huge Hepatocellular Carcinoma]

Transarterial chemoembolization (TACE) is a common treatment for unresectable hepatocellular carcinoma (HCC). The most common complications after TACE are non-specific symptoms called post-embolization syndrome, such as abdominal pain or fever. Rare complications, such as liver failure, liver abscess, sepsis, pulmonary embolism, cholecystitis, can also occur. On the other hand, gallbladder perforation is quite rare. This paper reports a case of gallbladder perforation following TACE. A 76-year-old male with a single 9-cm-sized HCC underwent TACE. Five days after TACE, he developed persistent right upper quadrant pain and ileus. An abdomen CT scan confirmed gallbladder perforation with bile in the right paracolic gutter and pelvic cavity. Percutaneous transhepatic gallbladder drainage was performed with the intravenous administration of antibiotics. After 1 month, the patient underwent right hemihepatectomy and cholecystectomy. Physicians should consider the possibility of gallbladder perforation, which is a rare complication after TACE, when unexplained abdominal pain persists.

Effectiveness of Albumin-bilirubin Score as a Predictor of Post-hepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Backgrounds/Aims

Post-hepatectomy liver failure (PHLF) is a major concern for patients with hepatocellular carcinoma (HCC) who have undergone liver resection. The albumin-bilirubin (ALBI) score is a novel model for assessing liver function. We aimed to investigate the effectiveness of the ALBI score as a predictor of PHLF in HCC patients who have undergone hepatectomy in South Korea.

Methods

Between January 2014 and November 2018, HCC patients who underwent hepatectomy and indocyanine retention rate at 15 min (ICG-R15) test were enrolled in this study.

Results

A total of 101 patients diagnosed with HCC underwent hepatectomy. Thirty-two patients (31.7%) experienced PHLF. The ALBI score (OR 2.83; 95% CI 1.22-6.55; p=0.015), ICG-R15 (OR 1.07; 95% CI 1.02-1.12; p=0.007) and ALBI grade (OR 2,86; 95% CI 1.08-7.58; p=0.035) were identified as independent predictors of PHLF by multivariable analysis. The area under the receiver operating characteristic curve of the ALBI score and ICG-R15 were 0.676 (95% CI 0.566-0.785) and 0.632 (95% CI 0.513-0.752), respectively. The optimal cutoff value of the ALBI score in predicting PHLF was -2.62, with a sensitivity of 75.0% and a specificity of 56.5%.

Conclusions

The ALBI score is an effective predictor of PHLF in patients with HCC, and its predictive ability is comparable to that of ICG-R15.

Fasciola Hepatica Induced Hepatic Abscess Treated with Triclabendazole

Fascioliasis is a zoonotic disease caused by Fasciola hepatica that infects mainly cattle, sheep, and goats. Humans can be infected by water or aquatic plants contaminated with metacercariae. The authors encountered two cases of F. hepatica infection. One patient reported abdominal discomfort with marked eosinophilia. The other patient had chest discomfort with marked eosinophilia. The abdominal CT images revealed hypodense lesions in the liver. The ultrasonography-guided liver biopsy findings in both patients were indicative of parasitic infections. Serological tests confirmed the definite diagnoses. Both patients were treated with a single dose of triclabendazole, which is the treatment of choice for fascioliasis. These findings suggest that a diagnosis of fascioliasis, particularly in the acute phase, should be considered in patients with abdominal pain, marked eosinophilia, and hypodense hepatic lesions on CT.

Risk factors associated with hypophosphatemia in chronic Hepatitis B patients treated with tenofovir disoproxil fumarate

Tenofovir disoproxil fumarate (TDF) is thought to cause varying degrees of hypophosphatemia in patients with chronic hepatitis B (CHB). Therefore, we investigated factors that cause hypophosphatemia in patients treated with TDF and methods to increase serum phosphorus concentrations in clinical practice.We completed a retrospective review of patients with CHB treated with TDF initially at Kosin University Gospel Hospital, Busan, Korea from January 2012 to January 2017. Subclinical hypophosphatemia and hypophosphatemia were defined as serum phosphorus below 3.0 mg/dL and 2.5 mg/dL, respectively.We screened 206 patients with CHB treated with TDF, among which 135 were excluded for the following reasons: baseline malignancy (59), limited data (50), co-administered other antivirals (14), hypophosphatemia at baseline (7), and other reasons (5). The final study population comprised 71 patients. Subclinical hypophosphatemia developed in 43 (60.5%) patients. Hypophosphatemia occurred in 18 patients (25.3%). Liver cirrhosis was the most significant predictor of hypophosphatemia (P = .038, OR = 3.440, CI = 1.082-10.937) Patients diagnosed with subclinical hypophosphatemia were encouraged to increase their intake of nuts and dairy products (25 patients) or reduce their alcohol intake (2), dose reduction of TDF (4) or placed under observation (4). Among patients with subclinical hypophosphatemia, serum phosphorus concentrations were elevated (>3.0 mg/dL) in 23 of 36 patients (63.8%). Increased nut and dairy intake increased phosphorus concentrations to more than 3.0 mg/dl in 16 of 25 patients (64.0%).Entecavir or tenofovir alafenamide fumarate (TAF) should be considered rather than TDF in patients with liver cirrhosis because of the risk of hypophosphatemia. Instead of stopping TDF treatment, encouraging increased intake of phosphorus-rich foods could increase serum phosphorus concentrations in clinical practice.

Percutaneous Transcholecystic Removal of Common Bile Duct Stones: Case Series in 114 Patients

Purpose To evaluate the safety and effectiveness of percutaneous transcholecystic removal of common bile duct (CBD) stones in 114 patients. Materials and Methods This retrospective study was approved by the institutional review board. From September 2011 through February 2017, 114 consecutive patients (68 men, 46 women; mean age, 73 years) underwent percutaneous transcholecystic removal of CBD stones. All patients had acute cholangitis or cholecystitis. Stones were extracted through a 12-F sheath by using a Wittich nitinol stone basket uder fluoroscopic guidance. Technical success rates, complications, and long-term follow-up were evaluated. Results Technical success was achieved in 96 of 114 (84.2%) patients. In 18 patients, stone removal was unsuccessful due to failure of cystic duct cannulation (n = 11), proximal migration of the CBD stone (n = 3), multiple CBD stones (n = 3), and low insertion of the cystic duct (n = 1). No major procedure-related complications were seen. During the mean follow-up of 644 days (range, 11-2206 days), CBD stones recurred in 12 patients after a mean of 884 days (range, 439-1799 days) after the procedure. Conclusion Percutaneous transcholecystic removal of common bile duct stones seems to be a safe and effective method. © RSNA, 2018 Online supplemental material is available for this article . See also the editorial by vanSonnenberg and Panchanathan in this issue.

Changes in antipsychotic drug usage and factors affecting the use of typical drugs based on nationwide health insurance data in South Korea

OBJECTIVES

To determine changes in antipsychotic drug usage in all South Korean patients with schizophrenia in 2011-2015 and factors affecting their utilisation in 2015.

DESIGN AND SETTING

Retrospective cohort study using health insurance claims data on patients with schizophrenia in South Korea in 2011-2015.

PARTICIPANTS

All treated patients with schizophrenia in South Korea in 2011-2015. The number of patients with schizophrenia was 171 302 in 2011, 175 488 in 2012, 177 763 in 2013, 180 079 in 2014 and 183 427 in 2015.

MAIN OUTCOME MEASURES

Changes in antipsychotic drug usage and factors affecting the use of antipsychotics.

RESULTS

Among patients with schizophrenia, there were tendencies of decreased use of antipsychotic combination therapy of typical drugs (from 11.5% to 7.5%) but increased use of combination therapy of atypical drugs (from 21.8% to 29.0%). Factors affecting the use of typical drugs were sex, age, geographical region, type of benefits/insurances and type of medical institutions. Use of typical antipsychotics was increased by age (OR=1.02, 95% CI 1.02 to 1.02). It was higher in men (OR=1.27, 95% CI 1.23 to 1.30) than that in women. It was higher in Medicaid benefiters (OR=4.49, 95% CI 4.35 to 4.64) than that in patients with health insurance. Use of typical drugs was higher among patients treated in general hospitals (OR=1.46, 95% CI 1.32 to 1.64), primary hospitals (OR=3.25, 95% CI 2.95 to 3.59), long-term care hospitals (OR=3.00, 95% CI 2.59 to 3.49) and clinics (OR=8.87, 95% CI 8.06 to 9.76) compared with that in tertiary care hospitals. Compared with metropolitan region, higher use of typical antipsychotics was seen in Gangwon (OR=1.14, 95% CI 1.05 to 1.25), Jeolla (OR=1.32, 95% CI 1.26 to 1.39) and Gyeongsang (OR=1.14, 95% CI 1.10 to 1.18) provinces.

CONCLUSIONS

Results of this study confirmed changes of antipsychotic drug usage from typical to atypical antipsychotics in the treatment of schizophrenia and identified factors affecting the use of typical drugs, in contrast with current treatment trend in South Korea. These results may be used in the improvement of a medical system.

Humor as Wisdom for Reframing Life

Human beings inevitably experience anxiety but attempt to avoid facing it through various forms of self-deception. This avoidance can lead to pathological symptoms. Young and middle-aged adults may be especially susceptible to suffering from anxiety because they are often single-mindedly pursuing means of achieving security. For these and others who fail to embrace life with warm enthusiasm, humor can serve to alleviate stress. This article views humor as a characteristic disposition of older adults-their humor signifying a sense of integrity and wisdom that often accompanies the aging process. Humor binds together feelings of despair and joy and contributes to a faithful reframing of faith and life. This article proposes that individuals acquire humor by perceiving the world as if on a journey to an exotic new place, seeing with new eyes even the most mundane of everyday objects and events. This capacity to perceive beauty in the ordinary world reflects a wisdom of older adults potentially available even to the young.

Long-Term Outcomes of Patients with Stent Tips Embedded into Internal Carotid Artery Branches during Aneurysm Coiling

BACKGROUND AND PURPOSE

During stent-assisted coiling of ICA aneurysms, stent tips are sometimes unintentionally embedded into ICA branches. Stent tips can be visualized because they have radiopaque markers. Concerns regarding stent tip misplacement include risks of artery perforation and occlusion. The aim of this study was to evaluate the long-term outcomes of ICA branches with embedded stent tips.

MATERIALS AND METHODS

ICA branches with embedded stent tips were identified among 35 patients with unruptured ICA aneurysms treated with stent-assisted coiling between November 2003 and November 2014. Patient clinical and angiographic outcomes associated with the embedded stent tip were analyzed.

RESULTS

Most of the 35 studied aneurysms were paraclinoid ICA aneurysms (n = 30). The most commonly involved ICA branch was the posterior communicating artery (26 patients, 74.3%), followed by the anterior choroidal artery (8 patients, 22.9%) and ophthalmic artery (1 patient, 2.9%). During the follow-up period (38.6 ± 17.9 months), no new neurologic deficits developed. Neither hemorrhagic nor thromboembolic events occurred. Angiography was performed during the final follow-up evaluation at a mean of 32.7 ± 18.0 months, and all ICA branches with embedded stent tips showed patent blood flow without severe luminal narrowing.

CONCLUSIONS

In our experience, placement of a stent tip into ICA branches during stent-assisted coiling was not associated with any major adverse events.

Barriers to treatment of failed or interferon ineligible patients in the era of DAA: single center study

BACKGROUND/AIMS

Interferon-based treatment is not appropriate for a large number of patients with chronic hepatitis C for various medical and social reasons. Newly developed directly acting antivirals (DAAs) have been used to treat chronic hepatitis C without severe adverse effects and have achieved a sustained viral response (SVR) rate of 80-90% with short treatment duration. We were interested to determine whether all patients who failed to respond to or were ineligible for interferon-based therapy could be treated with DAAs.

METHODS

Medical records of patients with positive serum anti-hepatitis C virus (HCV) or HCV RNA between January 2009 and December 2013 were reviewed. Demographic, clinical, and treatment data were collected for analysis.

RESULTS

A total of 876 patients were positive for both anti-HCV and HCV RNA. Of these, 244 patients were eligible for interferon, although this was associated with relapse in 39 (16%) of patients. In total, 130 patients stopped interferon therapy (67% adverse effects, 28% non-adherent, 4% malignancy, 1% alcohol abuse) and 502 patients were ineligible (66% medical contraindications, 25% non-adherent, 5% socioeconomic problems). Among 671 patients who were ineligible for or failed to respond to interferon therapy, more than 186 (27.7%) could not be treated with DAA due to financial, social, or cancer-related conditions.

CONCLUSIONS

Newly developed DAAs are a promising treatment for patients with chronic hepatitis C who are ineligible for or failed to respond to interferon-based therapy. Nevertheless, not all chronic hepatitis C patients can be treated with DAAs due to various reasons.

Transplantation of a Scaffold-Free Cartilage Tissue Analogue for the Treatment of Physeal Cartilage Injury of the Proximal Tibia in Rabbits

PURPOSE

The purpose of this study was to investigate the effects of transplantation of an in vitro-generated, scaffold-free, tissue-engineered cartilage tissue analogue (CTA) using a suspension chondrocyte culture in a rabbit growth-arrest model.

MATERIALS AND METHODS

We harvested cartilage cells from the articular cartilage of the joints of white rabbits and made a CTA using a suspension culture of 2×10⁷ cells/mL. An animal growth plate defect model was made on the medial side of the proximal tibial growth plate of both tibias of 6-week-old New Zealand white rabbits (n=10). The allogenic CTA was then transplanted onto the right proximal tibial defect. As a control, no implantation was performed on the left-side defect. Plain radiographs and the medial proximal tibial angle were obtained at 1-week intervals for evaluation of bone bridge formation and the degree of angular deformity until postoperative week 6. We performed a histological evaluation using hematoxylin-eosin and Alcian blue staining at postoperative weeks 4 and 6.

RESULTS

Radiologic study revealed a median medial proximal tibial angle of 59.0° in the control group and 80.0° in the CTA group at 6 weeks. In the control group, statistically significant angular deformities were seen 3 weeks after transplantation (p<0.05). On histological examination, the transplanted CTA was maintained in the CTA group at 4 and 6 weeks postoperative. Bone bridge formation was observed in the control group.

CONCLUSION

In this study, CTA transplantation minimized deformity in the rabbit growth plate injury model, probably via the attenuation of bone bridge formation.

Structured patch model for a unified automatic and interactive segmentation framework

We present a novel interactive segmentation framework incorporating a priori knowledge learned from training data. The knowledge is learned as a structured patch model (StPM) comprising sets of corresponding local patch priors and their pairwise spatial distribution statistics which represent the local shape and appearance along its boundary and the global shape structure, respectively. When successive user annotations are given, the StPM is appropriately adjusted in the target image and used together with the annotations to guide the segmentation. The StPM reduces the dependency on the placement and quantity of user annotations with little increase in complexity since the time-consuming StPM construction is performed offline. Furthermore, a seamless learning system can be established by directly adding the patch priors and the pairwise statistics of segmentation results to the StPM. The proposed method was evaluated on three datasets, respectively, of 2D chest CT, 3D knee MR, and 3D brain MR. The experimental results demonstrate that within an equal amount of time, the proposed interactive segmentation framework outperforms recent state-of-the-art methods in terms of accuracy, while it requires significantly less computing and editing time to obtain results with comparable accuracy.

Difference in suicide methods used between suicide attempters and suicide completers

Background

In light of the increased suicide rate in Korea, it has become important for researchers to examine the various factors associated with it. The purpose of this study is to compare and analyze the difference between suicide attempters and completers in terms of the suicide methods used and the lethality of these methods. In addition, we investigated certain demographic factors that are associated with the choice of suicide method by evaluating their lethality.

Finding

The most frequently used methods of suicide were different in the two groups of attempters and completers. Drug poisoning was the most frequent method in suicide attempters, whereas hanging was the most common method among suicide completers. Drug poisoning, stabbing, and other chemical poisoning were evaluated as relatively non-lethal compared to other suicide methods. While about 70.0% of the suicide attempters used relatively non-lethal methods, almost all suicide completers used lethal methods, based on our classification of the lethality of the method. In terms of gender, males used more lethal methods of suicide.

Conclusions

Suicide completers’ choice of suicide methods are different from those of suicide attempters and tend to be more lethal. Interventions to restrict access to more lethal suicidal methods could be a useful strategy to reduce the suicide rates in South Korea.

Apparent treatment-resistant hypertension among elderly Korean hypertensives: an insight from the HIT registry

The aim of this study was to determine the clinical characteristics of patients with resistant hypertension (RH) and predictors among elderly Korean hypertensives. This prospective, multi-center, observational study evaluated 2439 elderly hypertensive patients between December 2008 and November 2011, who visited secondary hypertension clinics for high blood pressure (BP). Patients were categorized as resistant if their BP was ≥140/90 mm Hg and if they reported using antihypertensive medications from three different drug classes, including a diuretic or drugs from ≥4 antihypertensive drug classes, regardless of BP. Characteristics of patients with RH were compared with those of patients who were controlled with one or two antihypertensive medications after 6-month antihypertensive treatment. In comparison with 837 patients with non-RH, 404 patients with RH were more likely to be aware of their status of high BP before enrollment and have a high baseline systolic BP ≥160 mm Hg, microalbuminuria, high body mass index (BMI) ≥24 kg m(-2) and diabetes mellitus (DM). In drug-naive patients, awareness of hypertension at baseline was the only independent predictor for RH. In elderly Korean hypertensives, BMI (≥24 kg m(-2)), baseline systolic BP (≥160 mm Hg), microalbuminuria, DM and awareness of hypertension showed an association with RH.

Learning full pairwise affinities for spectral segmentation

Segmenting a single image into multiple coherent groups remains a challenging task in the field of computer vision. Particularly, spectral segmentation which uses the global information embedded in the spectrum of a given image's affinity matrix is a major trend in image segmentation. This paper focuses on the problem of efficiently learning a full range of pairwise affinities gained by integrating local grouping cues for spectral segmentation. We first construct a sparse multilayer graph whose nodes are both the pixels and the oversegmented regions obtained by an unsupervised segmentation algorithm. By applying the semi-supervised learning strategy to this graph, the intra and interlayer affinities between all pairs of nodes can be estimated without iteration. These pairwise affinities are then applied into the spectral segmentation algorithms. In this paper, two types of spectral segmentation algorithms are introduced: $(K)$-way segmentation and hierarchical segmentation. Our algorithms provide high-quality segmentations which preserve object details by directly incorporating the full-range connections. Moreover, since our full affinity matrix is defined by the inverse of a sparse matrix, its eigendecomposition can be efficiently computed. The experimental results on the BSDS and MSRC image databases demonstrate the superiority of our segmentation algorithms in terms of relevance and accuracy compared with existing popular methods.

Joint depth map and color consistency estimation for stereo images with different illuminations and cameras

Abstract—In this paper, we propose a method that infers both accurate depth maps and color-consistent stereo images for radiometrically varying stereo images. In general, stereo matching and performing color consistency between stereo images are a chicken-and-egg problem since it is not a trivial task to simultaneously achieve both goals. Hence, we have developed an iterative framework in which these two processes can boost each other. First, we transform the input color images to log-chromaticity color space, from which a linear relationship can be established during constructing a joint pdf of transformed left and right color images. From this joint pdf, we can estimate a linear function that relates the corresponding pixels in stereo images. Based on this linear property, we present a new stereo matching cost by combining Mutual Information (MI), SIFT descriptor, and segment-based plane-fitting to robustly find correspondence for stereo image pairs which undergo radiometric variations. Meanwhile, we devise a Stereo Color Histogram Equalization (SCHE) method to produce color-consistent stereo image pairs, which conversely boost the disparity map estimation. Experimental results show that our method produces both accurate depth maps and color-consistent stereo images, even for stereo images with severe radiometric differences.

The Combination Therapy with Peg-interferon Alfa and Ribavirin for Chronic Hepatitis C in Korea as an Initial Treatment

Objectives The combination therapy with peginterferon and ribavirin has been used to treat chronic hepatitis C for several years in Korea but there is a few report about the results of the treatment. We evaluated safety and efficacy of the combination therapy with Peg-interferon and ribavirin and analyzed factors that may affect treatment. Methods Total 72 untreated chronic hepatitis C patients were administered pegylated interferon alfa-2a (180µg/week) or alfa-2b (1.5µg/kg/week) and ribavirin (800 mg/day in genotype 2, 1000-1200 mg/day in genotype 1). Duration of the treatment was 24 weeks in genotype 2 and 48 weeks in genotype 1. Response of the treatment was evaluated by rapid virologic response (RVR), early virologic response (EVR), end treatment virologic response (ETR), sustained virologic response (SVR) and adverse event. Results The RVR, EVR, ETR, SVR were 61.8%, 82.5%, 88.9% and 80.5% retrospectively. The SVR of genotype 1 was 63.4% and non-genotype 1 was 96.7%. Genotype (Odds ratio: 14.92) was an independent predictor of the SVR. Leukocytopenia, flu-like symptoms, itching, rash and anemia were common adverse events of the combination therapy and if then we reduced dose and there was one case of cessation. Conclusions The combination therapy with Peg-interferon and ribavirin shows efficacy to the Korean patients with chronic hepatitis C as an initial treatment. Genotypes 2 and 3 were more likely to have a sustained virologic response.

Hepatitis C virus (HCV) genotypes and the influence of HCV subtype 1b on the progression of chronic hepatitis C in Korea: a single center experience

Background/Aims

There is some controversy regarding whether or not hepatitis C virus (HCV) subtype 1b is more influential than non-1b subtypes on the progression of chronic hepatitis (CH) C to liver cirrhosis (LC) and hepatocellular carcinoma (HCC).

Methods

We retrospectively analyzed 823 patients with chronic HCV infection, including 443 CH patients, 264 LC patients, and 116 HCC patients, who were HCV RNA positive and HBsAg negative. These patients had not received any prior treatment with either interferon alone or a combination of interferon and ribavirin.

Results

HCV subtypes 1b (51.6%) and 2a/2c (39.5%) were the two most common genotypes. The proportions of genotypes 2 (2a/2c, 2b, and 2) and 3 were 45.8% and 1.1%, respectively. One case of genotype 4 was found. HCV subtype 1b (47.3%) was less common than the non-1b subtypes (52.7%) in non-LC patients, but its proportion (56.9%) was higher than that of non-1b subtypes (43.1%) in LC patients (P=0.006). The proportions of patients with HCV subtype 1b did not differ significantly between the LC (55.3%) and HCC (60.3%) groups. Older age, male gender, and the relative progression of liver damage (non-LC vs. compensated LC vs. decompensated LC) were significant risk factors for HCC, with odds ratios of 1.081 (95% confidence interval [CI], 1.056-1.106), 5.749 (95% CI, 3.329-9.930), and 2.895 (95% CI, 2.183-3.840), respectively. HCV subtype 1b was not a significant risk factor for HCC (odds ratio, 1.423; 95% CI, 0.895-2.262).

Conclusions

HCV subtypes 1b and 2a/2c were the two most common HCV genotypes. HCV subtype 1b seemed to be more influential than non-1b subtypes on the progression of CH to LC, but not on the development of HCC from LC.

NONRIGID VOLUME REGISTRATION USING SECOND-ORDER MRF MODEL

In this paper, we introduce a nonrigid registration method using a Markov Random Field (MRF) energy model with second-order smoothness priors. The registration determines an optimal labeling of the MRF energy model where the label corresponds to a 3D displacement vector. In the MRF energy model, spatial relationships are constructed between nodes using second-order smoothness priors. This model improves limitations of first-order spatial priors which cannot fully incorporate the natural smoothness of deformations. Specifically, the second-order smoothness priors can generate desired smoother displacement vector fields and do not suffer from fronto-parallel effects commonly occurred in first-order priors. The usage of second-order priors in the energy model enables this method to produce more accurate registration results. In the experiments, we will show comparative results using uni- and multi-modal Brain MRI volumes.

Interferon-alpha-induced destructive thyroiditis followed by Graves' disease in a patient with chronic hepatitis C: a case report

Interferon-induced thyroiditis (IIT) is a major clinical problem for patients receiving interferon-alpha (IFN-α) therapy. But, destructive thyroiditis followed by Graves' disease associated with IFN-α therapy is very rarely reported. Herein, we report a rare case of pegylated IFN-α (pegIFN-α) induced destructive thyroiditis followed by Graves' disease in a patient with HCV infection. A 31-yr-old woman suffered from chronic active hepatitis C and was treated with pegIFN-α and ribavirin for 12 months. Results of a thyroid function test and autoantibody levels were normal before IFN-α therapy was initiated. Destructive thyrotoxicosis appeared seven months after the initiation of IFN-α therapy, followed by Graves' thyrotoxicosis two months after the cessation of therapy. The diagnoses of destructive thyroiditis and Graves' disease were confirmed by the presence of TSH receptor antibodies in addition to Tc-99m scintigraphy findings. The patient's antithyroglobulin antibody titer increased gradually during IFN-α therapy and remained weakly positive after IFN-α therapy was discontinued.

Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report

Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of ≥0.5×10⁹/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.

Robust stereo matching using adaptive normalized cross-correlation

A majority of the existing stereo matching algorithms assume that the corresponding color values are similar to each other. However, it is not so in practice as image color values are often affected by various radiometric factors such as illumination direction, illuminant color, and imaging device changes. For this reason, the raw color recorded by a camera should not be relied on completely, and the assumption of color consistency does not hold good between stereo images in real scenes. Therefore, the performance of most conventional stereo matching algorithms can be severely degraded under the radiometric variations. In this paper, we present a new stereo matching measure that is insensitive to radiometric variations between left and right images. Unlike most stereo matching measures, we use the color formation model explicitly in our framework and propose a new measure, called the Adaptive Normalized Cross-Correlation (ANCC), for a robust and accurate correspondence measure. The advantage of our method is that it is robust to lighting geometry, illuminant color, and camera parameter changes between left and right images, and does not suffer from the fattening effect unlike conventional Normalized Cross-Correlation (NCC). Experimental results show that our method outperforms other state-of-the-art stereo methods under severely different radiometric conditions between stereo images.

Rolled fingerprint construction using MRF-based nonrigid image registration

This paper proposes a new rolled fingerprint construction approach incorporating a state-of-the-art nonrigid image registration method based upon a Markov random field (MRF) energy model. The proposed method finds dense correspondences between images from a rolled fingerprint sequence and warps the entire fingerprint area to synthesize a rolled fingerprint. This method can generate conceptually more accurate rolled fingerprints by preserving the geometric properties of the finger surface as opposed to ink-based rolled impressions and other existing rolled fingerprint construction methods. To verify the accuracy of the proposed method, various comparative experiments were designed to reveal differences among the rolled construction methods. The results show that the proposed method is significantly superior in various aspects compared to previous approaches.

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.

Partition-based extraction of cerebral arteries from CT angiography with emphasis on adaptive tracking

In this paper a method to extract cerebral arteries from computed tomographic angiography (CTA) is proposed. Since CTA shows both bone and vessels, the examination of vessels is a difficult task. In the upper part of the brain, the arteries of main interest are not close to bone and can be well segmented out by thresholding and simple connected-component analysis. However in the lower part the separation is challenging due to the spatial closeness of bone and vessels and their overlapping intensity distributions. In this paper a CTA volume is partitioned into two sub-volumes according to the spatial relationship between bone and vessels. In the lower sub-volume, the concerning arteries are extracted by tracking the center line and detecting the border on each cross-section. The proposed tracking method can be characterized by the adaptive properties to the case of cerebral arteries in CTA. These properties improve the tracking continuity with less user-interaction.

Robust segmentation of cerebral arterial segments by a sequential Monte Carlo method: particle filtering

In this paper a method to extract cerebral arterial segments from CT angiography (CTA) is proposed. The segmentation of cerebral arteries in CTA is a challenging task mainly due to bone contact and vein contamination. The proposed method considers a vessel segment as an ellipse travelling in three-dimensional (3D) space and segments it out by tracking the ellipse in spatial sequence. A particle filter is employed as the main framework for tracking and is equipped with adaptive properties to both bone contact and vein contamination. The proposed tracking method is evaluated by the experiments on both synthetic and actual data. A variety of vessels were synthesized to assess the sensitivity to the axis curvature change, obscure boundaries, and noise. The experimental results showed that the proposed method is also insensitive to parameter settings and requires less user intervention than the conventional vessel tracking methods, which proves its improved robustness.

Enantiomer Separation of a Novel Aminothiazolecarboxamide Fungicide Using Polysaccharide-Derived Chiral Stationary Phases

The direct enantioseparation of a novel aminothiazolecarboxamide fungicide, ethaboxam, on polysaccharide-derived chiral stationary phases (CSPs) is described. Good resolution is achieved with several polysaccharide-derived CSPs. Chiralcel OD (OD-H) and Chiralpak AS are excellent for direct enantiomer separation of ethaboxam. The elution behavior and the effects of eluent composition on the resolution of ethaboxam are also investigated. Furthermore, the mechanism for chiral recognition using molecular mechanics is discussed.

Cerebral lipiodol embolism during transcatheter arterial chemoembolization

Cerebral lipiodol embolism (CLE) is a rare complication that may occur during chemoembolization. The authors present three cases of CLE during transcatheter arterial chemoembolization for hepatocellular carcinoma. Multiple small nonconfluent hyperintense intracerebral lesions were found on the diffusion-weighted and fluid-attenuated inversion recovery MRI. Clinical signs completely resolved and MRI lesions markedly improved on follow-up evaluation within a 3-week period.

[The clinical meaning of the emergence of viral breakthrough during lamivudine treatment in patients with hepatitis B virus related chronic liver disease]

BACKGROUND/AIMS

Viral breakthrough has been considered a major limitation of lamivudine in the treatment of hepatitis B virus related chronic liver disease. Its clinical meaning has not been thoroughly assessed.

METHODS

64 patients who showed viral breakthrough during lamivudine treatment were retrospectively reviewed. We evaluated the rate of HBeAg seroconversion and hepatic decompensation after viral breakthrough.

RESULTS

After viral breakthrough, serum alanine transaminase (ALT) elevation more than 1.2 x upper limit of normal (ULN) was noticed in 40 patients (62.5%). Acute flare (serum ALT elevation > x 5 ULN, or serum bilirubin >3 mg/dL) occurred in 15 patients (23.4%). During the period of follow up (15.0 +/- 9.7 months; range, 0-31 months) since viral breakthrough, decreased serum HBV-DNA level to below the detection limit and serum ALT normalization was seen in 15 patients (23.4%). HBeAg seroconversion was noticed in 7 (13.7%) of a total of 51 HBeAg positive patients at base line; in 4 (15.4%) of 26 patients with non-hepatic failure (chronic hepatitis or Child-Pugh class A liver cirrhosis) at base line; and in 2 (40.0%) of 5 patients with non-hepatic failure at base line and acute flare after viral breakthrough. During this period, terminal hepatic decompensation (Child-Pugh class C) or death was noticed in 9 (90.0%) of 10 patients who had hepatic decompensation (Child-Pugh class B or C) at baseline and acute flare after viral breakthrough.

CONCLUSIONS

Acute flare after viral breakthrough seemed to continue during HBeAg seroconversion and rarely developed into terminal hepatic decompensation or death in patients with non-hepatic decompensation at baseline. Its incidence is not only high but lethal to most patients with hepatic decompensation at baseline.

Models and algorithms for efficient multiresolution topology estimation of measured 3-D range data

In this paper, we propose a new efficient topology estimation algorithm to construct a multiresolution polygonal mesh from measured three-dimensional (3-D) range data. The topology estimation problem is defined under the constraints of cognition, compactness, and regularity, and the algorithm is designed to be applied to either a cloud of points or a dense mesh. The proposed algorithm initially segments the range data into a finite number of Voronoi patches using the K-means clustering algorithm. Each patch is then approximated by an appropriate polygonal and eventually a triangular mesh model. In order to improve the equiangularity of the mesh, we employ a dynamic mesh model, in which the mesh finds its equilibrium state adaptively, according to the equiangularity constraint. Experimental results demonstrate that satisfactory equiangular triangular mesh models can be constructed rapidly at various resolutions, while yielding tolerable modeling error.

Bile duct: analysis of percutaneous transluminal forceps biopsy in 130 patients suspected of having malignant biliary obstruction

PURPOSE

To evaluate percutaneous transluminal forceps biopsy in patients suspected of having a malignant biliary obstruction.

MATERIALS AND METHODS

One hundred thirty consecutive patients (82 men and 48 women; mean age, 59 years) with obstructive jaundice underwent transluminal forceps biopsy during or after percutaneous transhepatic biliary drainage. The lesions involved the common bile duct (n = 58), common hepatic duct (n = 39), hilum (n = 14), ampullary segment of the common bile duct (n = 11), right or left intrahepatic bile duct (n = 5), or the entire extrahepatic bile duct (n = 3). In each patient, three to five specimens (mean, 4.1 specimens) were taken from the lesion with 5.4-F biopsy forceps. The final diagnosis for each patient was confirmed with pathologic findings at surgery, additional histocytologic data, or clinical and radiologic follow-up. Statistical analysis was performed with the chi(2) test; a P value < or =.05 was considered to indicate a significant difference.

RESULTS

Ninety-eight of 130 biopsies resulted in correct diagnoses of malignancy. Five biopsy diagnoses proved to be true-negative. There were 27 false-negative diagnoses and no false-positive diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstructions was as follows: sensitivity, 78.4%; specificity, 100%; and accuracy, 79.2%. Sensitivity of biopsy in the 82 patients with cholangiocarcinoma was higher than in the 43 patients with malignant tumors other than cholangiocarcinoma (86.6% vs 62.8%, P <.005). Sensitivity was significantly lower in the ampullary segment of the common bile duct than in other sites (P <.01). No major complications related to the biopsy procedures occurred.

CONCLUSION

Percutaneous transluminal forceps biopsy is a safe procedure that is easy to perform through a transhepatic biliary drainage tract. It provides relatively high accuracy in the diagnosis of malignant biliary obstructions.

Identity of activation molecule 3 on superantigen-stimulated bovine cells is CD26

Most CD8(+) T cells in cultures of bovine mononuclear cells stimulated with staphylococcal enterotoxin C1 develop an unusual phenotype characterized by expression of activation molecule 3 (ACT3). This superantigen-dependent phenotype may be relevant to immunopathogenesis mediated by certain microbial toxins. The size and N-terminal sequence of immunoprecipitated ACT3 indicate that ACT3 is the bovine orthologue of CD26.

Epidemiological significance of sero-positive inhabitants against sparganum in Kangwon-do, Korea

Sparganum is a plerocercoid of pseudophyllidean tapeworms, Diphyllobothrium or Spirometra spp. Human sparganosis is endemic mainly in East and Southeast Asian countries where the custom of eating raw snake or frog meat, or poulticing with snake's skin exists. From January 1995 to November 1999, an epidemiological survey was undertaken to evaluate the serum levels of anti-sparganum specific IgG antibodies in Whachon-gun residents, Korea. An enzyme- linked immunosorbent assay (ELISA) and immunoblot analysis of the sera from 316 subjects were used. In addition, a stool examination from 416 inhabitants and questionnaires regarding the consumption of raw meat were given. Out of 416 inhabitants examined coprologically, one was infected with Clonorchis sinensis and two were infected with Metagonimus spp. The sera from 36 inhabitants (11.4 %) showed a positive reaction to the sparganum antigen. Out of these 36 inhabitants, the sera from 25 people were examined 7, 19, and 50 months later. The sera were found to still show positive reactions without any remarkable changes of anti-sparganum specific antibody titers except for one. An analysis of the questionnaires suggested that a history of eating of raw snakes or frogs was important risk factor for clinical or covert sparganosis (odd ratio=15.6 and 3.1, respectively).

A case of torsade de pointes associated with hypopituitarism due to hemorrhagic fever with renal syndrome

We describe a 51-yr-old man presenting with syncope due to torsade de pointes. The torsade de pointes was refractory to conventional medical therapy, including infusion of isoproterenol, MgSO4, potassium, lidocaine, and amiodarone. His past history, physical findings, and hormone study confirmed that QT prolongation was caused by anterior hypopituitarism that developed as a sequela of hemorrhagic fever with renal syndrome. The long QT interval with deep inverted T wave was completely normalized 4 weeks after starting steroid and thyroid hormone replacement. Hormonal disorders should be considered as a cause of torsade de pointes, because this life-threatening arrhythmia can be treated by replacing the missing hormone.

Short-term effect of mitomycin-C augmented trabeculectomy on axial length and corneal astigmatism

PURPOSE

To evaluate the short-term effect of trabeculectomy with adjunctive mitomycin-C (MMC) on corneal astigmatism and axial length.

SETTING

Asan Medical Center, University of Ulsan, Department of Ophthalmology, Seoul, Korea.

METHODS

Eighteen consecutive eyes of 16 patients having trabeculectomy with adjunctive MMC were prospectively analyzed. Intraocular pressure (IOP) and axial length were evaluated preoperatively and 1, 3, 6, and 12 months postoperatively. Postoperative changes in corneal astigmatism were evaluated using vector analysis.

RESULTS

The overall mean induced astigmatism showed with-the-rule change up to 3 months postoperatively followed by an against-the-rule shift. The mean axial length was significantly less postoperatively and changed throughout the 12 month follow-up. There was a positive correlation between postoperative axial length and IOP. Eyes with higher preoperative IOP had a greater decrease in axial length after trabeculectomy with MMC.

CONCLUSION

The induced corneal astigmatism after trabeculectomy with MMC was long lasting, although less than that in previous studies. The change in axial length after surgery was significant, especially in eyes with a high preoperative IOP. The decrease in axial length persisted throughout the follow-up.

Changes in posterior disc bulging and intervertebral foraminal size associated with flexion-extension movement: a comparison between L4-5 and L5-S1 levels in normal subjects

BACKGROUND CONTEXT

No previous study has used magnetic resonance imaging (MRI) to evaluate changes of posterior disc bulging and intervertebral foraminal size in the normal spine with flexion-extension movement, comparing L4-5 versus L5-S1 intervertebral levels.

PURPOSE

To determine changes in posterior disc bulging and intervertebral foraminal size with flexion-extension movement, comparing L4-5 versus L5-S1 intervertebral levels.

STUDY DESIGN

An in vivo study of magnetic resonance kinematics with spine flexion extension.

METHODS

Spines of three volunteers with no history of low back pain were scanned in neutral, flexion, and extension positions in a vertically open MRI system. MRI was repeated after 6 hours of normal activity and an additional 4 hours of heavy activity with a weighted vest. Posterior bulging of the intervertebral disc and the size of intervertebral foramen were measured at the L4-5 and L5-S1 levels.

RESULTS

With spine flexion, posterior bulging of the discs increased at L4-5 in eight of nine measurements (three different spine-loading states for each of three subjects) and L5-S1 discs in six of nine measurements. In most cases, posterior bulging decreased with extension. No significant difference was noted in the degree of disc bulge between levels. Foraminal size at L4-5 increased with flexion and decreased with extension, and the extent of these changes was greater at the L4-5 level than at L5-S1.

CONCLUSIONS

This pilot study demonstrates two distinct behavior characteristics of the normal spine with flexion-extension movement.

Enterobius vermicularis egg positive rate of pre-school children in Chunchon, Korea (1999)

Pre-school children were examined for the presence of Enterobius vermicularis egg by perianal swab method. We visited 67 nurseries and 25 kindergartens between January, 1999 and April, 1999 in Chunchon, Korea. Of the 4,711 children examined, 434 (9.2%) were found to be positive for E. vermicularis egg. The egg positive rates of boys and girls were 10.1% and 8.1%, respectively. The rates were 7.8% in kindergartens and 9.7% in nurseries. Positive rate of 50 institutions was less than 10%. Rate in 35 institutions was from 10% to less than 20%. Rate in 7 institutions was equal to or over 20%. Out of 1,113 children examined twice, 28 (2.5%) children were positive consecutively, 53 (4.8%) were positive with negative conversion, 47 (4.2%) were negative with positive conversion, and 985 (88.5%) were consecutively negative. It means that in the low endemic area of enterobiasis with around 10% positive rate, the two consecutive examinations may increase the egg detection rate of 4.2-4.8%. The small number of consecutive egg positive children also suggests that the worm burden of the positive children might be low. Since the egg positive rate of that age group in this City increased from 1.85% (1997), and 3.0% (1998), the more intensive regular control should be executed.

Five cases of ocular toxocariasis confirmed by serology

We report 5 cases of ocular toxocariasis in Korean adults complaining of visual impairment along with floating or bubbling sensation. Fundoscopic examination revealed a retinal detachment along with exudate in 4 cases. They all showed typical reaction by ELISA and immunoblot against Toxocra excretory-secretory antigen. One case showed high level of anti-Toxocara IgE antibodies (34,000 Toxocara units/L) as well as increased level of serum total IgE antibodies and the specific IgE antibodies for 3 inhalant antigens, suggesting that high level of anti-Toxocara IgE antibodies was associated with an atopic status. Clinical manifestations were improved after the sequential use of steroids then mebendazole. We also suggest that ocular toxocariasis should be thoroughly investigated even when an evocative uniocular inflammatory lesion is encountered in peripheral retina without a systematic disease.

MR and MR arthrography to identify degenerative and posttraumatic diseases in the shoulder joint

MR imaging provides a comprehensive evaluation of a wide spectrum of both intraarticular and extraarticular pathology of the shoulder. MR imaging enables the detection or exclusion of degenerative and posttraumatic diseases of the shoulder with a reasonable accuracy. MR arthrography is useful in the visualization of subtle anatomic details and further improves the differentiation. In this article, findings of MR imaging and MR arthrography of degenerative and posttraumatic shoulder diseases (impingement syndrome, rotator cuff tears, and glenohumeral instability) has been reviewed.

Stereochemical requirement at 4-position of 4-phenyl-1-arylsulfonylimidazolidinones for their cytotoxicities

In order to investigate the stereochemical requirements of planar structure at 4-position of 4-phenyl-1-arylsulfonylimidazolidinones (1) for their cytoxicities against human cancer cell lines, the size, the distance from imidazolidinone ring, and the conformation of this moiety were variegated. Replacement of phenyl moiety with naphthyl in compounds 2 and 3 or benzyl moiety in compound 4 sharply reduced activity of 1. Conformational restriction on phenyl ring in compound 5 also resulted in the loss of activity of 1. Therefore, phenyl moiety without any substituents directly attached to imidazolidinone ring of 1 should be considered as an essential pharmacophore for this analog.

An error detection and recovery algorithm for compressed video signal using source level redundancy

The motion compensation-discrete cosine transform (MC-DCT) coding is an efficient compression technique for a digital video sequence. However, the compressed video signal is vulnerable to transmission errors over noisy channels. In this paper, we propose a robust video transmission algorithm, which protects the compressed video signal by inserting redundant information at the source level. The proposed algorithm encodes every lth frame in the semi-intra frame (S-frame) mode, in which the redundant parity-check DC coefficients (PDCs) are systematically inserted into the compressed bitstream. Then, the decoder is capable of recovering very severe transmission errors, such as loss of an entire frame, in addition to detecting the errors effectively without requesting any information from external devices. The proposed algorithm is implemented based on the H.263 coder, and tested intensively in realistic error prone environment. It is shown that the proposed algorithm provides much better objective and subjective performances than the conventional H.263 coder in the error prone environment.

A cytogenetic study on human intestinal trematodes of the genus Metagonimus (Digenea: Heterophyidae) in Korea

In order to analyze chromosome numbers and karyotypes of intestinal trematodes belonging to the genus, Metagonimus, the gonad tissues of M. takahashii, M. miyatai, and M. yokogawai were prepared and examined. The number of bivalents in the first meiotic division of M. takahashii was nine (n = 9). The diploid number of M. miyatai was observed to be eighteen (2n = 18) and their chromosomes consisted of one pair of metacentric, 7 pairs of submetacentric, and one pair of telocentric chromosomes. The diploid number of M. yokogawai was thirty-two (2n = 32) and the chromosome complements were composed of two pairs of metacentric, 11 pairs of submetacentric, and three pairs of subtelocentric chromosomes. These results could be a supporting evidence for the validity of the new species, M. miyatai, distinct from M. yokogawai.