UniCon: A unified star-operation to efficiently find connected components on a cluster of commodity hardware

With a cluster of commodity hardware, how can we efficiently find all connected components of an enormous graph containing hundreds of billions of nodes and edges? The problem of finding connected components has been used in various applications such as pattern recognition, reachability indexing, graph compression, graph partitioning, and random walk. Several studies have been proposed to efficiently find connected components in various environments. Most existing single-machine and distributed-memory algorithms are limited in scalability as they have to load all data generated during the process into the main memory; they require expensive machines with vast memory capacities to handle large graphs. Several MapReduce algorithms try to handle large graphs by exploiting distributed storage but fail due to data explosion problems, which is a phenomenon that significantly increases the size of data as the computation proceeds. The latest MapReduce algorithms resolve the problem by proposing two distinguishing star-operations and executing them alternately, while the star-operations still cause massive network traffic as a star-operation is a distributed operation that connects each node to its smallest neighbor. In this paper, we unite the two star-operations into a single operation, namely UniStar, and propose UniCon, a new distributed algorithm for finding connected components in enormous graphs using UniStar. The partition-aware processing of UniStar effectively resolves the data explosion problems. We further optimize UniStar by filtering dispensable edges and exploiting a hybrid data structure. Experimental results with a cluster of 10 cheap machines each of which is equipped with Intel Xeon E3-1220 CPU (4-cores at 3.10GHz), 16GB RAM, and 2 SSDs of 1TB show that UniCon is up to 13 times faster than competitors on real-world graphs. UniCon succeeds in processing a tremendous graph with 129 billion edges, which is up to 4096 times larger than graphs competitors can process.

PACC: Large scale connected component computation on Hadoop and Spark

A connected component in a graph is a set of nodes linked to each other by paths. The problem of finding connected components has been applied to diverse graph analysis tasks such as graph partitioning, graph compression, and pattern recognition. Several distributed algorithms have been proposed to find connected components in enormous graphs. Ironically, the distributed algorithms do not scale enough due to unnecessary data IO & processing, massive intermediate data, numerous rounds of computations, and load balancing issues. In this paper, we propose a fast and scalable distributed algorithm PACC (Partition-Aware Connected Components) for connected component computation based on three key techniques: two-step processing of partitioning & computation, edge filtering, and sketching. PACC considerably shrinks the size of intermediate data, the size of input graph, and the number of rounds without suffering from load balancing issues. PACC performs 2.9 to 10.7 times faster on real-world graphs compared to the state-of-the-art MapReduce and Spark algorithms.

FlexGraph: Flexible partitioning and storage for scalable graph mining

How can we analyze large graphs such as the Web, and social networks with hundreds of billions of vertices and edges? Although many graph mining systems have been proposed to perform various graph mining algorithms on such large graphs, they have difficulties in processing Web-scale graphs due to massive communication and I/O costs caused by communication between workers, and reading subgraphs repeatedly. In this paper, we propose FlexGraph, a scalable distributed graph mining method reducing the costs by exploiting properties of real-world graphs. FlexGraph significantly decreases the communication cost, which is the main bottleneck of distributed systems, by exploiting different edge placement policies based on types of vertices. Furthermore, we propose a flexible storage format to reduce I/O costs when reading input graph repeatedly. Experiments show that FlexGraph succeeds in processing up to 64× larger graphs than existing distributed memory-based graph mining methods, and consistently outperforms previous disk-based graph mining methods.

Randomized clinical trial of preoperative skin antisepsis with chlorhexidine gluconate or povidone–iodine

Background

Skin antiseptic agents are used to prevent surgical-site infection (SSI); few trials have reported the superiority of any specific agent in clean-contaminated abdominal surgery. This RCT was designed to compare the effectiveness of chlorhexidine gluconate and povidone–iodine.

Methods

Consecutive patients who underwent clean-contaminated upper gastrointestinal or hepatobiliary–pancreatic open surgery between 2011 and 2014 were assigned randomly to either chlorhexidine gluconate or povidone–iodine. The primary endpoint was the occurrence of SSI within 30 days of surgery. Secondary endpoints included causative organisms and risk factors for SSI.

Results

A total of 534 patients were randomized; 31 (5·8 per cent) developed an SSI. There was no difference in the overall SSI rate in the chlorhexidine gluconate and povidone–iodine groups: 15 of 267 (5·6 per cent) and 16 of 267 (6·0 per cent) respectively (P = 0·853). The most common causative organism was Enterococcus faecalis. In subgroup analysis, biliary–pancreatic surgery had a higher SSI rate (26 of 127, 20·5 per cent) than upper gastrointestinal (2 of 204, 1·0 per cent) and hepatic (3 of 203, 1·5 per cent) resection. Both age (60 years and over) and type of incision were associated with the risk of SSI.

Conclusion

No difference was detected between chlorhexidine gluconate and povidone–iodine antiseptics for prevention of SSI. Registration number: NCT01495117 (http://www.clinicaltrials.gov).

Note: Near infrared interferometric silicon wafer metrology

In this investigation, two near infrared (NIR) interferometric techniques for silicon wafer metrology are described and verified with experimental results. Based on the transparent characteristic of NIR light to a silicon wafer, the fiber based spectrally resolved interferometry can measure the optical thickness of the wafer and stitching low coherence scanning interferometry can reconstruct entire surfaces of the wafer.

Control of mesenchymal stem cell phenotype and differentiation depending on cell adhesion mechanism

Control of cell-matrix adhesion has become an important issue in the regulation of stem cell function. In this study, a maltose-binding protein (MBP)-linked basic fibroblast growth factor (FGF2)-immobilised polystyrene surface (PS-MBP-FGF2) was applied as an artificial matrix to regulate integrin-mediated signalling. We sought to characterise human mesenchymal-stem cell (hMSC) behaviour in response to two different mechanisms of cell adhesion; (i) FGF2-heparan sulphate proteoglycan (HSPG)-mediated adhesion vs. (ii) fibronectin (FN)-integrin-mediated adhesion. Heparin inhibited hMSC adhesion to PS-MBP-FGF2 but not to FN-coated surface. The phosphorylation of focal adhesion kinase, cytoskeletal re-organisation, and cell proliferation were restricted in hMSCs adhering to PS-MBP-FGF2 compared to FN-coated surface. Expression of MSC markers, such as CD105, CD90 and CD166, decreased in hMSCs expanded on PS-MBP-FGF2 compared to expression in cells expanded on FN-coated surface. hMSCs that were expanded on FN-coated surface differentiated into osteogenic and adipogenic cells more readily than those that were expanded on PS-MBP-FGF2. Furthermore, we characterised the N-linked glycan structures of hMSCs depending on the cell adhesion mechanism using mass spectrometry (MS)-based quantitative techniques. MS analysis revealed that 2,3-sialylated glycans, a potential marker of stem cell function, were more abundant on hMSCs expanded on FN-coated surface than on those expanded on PS-MBP-FGF2. Thus, the differentiation potential of hMSCs is controlled by the type of adhesion substrate that might provide an idea for the design of biomaterials to control stem cell fate. Elucidation of the glycan structure on the cell membrane may help characterise hMSC function.

Spin-induced band modifications of graphene through intercalation of magnetic iron atoms

Intercalation of magnetic iron atoms through graphene formed on the SiC(0001) surface is found to induce significant changes in the electronic properties of graphene due mainly to the Fe-induced asymmetries in charge as well as spin distribution. From our synchrotron-based photoelectron spectroscopy data together with ab initio calculations, we observe that the Fe-induced charge asymmetry results in the formation of a quasi-free-standing bilayer graphene while the spin asymmetry drives multiple spin-split bands. We find that Fe adatoms are best intercalated upon annealing at 600 °C, exhibiting split linear π-bands, characteristic of a bilayer graphene, but much diffused. Subsequent changes in the C 1s, Si 2p, and Fe 3p core levels are consistently described in terms of Fe-intercalation. Our calculations together with a spin-dependent tight binding model ascribe the diffuse nature of the π-bands to the multiple spin-split bands originated from the spin-injected carbon atoms residing only in the lower graphene layer.

Unusual congenital pulmonary anomaly with presumed left lung hypoplasia in a young dog

A seven-month-old, entire, male miniature schnauzer dog was referred with acute vomiting, inappetence and depression primarily as a result of a gastric foreign body (pine cones). During investigations, thoracic radiographs revealed increased volume of the right lung lobes, deviated cardiomediastinal structures and elevation of the heart from the sternum. Thoracic computed tomography revealed left cranial lung lobe hypoplasia and extension of the right cranial lung parenchyma across the midline to the left hemithorax. Branches of the right pulmonary vessels and bronchi also crossed the midline and extended to the left caudal lung lobe. These findings suggested that the right and left lungs were fused. In humans this finding is consistent with horseshoe lung, which is an uncommon congenital malformation. To the authors' knowledge, this case represents the first report of such a pulmonary anomaly in a dog.

Association between VEGF and eNOS gene polymorphisms and lumbar disc degeneration in a young Korean population

Disturbances in blood flow to intervertebral discs (IVD) play an important role in IVD degeneration. Vascular endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS) are extremely important angiogenic factors for vasodilation and neovascularization. We investigated the relationship between single nucleotide polymorphisms (SNPs) of the VEGF and eNOS genes and genetic susceptibility to lumbar IVD degeneration in a young adult Korean population. Two hundred and forty-one participants (aged 18 to 30 years), with or without low back pain, were selected for the study. Magnetic resonance imaging was made of the lumbar spine in all participants. The patient group (N = 102) had low back pain clinically and lumbar IVD degeneration radiographically. The control group (N = 139) included subjects with and without low back pain; all were negative radiographically for lumbar IVD degeneration. Using PCR-RFLP analysis, we analyzed VEGF (-2578C>A, -1154G>A, -634G>C, and 936C>T) and eNOS (-786T>C, 4a4b and 894G>T) SNPs. We made combined analyses of the genes and performed haplotype analyses. There were no significant differences in the genotype distribution of polymorphisms of VEGF and eNOS genes among patients and controls. However, the frequency of VEGF -2578CA +AA/-634CC combined genotypes was significantly higher in patients when compared with controls [odds ratio (OR) = 21.00; 95% confidence interval (CI) = 2.590- 170.240]. The frequencies of the -2578A/-1154A/-634C/936C (OR = 3.831; 95%CI = 1.068-13.742), -2578A/-1154A/-634C (OR = 3.356; 95%CI = 1.198-9.400), and -2578A/-634C/936C (OR = 10.820; 95%CI = 2.811-41.656) haplotypes were also significantly higher in patients than in controls. We conclude that the combined genotype VEGF -2578CA+AA/-634CC is a possible risk factor for IVD degeneration and the VEGF -2578A/-1154A/-634C/936C haplotype may increase the risk for development of IVD degeneration. Furthermore, the VEGF -634C allele appears to be associated with susceptibility to IVD degeneration.

Pregnenolone sulfate enhances spontaneous glutamate release by inducing presynaptic Ca2+-induced Ca2+ release

Pregnenolone sulfate (PS) acts as an excitatory neuromodulator and has a variety of neuropharmacological actions, such as memory enhancement and convulsant effects. In the present study, we investigated the effect of PS on glutamatergic spontaneous excitatory postsynaptic currents (sEPSCs) in acutely isolated dentate gyrus (DG) hilar neurons by use of a conventional whole-cell patch-clamp technique. PS significantly increased sEPSC frequency in a concentration-dependent manner without affecting the current amplitude, suggesting that PS acts presynaptically to increase the probability of spontaneous glutamate release. However, known molecular targets of PS, such as α7 nicotinic ACh, NMDA, σ1 receptors and voltage-dependent Ca(2+) channels, were not responsible for the PS-induced increase in sEPSC frequency. In contrast, the PS-induced increase in sEPSC frequency was completely occluded in a Ca(2+)-free external solution, and was significantly reduced by either the depletion of presynaptic Ca(2+) stores or the blockade of ryanodine receptors, suggesting that PS elicits Ca(2+)-induced Ca(2+) release (CICR) within glutamatergic nerve terminals. In addition, the PS-induced increase in sEPSC frequency was completely occluded by transient receptor potential (TRP) channel blockers. These data suggest that PS increases spontaneous glutamate release onto acutely isolated hilar neurons via presynaptic CICR, which was triggered by the influx of Ca(2+) through presynaptic TRP channels. The PS-induced modulation of excitatory transmission onto hilar neurons could have a broad impact on the excitability of hilar neurons and affect the pathophysiological functions mediated by the hippocampus.

Extension of the Helmholtz-Smoluchowski velocity to the hydrophobic microchannels with velocity slip

Electrokinetic flows through hydrophobic microchannels experience velocity slip at the microchannel wall, which affects volumetric flow rate and solute retention time. The usual method of predicting the volumetric flow rate and velocity profile for hydrophobic microchannels is to solve the Navier-Stokes equation and the Poisson-Boltzmann equation for the electric potential with the boundary condition of velocity slip expressed by the Navier slip coefficient, which is computationally demanding and defies analytic solutions. In the present investigation, we have devised a simple method of predicting the velocity profiles and volumetric flow rates of electrokinetic flows by extending the concept of the Helmholtz-Smoluchowski velocity to microchannels with Navier slip. The extended Helmholtz-Smoluchowski velocity is simple to use and yields accurate results as compared to the exact solutions. Employing the extended Helmholtz-Smoluchowski velocity, the analytical expressions for volumetric flow rate and velocity profile for electrokinetic flows through rectangular microchannels with Navier slip have been obtained at high values of zeta potential. The range of validity of the extended Helmholtz-Smoluchowski velocity is also investigated.

Recursive estimation of transient inhomogeneous zeta potential in microchannel turns using velocity measurements

In the various biomedical microfluidic devices the target biomolecules are delivered by activating electroosmotic flows. The zeta potential of a microchannel wall, which determines the strength of the electroosmotic flow, is apt to change due to the adhesion of biomolecules such as DNA or protein especially around the microchannel turns. The resulting transient inhomogeneous profile of zeta potential alters flow pattern, volumetric flow rate and the band broading of solutes. In the present work, we have developed a method for the recursive estimation of transient inhomogeneous zeta potential in microchannel turns using velocity measurements. For the real time implementation of the present method, a compact and accurate reduced-order model is derived using the Karhunen-Loève Galerkin method and the Helmholtz-Smoluchowski slip velocity. The present scheme of recursive estimation is an important prerequisite to the real time control of microfluidic devices.

Effect of viscoelasticity on the flow pattern and the volumetric flow rate in electroosmotic flows through a microchannel

Many lab-on-a-chip based microsystems process biofluids such as blood and DNA solutions. These fluids are viscoelastic and show extraordinary flow behaviors, not existing in Newtonian fluids. Adopting appropriate constitutive equations these exotic flow behaviors can be modeled and predicted reasonably using various numerical methods. In the present paper, we investigate viscoelastic electroosmotic flows through a rectangular straight microchannel with and without pressure gradient. It is shown that the volumetric flow rates of viscoelastic fluids are significantly different from those of Newtonian fluids under the same external electric field and pressure gradient. Moreover, when pressure gradient is imposed on the microchannel there appear appreciable secondary flows in the viscoelastic fluids, which is never possible for Newtonian laminar flows through straight microchannels. The retarded or enhanced volumetric flow rates and secondary flows affect dispersion of solutes in the microchannel nontrivially.

ACE I/D polymorphism in Korean patients with ischemic stroke and silent brain infarction

OBJECTIVES

Angiotensin-converting enzyme (ACE) polymorphism may play a role in stroke and silent brain infarction (SBI) susceptibility, but the results among the populations studied to date have not been consistent. Thus, we investigated the association between ACE genotypes and ischemic stroke and SBI in Korean patients.

SUBJECTS AND METHODS

DNA samples from 237 stroke patients, 264 SBI patients and 234 age-matched controls were amplified using polymerase chain reaction to detect the ACE ins/del (I/D) polymorphism. Genotype was determined by the presence of a 490-bp band (I allele) or a 190-bp band (D allele) in agarose gel electrophoresis.

RESULTS

Odds ratios of the I/D and D/D genotypes and the overall (I/D + D/D) for the I/I genotype were significantly different between stroke patients and normal controls. However, there was no significant difference between patients with SBI and controls.

CONCLUSIONS

This study is the first report of a significant association between ACE polymorphism and ischemic stroke in the Asian population. Although no consistent associations have been found between ACE polymorphism and stroke in the populations studied to date, the ACE polymorphism may be a genetic determinant of ischemic stroke, at least in Korean patients.

Comparison of the Nernst–Planck model and the Poisson–Boltzmann model for electroosmotic flows in microchannels

In the analysis of electroosmotic flows, the internal electric potential is usually modeled by the Poisson-Boltzmann equation. The Poisson-Boltzmann equation is derived from the assumption of thermodynamic equilibrium where the ionic distributions are not affected by fluid flows. Although this is a reasonable assumption for steady electroosmotic flows through straight microchannels, there are some important cases where convective transport of ions has nontrivial effects. In these cases, it is necessary to adopt the Nernst-Planck equation instead of the Poisson-Boltzmann equation to model the internal electric field. In the present work, the predictions of the Nernst-Planck equation are compared with those of the Poisson-Boltzmann equation for electroosmotic flows in various microchannels where the convective transport of ions is not negligible.

Helmholtz-Smoluchowski velocity for viscoelastic electroosmotic flows

Many biofluids such as blood and DNA solutions are viscoelastic and exhibit extraordinary flow behaviors, not existing in Newtonian fluids. Adopting appropriate constitutive equations these exotic flow behaviors can be modeled and predicted reasonably using various numerical methods. However, the governing equations for viscoelastic flows are not easily solvable, especially for electroosmotic flows where the streamwise velocity varies rapidly from zero at the wall to a nearly uniform velocity at the outside of the very thin electric double layer. In the present investigation, we have devised a simple method to find the volumetric flow rate of viscoelastic electroosmotic flows through microchannels. It is based on the concept of the Helmholtz-Smoluchowski velocity which is widely adopted in the electroosmotic flows of Newtonian fluids. It is shown that the Helmholtz-Smoluchowski velocity for viscoelastic fluids can be found by solving a simple cubic algebraic equation. The volumetric flow rate obtained using this Helmholtz-Smoluchowski velocity is found to be almost the same as that obtained by solving the governing partial differential equations for various viscoelastic fluids.

Efficacy and tolerability of estradiol 1mg and drospirenone 2mg in postmenopausal korean women: A double-blind, randomized, placebo-controlled, multicenter study

OBJECTIVES

The aim of this study was to demonstrate that the therapeutic efficacy of an estradiol 1mg/drospirenone 2mg (E2/DRSP) preparation is superior to a placebo in postmenopausal Korean women with hot flushes and other climacteric symptoms, and to demonstrate that this treatment is both safe and tolerable.

METHODS

This was a double-blind, randomized, placebo-controlled, multicenter study over four 28-day treatment cycles. A total of 158 subjects were screened and 90 women were randomized into two treatment groups (E2/DRSP group, n=45; placebo group, n=45). The primary efficacy parameter was the individual relative change of hot flushes. The secondary efficacy parameters such as other climacteric, urogenital symptoms and vaginal bleeding patterns were also evaluated, and the occurrence of any adverse events was noted. In addition, physical, gynecological examinations and laboratory analyses were performed at the beginning and end of the study.

RESULTS

The mean number of hot flushes per week during treatment weeks 3-16 decreased by 48.1% during treatment with placebo, and by 84.4% during treatment with E2/DRSP (p<0.001). The E2/DRSP combination also reduced the incidence and intensity of menopausal symptoms in postmenopausal women. Most of adverse events was mild or moderate degree of intensity. None of the parameters measured in the study, including laboratory analyses, physical and gynecological examinations, vital signs, and weight, led to any concerns of safety.

CONCLUSIONS

The E2 1mg/DRSP 2mg combination tested in the study was efficacious and safe in the treatment of hot flushes and other climacteric symptoms in postmenopausal Korean women.

Estimation of zeta potential of electroosmotic flow in a microchannel using a reduced-order model

A reduced-order model is derived for electroosmotic flow in a microchannel of nonuniform cross section using the Karhunen-Loève Galerkin (KLG) procedure. The resulting reduced-order model is shown to predict electroosmotic flows accurately with minimal consumption of computer time for a wide range of zeta potential zeta and dielectric constant epsilon. Using the reduced-order model, a practical method is devised to estimate zeta from the velocity measurements of the electroosmotic flow in the microchannel. The proposed method is found to estimate zeta with reasonable accuracy even with noisy velocity measurements.

Simultaneous estimation of zeta potential and slip coefficient in hydrophobic microchannels

Electroosmotic flows through hydrophobic microchannels experience velocity slip at the channel wall, which increases the volumetric flow rate at a given electric potential gradient. The conventional method of zeta potential estimation using the volumetric flow rate may yield quite inaccurate zeta potential unless the velocity slip is appropriately taken care of. In the present investigation we develop a method for simultaneous estimation of zeta potential and velocity slip coefficient in the electroosmotic flow through a hydrophobic microchannel using velocity measurements. The relevant inverse problem is solved through the minimization of a performance function utilizing a conjugate gradient method. The present method is found to estimate the zeta potential and slip coefficient accurately even with noisy velocity measurements.

Estimation of the zeta potential and the dielectric constant using velocity measurements in the electroosmotic flows

In this paper we develop a method for the determination of the zeta potential zeta and the dielectric constant epsilon by exploiting velocity measurements of the electroosmotic flow in microchannels. The inverse problem is solved through the minimization of a performance function utilizing the conjugate gradient method. The present method is found to estimate zeta and epsilon with reasonable accuracy even with noisy velocity measurements.

Supplementation of whole persimmon leaf improves lipid profiles and suppresses body weight gain in rats fed high-fat diet

The objective of this study was to investigate the hypolipidemic effects of powdered whole persimmon leaf supplement in rats fed high-fat diet. Three groups of male Sprague-Dawley rats during 6 weeks were fed different diet: normal control (NC), high-fat (HF), and high-fat supplemented with powdered whole persimmon leaf (PL; 5%, wt/wt) groups. Body weight and relative weight of interscapular brown adipose tissue were significantly lower in the PL group than in the HF group, while plasma leptin concentration was higher. The supplementation of persimmon leaf significantly lowered the plasma total cholesterol and triglyceride concentrations, whereas elevated the ratio of HDL-C/total-C and improved the atherogenic index. Persimmon leaf supplementation led the hepatic cholesterol and triglyceride values to similar levels to the NC group. Accumulation of hepatic lipid droplets and the epididymal white adipocyte size of PL group were diminished comparing to the HF group. Hepatic HMG-CoA and ACAT activities were significantly higher in the PL group than in other groups. Contents of fecal triglyceride, cholesterol and acidic sterol were significantly higher in the PL group than in the HF group. Accordingly, we suggest that supplementation of the powdered whole persimmon leaf improves plasma and hepatic lipid levels profile partly via the increased fecal lipids in high-fat fed rats. These beneficial effects may be due to the properties of its phenolic compounds (1.15 g/100g) and high fiber (63.48 g/100g) content in the powdered persimmon leaf.

Mullerian adenosarcoma with sarcomatous overgrowth of the cervix presenting as cervical polyp: a case report and review of the literature

An aggressive variant of adenosarcoma, mullerian adenosarcoma with sarcomatous overgrowth (MASO) in the cervix is extremely rare. This variant contains obvious, high-grade sarcoma in addition to a low-grade form. In this report, we describe a case of MASO of the uterine cervix and review the clinical and pathological features of these tumors. The patient was a 37-year-old woman with a cervical polypoid mass, which was morphologically considered as a benign endocervical polyp. Microscopically, polypoid cervical mass showed diffuse and dense malignant spindle cell proliferation around the benign endocervical glands and also an area of markedly anaplastic and pleomorphic spindle cell proliferation, so called, sarcomatous overgrowth. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymph node dissection were performed. The patient has been followed-up and neither chemotherapy nor other adjuvant therapies have been administered. At present, she has been clinically free of disease for 9 months since she received surgery. It is extremely rare that MASO of the uterine cervix is presented in premenopausal woman. Gynecologists and pathologists should be aware of the difficulties associated with a delay in the diagnosis of MASO when the tumor is present as a benign looking cervical polyp.

Korean experience with the OSTA risk index for osteoporosis: a validation study

The Osteoporosis Self-assessment Tool for Asians (OSTA) was developed to help physicians focus their efforts on patients at increased risk, and encourage appropriate use of bone mineral density (BMD) measurements. Previously, OSTA performed well in a sample of women from eight countries in Asia, and in a validation group of Japanese women. In this study, we evaluate the performance of OSTA using a sample of 1101 postmenopausal women from a clinic in Korea who had femoral neck BMD measurements by dual-energy X-ray absorptiometry (DXA). The OSTA had a high sensitivity (87%), and good specificity (67%) for identifying osteoporosis (BMD T-scores <or= -2.5); the corresponding values were 80% and 72% for identifying T-scores <or= -2.0. The prevalence of osteoporosis ranged from 2% among women classified as low risk (OSTA > -1) to 64% among those classified as high risk (OSTA < -4); these results were almost identical to those reported earlier for a sample of women from eight Asian countries. We conclude that the OSTA risk tool performed well in this sample of postmenopausal Korean women, similar to previous results in other Asian women. The OSTA tool is free and very easy to use; risk can be tabulated by age and weight, so that calculations are not necessary. Using OSTA could encourage patients and clinicians to actively assess osteoporosis, and measure BMD when appropriate, before fractures occur.

Vestibular diagnosis as prognostic indicator in sudden hearing loss with vertigo

The majority of episodes of sudden hearing loss are caused by inner ear disorders, often accompanied by vertigo. The patterns of hearing loss usually influence the prognosis. The purpose of this study was to analyze vestibular diagnoses in sudden hearing loss with vertigo, and to correlate them with the recovery of hearing loss. The clinical records of 125 patients with sudden hearing loss were reviewed. Various vestibular evaluations were performed in 36 patients with vertigo. The vertigo in these patients was classified as normal, unilateral hypofunction, directional preponderance, benign paroxysmal positional vertigo (BPPV), non-specific or irritative. The initial and final pure-tone audiograms of these patients were compared. The distribution of vestibular diagnoses was unilateral hypofunction in 30.6% of patients, BPPV in 25.7%, normal in 19.4%, non-specific in 11.1%, directional preponderance in 8.3% and irritative in 8.3%. The recovery of hearing in patients with vertigo was significantly worse than in those without vertigo. The recovery of hearing in patients with spinning vertigo did not differ from that of patients with non-spinning vertigo. The recovery of hearing was worst in the BPPV group, especially in the high frequency range, followed by the unilateral hypofunction group, who showed hearing thresholds between those in the BPPV group and those in the normal vestibular function test group. This study suggests that the diagnostic classification of vestibulopathy is a useful prognostic indicator of hearing recovery in sudden hearing loss with vertigo. We conclude that otolithic and semicircular canal involvement may cause poor hearing results, especially in the high frequency range.

Negative regulation of filamentous growth and flocculation by Lkh1, a fission yeast LAMMER kinase homolog

We have isolated a full-length cDNA clone that encodes for a Schizosaccharomyces pombe homolog of the dual-specificity protein kinase of the LAMMER family, lkh1 (lammer kinase homolog). The proposed Lkh1 protein contains 575 amino acids. The lkh1(+) null mutant is viable, but exhibits flocculation upon reaching stationary phase in liquid media and filamentous adhesion growth on solid media. Analysis of the flocculation activity of the lkh1(+) null mutant indicates that asexual aggregation of S. pombe cells into floccules is divalent cation-dependent and galactose-specific. We also demonstrate that the Saccharomyces cerevisiae LAMMER kinase homolog, Kns1, can substitute for the Lkh1 function in S. pombe.

Observation of a (6)(LambdaLambda)He double hypernucleus

A double-hyperfragment event has been found in a hybrid-emulsion experiment. It is identified uniquely as the sequential decay of ( 6)(LambdaLambda)He emitted from a Xi(-) hyperon nuclear capture at rest. The mass of ( 6)(LambdaLambda)He and the Lambda-Lambda interaction energy DeltaB(LambdaLambda) have been measured for the first time devoid of the ambiguities due to the possibilities of excited states. The value of DeltaB(LambdaLambda) is 1.01+/-0.20(+0.18)(-0.11) MeV. This demonstrates that the Lambda-Lambda interaction is weakly attractive.

Elevated gastrin secretion by in vivo gene electroporation in skeletal muscle

Whether or not in vivo gene transfer of gastrin gene into skeletal muscle by electroporation could modify gastrin secretion was examined. The expression plasmid vector, either pMEPrGaspA encoding the rat gastrin gene or pEGFP-N1 encoding the GFP reporter gene was injected into M. rectus abdominis of rats or M. biceps formis of mice. Subsequently, square electric pulses of direct current were applied six times at 25 V with a loading period of 100 msec per pulse. Clear foreign gene expression in the skeletal muscle was demonstrated by both GFP fluorescence and immunostaining of rat gastrin. Time course changes in plasma gastrin levels after transfection revealed that in rats, gastrin gene transfer significantly increased the plasma gastrin level for 4 weeks post-transfection (P<0.05), but the difference diminished at the end of the 10-week period. In mice, plasma gastrin level elevated similarly for 3 weeks, and pH of gastric contents decreased in the gastrin gene transfected group compared with the control counterpart (P<0.05). These findings suggest that localized in vivo gene transfer by electroporation allows skeletal muscle to become an artificial endocrine tissue for hormonal manipulation of animals.

Immobilization of arsenic in tailing by using iron and hydrogen peroxide

Under environmental conditions, arsenic (As) reveals anionic behavior and is converted into various forms in accordance with the Eh/pH condition. This causes the difficulty of treating As with other heavy metals in tailing. This study was carried out to develop the immobilization method of arsenic in tailing as ferric arsenate (FeAsO4) using hydrogen peroxide. According to experimental results, the extracted concentrations of arsenic and iron (Fe) from tailing were reduced up to 84% and 93%, respectively. In the experiment using pure Pyrite (FeS2) and As solution, As concentration decreased with an increase of hydrogen peroxide dosage. The experimental results of re-extraction showed that only 10% of As and 20% of Fe were extracted in the case of using hydrogen peroxide. As a result, the long-term stability of this method was clarified.

A simple tool to identify asian women at increased risk of osteoporosis

Patients with low bone mineral density (BMD) have a high risk of future fractures, and should be actively considered for treatment to reduce their risk. However, BMD measurements are not widely available in some communities, because of cost and lack of equipment. Simple questionnaires have been designed to help target high-risk women for BMD measurements, thereby avoiding the cost of measuring women at low risk. However, such tools have previously focused on evaluation of non-Asian women. We collected information about numerous risk factors from postmenopausal Asian women in eight countries in Asia using questionnaires, and evaluated the ability of these risk factors to identify women with osteoporosis as defined by femoral neck BMD T-scores < or =-2.5. Multiple variable regression analysis and item reduction yielded a final tool based on only age and body weight. This risk index had a sensitivity of 91% and specificity of 45%, with an area under the curve of 0.79. Previously published risk indices based on larger numbers of variables performed similarly well in this Asian population. Large differences in risk were identified using our index to create three categories: 61% of the high-risk women had osteoporosis, compared with only 15% and 3% of the intermediate- and low-risk women, respectively. The low-risk group represented 40% of all women, for whom BMD measurements are probably not needed unless important risk factors, such as prior nonviolent fracture or corticosteroid use, are present. An existing population-based sample of postmenopausal Japanese women was used to validate our index. In this sample of Japanese women the sensitivity was 98% and specificity was 29%; the low-risk category, for whom BMD is probably unnecessary, represented 25% of all women. We conclude that our index performed well for classifying the risk of osteoporosis among postmenopausal Asian women and applying it would result in more prudent use of BMD technology.

In vivo gene electroporation in skeletal muscle with special reference to the duration of gene expression

To determine the limits of the duration of in vivo transferred foreign gene expression, we conducted electroporation (EP), a powerful non-viral means of gene transfer for living animals, into skeletal muscle of rats and mice with a luciferase, GFP or erythropoietin (EPO)-encoding reporter plasmid. The luciferase reporter plasmid was used for optimization of EP conditions, while GFP and EPO plasmids were used for monitoring the duration of gene expression. In the rat, increased hematocrit levels were maintained for at least 9 weeks with approximately a 3-fold increase in plasma EPO protein concentration at 4 weeks post-transfection. In the mouse, the GFP plasmid transfer confirmed that the reporter gene expression lasted as long as 3 months post-transfection. By introducing the EPO gene in vivo in the mouse, increased hematocrit levels revealed that duration of reporter gene expression was at least 14.5 months after in vivo gene EP into skeletal muscle. These results implicate an excellent potential of in vivo gene EP, applicable to both experimental and therapeutic purposes.

In vivo gene electroporation confers nutritionally-regulated foreign gene expression in the liver

Whether or not nutritionally-regulated foreign gene expression in vivo is achievable was examined in mouse liver after in vivo gene transfer by electroporation (EP). Electric pulses were applied to a left liver lobe immediately after injection of a luciferase reporter gene driven by the liver-type phosphoenolpyruvate carboxykinase (PEPCK) gene promoter. Cooling treatments especially with solid carbon dioxide in the transfection site prior to the in vivo gene EP increased reporter gene expression by a factor of 100. Body bioluminescence imaging also confirmed strong expression of the in vivo transferred reporter gene in a transfected area of the liver. Fasting conferred a 13-fold increase in the reporter gene expression in vivo in the liver when driven by the liver-type PEPCK promoter, whereas virtually no induction was found either by the SV40 promoter or by the same PEPCK promoter in the muscle when the mice were fasted. The administration of cAMP mimicked the fasting-induced reporter gene expression by the PEPCK promoter in the liver of fed mice. These results implicate that nutritionally-regulated foreign gene expression in vivo is attainable at least locally in the liver by a simple and convenient non-viral gene EP method.

Antioxidative phenolic compounds from the roots of Rhodiola sachalinensis A. Bor

The acetone extract of the roots of Rhodiola sachalinensis has furnished six phenolic compounds which exhibited significant scavenging effects against DPPH free radical. The structures of these compounds were identified and determined as gallic acid (1), (-)-epigallocatechin 3-O-gallate (2), kaempferol (3), kaempferol 7-O-alpha-L-rhamnopyranoside (4), herbacetin 7-O-alpha-L-rhamnopyranoside, (5) and rhodiolinin (6) by physico-chemical and spectral evidences.

In vivo gene electroporation confers strong transient expression of foreign genes in the chicken testis

To attain foreign gene expression in vivo in the testis of living chickens, chloramphenicol acetyltransferase (CAT) and firefly luciferase reporter genes were transfected by electroporation (EP). Bioluminescence imaging indicated clear expression of the luciferase reporter gene localized in and around the injection site of the chicken testis. The CAT activity decreased sharply from 7 to 14 d posttransfection (P < 0.01) and remained low until 28 d. The presence of the self-replication sequence of Epstein-Barr virus did not give significantly higher CAT gene expression over the 28-d posttransfection. The results suggest that in vivo gene EP confers strong, likely transient, foreign gene expression in the testis of living chickens.

COUP-TF plays a dual role in the regulation of the ovalbumin gene

The ovalbumin (Ov) gene contains a number of regulatory elements that control its transcriptional activity and restrict expression to avian oviduct. One major regulatory region, the steroid-dependent regulatory element (SDRE), is required for induction by estrogen and corticosterone. Another region, the negative regulatory element (NRE), downstream of the SDRE, acts primarily to repress gene expression. In addition, experiments within indicate that the binding site for the COUP transcription factor (COUP-TF) is also required for Ov gene transcription. To examine the interactions involving the SDRE, the NRE, and the COUP binding sites on Ov gene transcription, mutations in these regions were made and transfected into primary oviduct cell cultures. These experiments show that without the NRE, the SDRE is sufficient for induction by estrogen and corticosterone, irrespective of the COUP site. However, with the NRE intact, the COUP site is required for steroid induction, although without the NRE, the COUP site attenuates transcriptional activity. More interestingly, overexpression of COUP-TF1 with the Ov wild-type reporter construct alleviates the requirement for steroid hormones. These results demonstrate that the COUP site is essential and has a dual role in Ov gene transcription and that steroid hormones might directly or indirectly regulate the activity of COUP-TF1.

Inhibition of fungal cell wall synthesizing enzymes by trans-cinnamaldehyde

This study examined the inhibitory effects of trans-cinnamaldehyde (CA), an aromatic aldehyde derived from Cinnamomi Cortex, on Saccharomyces cerevisiae cell wall synthesizing enzymes in vitro. This compound was found to be a noncompetitive inhibitor of beta-(1,3)-glucan synthase and a mixed inhibitor of chitin synthase 1 with 50% inhibitory concentrations (IC50) of 0.84 and 1.44 mM, respectively. Chitin synthases 2 and 3 were less sensitive than chitin synthase 1 to CA. CA can be useful as a model compound of cell wall inhibitors for the development of effective antifungal agents.

Sentinel lymph node biopsy for melanoma: experience with 234 consecutive procedures

Sentinel lymph node biopsy is increasingly used to identify occult metastases in regional lymph nodes of patients with melanoma. Selection of patients for sentinel lymph node biopsy and subsequent lymphadenectomy is an area of debate. The purpose of this study was to describe a large clinical series of these biopsies for cutaneous melanoma and to identify patients most likely to gain useful clinical information from sentinel lymph node biopsy. The Indiana University Melanoma Program computerized database was queried to identify all patients who underwent this procedure for clinically localized cutaneous melanoma. It was performed using preoperative technetium Tc 99m lymphoscintigraphy and isosulfan blue dye. Pertinent demographic, surgical, and histopathologic data were recorded. Univariate and multivariate logistic regression and classification table analyses were performed to identify clinical variables associated with sentinel node and nonsentinel node positivity. In total, 234 biopsy procedures were performed to stage 291 nonpalpable regional lymph node basins. Mean Breslow's thickness was 2.30 mm (2.08 mm for negative sentinel lymph node biopsy, 3.18 mm for positive). The mean number of sentinel nodes removed was 2.17 nodes per basin (range, 1 to 8). Forty-seven of 234 melanomas (20.1 percent) and 50 of 291 basins (17.2 percent) had a positive biopsy. Positivity correlated with AJCC tumor stage: T1, 3.6 percent; T2, 8.1 percent; T3, 27.4 percent; T4, 44 percent. By univariate logistic regression, Breslow's thickness (p = 0.003, continuous variable), ulceration (p = 0.003), mitotic index > or = 6 mitoses per high power field (p = 0.008), and Clark's level (p = 0.04) were significantly associated with sentinel lymph node biopsy result. By multivariate analysis, only Breslow's thickness (p = 0.02), tumor ulceration (p = 0.02), and mitotic index (p = 0.02) were significant predictors of biopsy positivity. Classification table analysis showed the Breslow cutpoint of 1.2 mm to be the most efficient cutpoint for sentinel lymph node biopsy result (p = 0.0004). Completion lymphadenectomy was performed in 46 sentinel node-positive patients; 12 (26.1 percent) had at least one additional positive nonsentinel node. Nonsentinel node positivity was marginally associated with the presence of multiple positive sentinel nodes (p = 0.07). At mean follow-up of 13.8 months, four of 241 sentinel node-negative basins demonstrated same-basin recurrence (1.7 percent). Sentinel lymph node biopsy is highly reliable in experienced hands but is a low-yield procedure in most thin melanomas. Patients with melanomas thicker than 1.2 mm or with ulcerated or high mitotic index lesions are most likely to have occult lymph node metastases by sentinel lymph node biopsy. Completion therapeutic lymphadenectomy is recommended after positive biopsy because it is difficult to predict the presence of positive nonsentinel nodes.

Cervical sentinel lymph node biopsy for melanomas of the head and neck and upper thorax

OBJECTIVE

To describe a clinical experience with sentinel lymph node biopsy (SLNB) of head and neck nodal basins for clinical stage I melanomas draining to these areas.

DESIGN

Consecutive clinical case series with a mean follow-up of 10.7 months.

SETTING

University tertiary care referral medical center.

PATIENTS

Seventy patients with clinical stage I cutaneous melanoma who underwent SLNB of cervical and/or parotid lymph node basins.

INTERVENTIONS

Patients underwent same-day preoperative technetium Tc 99m lymphoscintigraphy followed by SLNB using gamma probe and blue dye (66 patients) and blue dye alone (4 patients). Patients with histological evidence of tumor (here in after "positive") according to SLNB results underwent modified cervical completion lymph node dissection, including parotidectomy, as appropriate. Patients without histological evidence of tumor (hereinafter "negative") according to SLNB results were followed up clinically without undergoing completion lymph node dissection.

MAIN OUTCOME MEASURES

The rates of SLNB success, SLNB positivity, completion lymph node dissection positivity, complications, and SLNB false-negative results were determined by clinical follow-up.

RESULTS

Locations of melanomas in the 70 patients were the face (n = 20), neck (n = 14), ear (n = 9), scalp (n = 9), and upper thorax (n = 18). Locations of basins that underwent biopsy (n = 104) were in the cervical (n = 68), parotid (n = 19), and axillary (n = 17) regions. The mean Breslow thickness was 2.1 mm (range, 0.4-12.0 mm). Sentinel lymph node biopsy was successful in 103 basins (99%). The mean number of sentinel lymph nodes per basin was 2.5 (range, 1.0-8.0). Positive sentinel lymph nodes were found in 12 patients (17%) and 15 basins (14%). Sentinel lymph node biopsy results correlated with the American Joint Committee on Cancer tumor stage (P = .05) and a Breslow thickness of 1.23 mm or greater (P = .03). Additional tumor-containing nodes were noted in 5 (42%) of the 12 patients who underwent completion lymph node dissection, and these results correlated with the presence of multiple positive sentinel lymph nodes (P = .01). There were complications in 3 patients (4%) (seromas in 2 patients and temporary spinal accessory nerve paresis in 1 patient). One nodal recurrence in a basin that was negative according to SLNB results (SLNB with blue dye only) was noted (false-negative rate, 2%). The results of SLNB were accurate in 69 patients (99%).

CONCLUSIONS

Sentinel lymph node biopsy using lymphoscintigraphy and blue dye to manage cutaneous melanomas draining to the head and neck nodal areas is reliable and safe. Sentinel lymph node biopsy results correlated with a Breslow thickness of 1.23 mm or greater and the American Joint Committee on Cancer tumor stage. Completion lymph node dissection is recommended after determining positive SLNB results.

Effects of adjuvants on the immune response of staphylococcal alpha toxin and capsular polysaccharide (CPS) in rabbit

This study was performed to isolate a vaccine strain of S. aureus from clinical or subclinical mastitis and to choose the most optimal adjuvant for immune response of alpha toxin and capsular polysaccharide (CPS) of field strain. Of thirty strains of S. aureus isolated from milk of clinical or subclinical mastitis, V112 strain isolated from milk of gangrenous mastitis was used in this vaccine. Twenty one of rabbits were allocated into 5 groups based on adjuvants and immunized twice every 2 weeks for 8 weeks. This vaccine was composed of alpha toxin (10 hemolytic units) and formalinized whole cells (1 x 10(11) cells/ml. Five rabbits received PBS solution as a control group. The highest antibody titers against alpha toxin and CPS were observed in dextran sulfate- and aluminium hydroxide-adjuvant group at 8 weeks after immunization, respectively. These results of the study showed that one adjuvant could not induce strong and long-term immune response of alpha toxin and CPS antigens. Therefore, the use of combined adjuvants in subunit vaccine may be useful and feasible.

Foreign gene expression by in vivo gene electroporation in the quail testis

To investigate whether or not foreign gene expression is attained in the testis of living Japanese quails, a firefly luciferase reporter gene was transfected by in vivo electroporation (EP), and transcriptional activity of different promoters was compared. In addition, the effect of the Epstein-Barr virus self-replication sequence was also tested. The results showed that luciferase activity in the testis reached almost a plateau value at 50 V. Under this EP condition, no difference was found in transcriptional activity between the simian virus 40 (SV40) and miw promoters. The reporter gene expression in the quail testis was observed over 28 days after in vivo gene EP, although the activity gradually decreased, and the presence of the Epstein-Barr virus self-replication sequence in the SV40 promoter did not significantly prolong the luciferase activity. These results suggest that in vivo gene EP confers strong, though transient, foreign gene expression in the Japanese quail, and it may provide a new powerful approach for studies on transcriptional regulation of genes during proliferation and differentiation of spermatogenic cells in the quail testis.

Audiologic evaluation of neonates with severe hyperbilirubinemia using transiently evoked otoacoustic emissions and auditory brainstem responses

OBJECTIVES

To audiologically clarify the lesion site and to test the reliability of transiently evoked otoacoustic emissions (TEOAEs) in hearing screening of hyperbilirubinemic neonates.

STUDY DESIGN

Eleven neonates with severe hyperbilirubinemia who had exchange transfusion in the neonatal intensive care unit of an academic hospital over a 3-year period were included in this study. They were tested with auditory brainstem response (ABR) and TEOAEs after exchange transfusion during hospitalization or at an immediate follow-up visit after discharge. Follow-up ABR tests were performed when infants showed significant hearing loss.

METHODS

ABR and TEOAE tests were performed on the 11 neonates with severe hyperbilirubinemia after exchange transfusion. Follow-up ABR tests were carried out in 3-month intervals in the four neonates who showed abnormal or no response on initial ABR.

RESULTS

Four neonates showed abnormal or no response and the other seven demonstrated normal response in ABR. All 11 neonates passed TEOAEs. Two neonates showed improvement in auditory function at 3- or 6-month follow-up ABR.

CONCLUSION

The results of this study indicate that the site of lesion in hearing loss caused by hyperbilirubinemia may be at the retrocochlear location while the cochlea remains intact. TEOAEs may have limitations in evaluation of hearing in the neonates with hyperbilirubinemia.

In vivo manipulation of foreign gene expression by steroid administration in the oviduct of laying hens

The experiments described herein were conducted to examine whether or not steroid administration allows in vivo induction of foreign gene expression in the oviduct of laying hens. The chloramphenicol acetyltransferase reporter gene driven by several viral and cellular promoters with or without steroid response elements was transfected by in vivo electroporation. The results indicated that in vivo, as observed in vitro, steroid administration induced transcriptional activities of the promoters with steroid response elements but it did not do so without steroid response elements. Our data implicate, therefore, that in vivo induction of foreign gene expression is possible in the oviduct of laying hens, and that the present in vivo gene transfer approach would serve as a useful tool to elucidate the mechanism of tissue-specific and steroid-induced transcription of chicken egg white genes.

Immunogenicity of alpha-toxin, capsular polysaccharide (CPS) and recombinant fibronectin-binding protein (r-FnBP) of Staphylococcus aureus in rabbit

This study was conducted to evaluate the antibody levels of alpha-toxin, capsular polysaccharides (CPS) and fibronectin-binding protein (FnBP) in rabbits immunized with an experimental vaccine against Staphylococcus aureus and to develop the bovine mastitis subunit vaccine in the future. Enzyme immunoassay was used for detection of IgG antibodies against staphylococcal CPS, alpha-toxin and FnBP. The levels of specific antibodies against CPS, alpha-toxin and FnBP in immunized rabbits were significantly increased after first immunization compared with control animals (p<0.05). Of three antigen used in vaccine, immunogenicity of CPS was relatively lower, compared with those of alpha toxin and fibronectin binding protein. Numbers of S. aureus in blood of immunized groups were lower than those of control group after bacterial challenge. But the bacterial numbers among immunized groups were not significantly different. S. aureus counts in excised organs were significantly lower in all immunized rabbits than in PBS-control group (p<0.05). The present study showed that alpha-toxin, capsular polysaccharide and fibronectin binding protein included in a subunit vaccine were protective.

The radiographic incidence of bony defects in the lateral lamella of the cribriform plate

The purpose of this study was to evaluate the incidence and radiographic characteristics of bony defects of the lateral lamella of the cribriform plate using a coronal computerised tomography (CT) scan. By retrospectively reviewing the coronal CT scans of 410 sinuses from 205 subjects, the overall incidence and the relationship to the subjects' age and depth of cribriform plate were analysed. Bony defects were identifiable in 59.5% of the sinuses. The incidence of a bony defect was not significantly different between the sinuses of the paediatric age group and the adult group. The sinuses having a deeper cribriform plate showed a higher incidence of bony defects in comparison with the sinuses with a less deep cribriform plate. The high incidence of radiologically detectable bony defects in this region may emphasize the particular risk of this area during endoscopic sinus surgery.

Identification of a gene, SOO1, which complements osmo-sensitivity and defect in in vitro beta1,3-glucan synthase activity in Saccharomyces cerevisiae

The soo1-1 (for suppressor of osmo-sensitivity) mutation results in a temperature-dependent osmo-sensitive phenotype at non-permissive temperature (37 degrees C), makes yeast cells more susceptible to Zymolyase and affects in vitro beta1,3-glucan synthase activity level. Transformation of soo1-1 mutant by SOO1 gene reverses these effects. Nucleotide sequencing of SOO1 revealed that this gene is identical to the recently reported alpha-COP that is involved in the intracellular protein translocation from endoplasmic reticulum to Golgi and vice versa. Although the soo1-1 mutant strain showed osmotically remediable growth at 37 degrees C, SOO1 disruptants could not grow in any culture conditions. Analysis of cell wall fractions revealed that the soo1-1 mutation causes a decrease in in vitro beta1,3-glucan synthase activity, and, thus, a subsequent alteration of the cell wall composition.

Lymph node tumor volumes in patients undergoing sentinel lymph node biopsy for cutaneous melanoma

BACKGROUND

Regional lymph node tumor volumes in patients undergoing sentinel lymph node (SN) biopsy (SNB) for treatment of cutaneous melanoma have not been described. The objectives of this study were to describe the lymph node tumor volumes typically seen in this population and to correlate tumor volumes with tumor thickness and positive SN characteristics.

METHODS

Review of a consecutive series of patients with clinically localized cutaneous melanoma who underwent SNB of nonpalpable regional lymph node basins followed by complete lymphadenectomy (LND) was performed. Multiple lymph node sections from positive SNs and nonsentinel nodes (NSNs) in LND specimens were examined microscopically. Individual tumor deposit diameters were measured using an ocular micrometer. Aggregate tumor volumes were calculated for SN and LND specimens. Tumor volumes and SN and LND positivity rates were correlated with tumor thickness, the number of positive SNs, and the presence of multiple SN tumor deposits.

RESULTS

SNB procedures were performed for 149 melanomas in 189 regional nodal basins. The mean tumor depth was 2.48 mm. The mean number of SNs/basin was 2.1. Thirty-two of 149 SNB procedures (21.5%) revealed a total of 34 nodal basins with at least one positive SN. The median tumor volume in positive SNs was 4.7 mm3 (range, 0.1-3618 mm3; mean, 209 mm3). The median aggregate tumor volume in positive LND specimens was 4.9 mm3 (range, 0.1-3618 mm3; mean, 224 mm3). Six basins (17.6%) contained at least one positive NSN. The regional node aggregate tumor volume correlated weakly with tumor thickness (Pearson's correlation coefficient = .302, P = .0934). NSN positivity was not predicted by tumor thickness, American Joint Committee on Cancer tumor stage, number of positive SNs, or number of metastatic deposits within SNs.

CONCLUSIONS

Most melanoma-positive SNs contain minute tumor volumes. Tumor thickness and patterns of SN metastases may not be predictive of tumor burden or the presence of positive NSNs.

Lymphoscintigraphy with sentinel lymph node biopsy in cutaneous Merkel cell carcinoma

Merkel cell carcinoma (MCC) is a rare cutaneous malignancy characterized by an aggressive clinical behavior with high rates of locoregional and systemic recurrence. Regional disease and distant metastases are associated with poor prognosis. Despite a predisposition of MCC to spread via the lymphatics, prophylactic lymph node dissection in the absence of clinically apparent lymph node involvement is controversial. The value of lymphoscintigraphy in cutaneous melanoma is established in lesions with ambiguous lymphatic drainage patterns. When used with sentinel lymph node biopsy (SLNB), it can identify subjects with occult regional node metastasis. The authors present 2 patients with MCC who underwent regional node staging with lymphoscintigraphy-directed SLNB. Both patients had sentinel nodes that were positive for metastatic disease. In patients with MCC, minimally invasive regional node staging SLNB may be useful in limiting the sequelae of routine lymphadenectomies. Whether early identification and treatment of patients with occult regional node disease can influence survival in MCC is not known.