The Korean Genetic Diagnosis Program for Rare Disease Phase II: outcomes of a 6-year national project

The Korean Genetic Diagnosis Program for Rare Disease (KGDP) enrolled 1890 patients with rare diseases between March 2017 and October 2022. Children and adolescents accounted for the majority of the patients, and systemic disease was the most common presenting symptom. The exome-based virtual disease-specific multigene panel was the most frequently used analytical method, with an overall diagnostic yield of 33.3%. A total of 629 positive cases were diagnosed, involving 297 genes. All 297 genes identified in these cases were confirmed to be known genes listed in the OMIM database. The nationwide KGDP network and its cooperation with the Korean Undiagnosed Diseases Program (KUDP) provide a more comprehensive genetic analysis of undiagnosed cases. The partnership between the KGDP and KUDP has the potential to improve the diagnosis and treatment options for patients. In conclusion, KGDP serves as the primary access point or gateway to KUDP.

SARS-CoV-2 shedding dynamics and transmission in immunosuppressed patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern have been emerging. However, knowledge of temporal and spatial dynamics of SARS-CoV-2 is limited. This study characterized SARS-CoV-2 evolution in immunosuppressed patients with long-term SARS-CoV-2 shedding for 73–250 days, without specific treatment. We conducted whole-genome sequencing of 27 serial samples, including 26 serial samples collected from various anatomic sites of two patients and the first positive sample from patient 2‘s mother. We analysed the intrahost temporal dynamics and genomic diversity of the viral population within different sample types. Intrahost variants emerging during infection showed diversity between individual hosts. Remarkably, N501Y, P681R, and E484K, key substitutions within spike protein, emerged in vivo during infection and became the dominant population. P681R, which had not yet been detected in the publicly available genome in Korea, appeared within patient 1 during infection. Mutually exclusive substitutions at residues R346 (R346S and R346I) and E484 (E484K and E484A) of spike protein and continuous turnover of these substitutions occurred. Unique genetic changes were observed in urine samples. A household transmission from patient 2 to his mother, at least 38 days after the diagnosis, was characterized. Viruses may differently mutate and adjust to the host selective pressure, which could enable the virus to replicate efficiently for fitness in each host. Intrahost variants could be candidate variants likely to spread to the population eventually. Our findings may provide new insights into the dynamics of SARS-CoV-2 in response to interactions between the virus and host.

Evidence of Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection After Recovery from Mild Coronavirus Disease 2019

BACKGROUND

Positive results from real-time reverse-transcription polymerase chain reaction (rRT-PCR) in recovered patients raise concern that patients who recover from coronavirus disease 2019 (COVID-19) may be at risk of reinfection. Currently, however, evidence that supports reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been reported.

METHODS

We conducted whole-genome sequencing of the viral RNA from clinical specimens at the initial infection and at the positive retest from 6 patients who recovered from COVID-19 and retested positive for SARS-CoV-2 via rRT-PCR after recovery. A total of 13 viral RNAs from the patients' respiratory specimens were consecutively obtained, which enabled us to characterize the difference in viral genomes between initial infection and positive retest.

RESULTS

At the time of the positive retest, we were able to acquire a complete genome sequence from patient 1, a 21-year-old previously healthy woman. In this patient, through the phylogenetic analysis, we confirmed that the viral RNA of positive retest was clustered into a subgroup distinct from that of the initial infection, suggesting that there was a reinfection of SARS-CoV-2 with a subtype that was different from that of the primary strain. The spike protein D614G substitution that defines the clade "G" emerged in reinfection, while mutations that characterize the clade "V" (ie, nsp6 L37F and ORF3a G251V) were present at initial infection.

CONCLUSIONS

Reinfection with a genetically distinct SARS-CoV-2 strain may occur in an immunocompetent patient shortly after recovery from mild COVID-19. SARS-CoV-2 infection may not confer immunity against a different SARS-CoV-2 strain.

Lactobacillus intestinalis YT2 restores the gut microbiota and improves menopausal symptoms in ovariectomized rats

There are many studies focusing on the alleviation of menopausal symptoms; however, little is known about the role of gut microorganisms in menopausal symptoms. Ovariectomized (OVX) rats were administered a novel strain (YT2) of Lactobacillus intestinalis (a species with significantly reduced abundance in OVX rats) and the potential probiotic effect on the improvement of menopausal symptoms was evaluated. Of note, the gut microbial composition completely shifted after ovariectomy in rats. Treatment with L. intestinalis YT2 significantly alleviated menopausal symptoms, such as increased fat mass, decreased bone mineral density, increased pain sensitivity, depression-like behaviour, and cognitive impairment. Additionally, the administration of L. intestinalis YT2 restored the intestinal microbial composition, including an increased Firmicutes/Bacteroides ratio. L. intestinalis YT2 also promoted gut barrier integrity by increasing the mRNA levels of tight junction-related markers. In conclusion, L. intestinalis YT2 treatment alleviated menopausal symptoms via the modulation of the gut microbiota. Importantly, these results suggest that L. intestinalis YT2 should be considered as a therapeutic probiotic agent for menopausal women.

Intronic LINE-1 insertion in SLCO1B3 as a highly prevalent cause of rotor syndrome in East Asian population

Rotor syndrome is caused by digenic loss-of-function variants in SLCO1B1 and SLCO1B3 but only a few studies have reported co-occurring inactivating variants from both genes. A rotor syndrome-causing long interspersed element-1 (LINE-1) insertion in SLCO1B3 had been reported to be highly prevalent in the Japanese population but there has been no additional report. In spite of its known association with various human diseases, LINE-1 is hard to detect with current sequencing technologies. In this study, we aimed to devise a method to screen the LINE-1 insertion variant and investigate the frequency of this variant in various populations. A chimeric sequence, that was generated by concatenating the reference sequence at the junction and a part of inserted LINE-1 sequence, was searched from 725 raw sequencing data files. In cases containing the chimeric sequence, confirmatory long-range PCR and gap-PCR were performed. In total, 95 (13.1%) of 725 patients were positive for the chimeric sequence, and all were confirmed to have the SLCO1B3 LINE-1 insertion by PCR-based tests. The same chimeric sequence was searched from the 1000 Genomes Project data repository and the carrier frequency was remarkably high in the East Asian populations (10.1%), especially in Southern Han Chinese (18.5%), but almost absent in other populations. This SLCO1B3 LINE-1 insertion should be screened in a population-specific manner under suspicion of Rotor syndrome and the methods proposed in this study would enable this in a simple way.

Longitudinal proteomic profiling provides insights into host response and proteome dynamics in COVID-19 progression

In managing patients with coronavirus disease 2019 (COVID‐19), early identification of those at high risk and real‐time monitoring of disease progression to severe COVID‐19 is a major challenge. We aimed to identify potential early prognostic protein markers and to expand understanding of proteome dynamics during clinical progression of the disease. We performed in‐depth proteome profiling on 137 sera, longitudinally collected from 25 patients with COVID‐19 (non‐severe patients, n = 13; patients who progressed to severe COVID‐19, n = 12). We identified 11 potential biomarkers, including the novel markers IGLV3‐19 and BNC2, as early potential prognostic indicators of severe COVID‐19. These potential biomarkers are mainly involved in biological processes associated with humoral immune response, interferon signalling, acute phase response, lipid metabolism, and platelet degranulation. We further revealed that the longitudinal changes of 40 proteins persistently increased or decreased as the disease progressed to severe COVID‐19. These 40 potential biomarkers could effectively reflect the clinical progression of the disease. Our findings provide some new insights into host response to SARS‐CoV‐2 infection, which are valuable for understanding of COVID‐19 disease progression. This study also identified potential biomarkers that could be further validated, which may support better predicting and monitoring progression to severe COVID‐19.

Organotypic Spheroid Culture to Mimic Radiation-Induced Salivary Hypofunction

Radiation treatment often leads to irreversible damage to normal salivary glands (SGs) because of their proximity to head and neck cancers. Optimization of the in vitro model of irradiation (IR)-induced SG damage is warranted to investigate pathophysiology and monitor treatment outcome. Here, we present an organotypic spheroid culture model to investigate the impact of IR on SGs and the mechanisms underlying IR-induced structural and functional changes. Human parotid epithelial cells were obtained from human parotid glands and plated on either plastic plates or Matrigel. A number of 3-dimensional (3D) spheroids were assembled on Matrigel. After IR at 10 and 20 Gy, morphologic changes in cells in 2D monolayers and 3D spheroids were observed. As the structural integrity of the 3D spheroids was destroyed by IR, the expression levels of salivary epithelial and structural proteins and genes decreased proportionally with radiation dosage. Furthermore, the spheroid culture allowed better measurement of functional alterations following IR relative to the monolayer culture, in which IR-inflicted spheroids exhibited a loss of acinar-specific cellular functions that enable Ca²⁺ influx or secretion of α-amylase in response to cholinergic or β-adrenergic agonists. p53-mediated apoptotic cell death was observed under both culture conditions, and its downstream signals increased, such as p53 upregulated modulator of apoptosis (PUMA), Bax, cytochrome c, caspase 9, and caspase 3. These results suggest that the organotypic spheroid culture could provide a useful alternative model for exploration of radiobiology and mode of action of new therapies for prevention of radiation-induced salivary hypofunction.

Evaluation of trabecular bone score in patients with a distal radius fracture

We compared bone mineral density (BMD) and trabecular bone score (TBS) in postmenopausal women with a distal radius fracture older than 50 years with controls. Total hip BMD was significantly different, but TBS was not different between two groups, suggesting TBS does not reflect microarchitectural changes of the distal radius.

INTRODUCTION

The purpose of this study was to determine whether trabecular bone score (TBS) has additive value for discriminating distal radius fracture (DRF) independent of BMD.

METHODS

We compared BMD and TBS in 258 postmenopausal women with a DRF older than 50 years of age with age- and body mass index (BMI)-matched controls who had no history of osteoporotic fracture. BMD was measured at the lumbar spine and hip using dual energy X-ray absorptiometry scans (GE Lunar Prodigy). TBS was calculated on the same spine image. A multivariate logistic regression analysis was used to analyze the odds ratio (OR) for the occurrence of DRF using age, BMI, lumbar spine BMD, total hip BMD, and TBS.

RESULTS

Patients with a DRF had significantly lower BMDs at hip (neck, trochanter and total) than those of controls: 0.752 ± 0.097, 0.622 ± 0.089, and 0.801 ± 0.099 in patients and 0.779 ± 0.092, 0.648 ± 0.089, 0.826 ± 0.101 in controls. However, lumbar spine BMD and TBS were not significantly different between the groups (p = 0.400 and 0.864, respectively). The multivariate analysis indicated that only total hip BMD was significantly associated with the occurrence of DRF (OR, 10.231; 95 % confidence interval, 1.724-60.702; p = 0.010).

CONCLUSIONS

TBS was not different between women with a DRF and those without a history of osteoporotic fracture, suggesting that TBS measured at the lumbar spine does not reflect early microarchitectural changes of the distal radius. Only total hip BMD is associated with the risk of DRF in Korean women.

Evaluation of vitamin D levels in women with carpal tunnel syndrome

Studies suggest that vitamin D has a role in neuroprotection. We investigated whether vitamin D status is associated with carpal tunnel syndrome. Vitamin D levels were compared between carpal tunnel syndrome women (n = 135) and healthy control women (n = 135) or patients with other upper limb conditions (n = 135). There were no differences in vitamin D levels between the patients with carpal tunnel syndrome and the controls. However, women with carpal tunnel syndrome younger than 50 years old had significantly lower vitamin D levels than age-matched healthy control women (P = 0.023) or patients with other upper limb conditions (P = 0.035). When women with carpal tunnel syndrome and healthy control women were pooled, the incidence of carpal tunnel syndrome was higher in vitamin D deficient women than in non-deficient women, especially in those younger than 50 years. This study suggests a potential link between vitamin D status and the occurrence of carpal tunnel syndrome in women younger than 50 years but causation is not established.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic Level III.

Complications in Stent-Assisted Endovascular Therapy of Ruptured Intracranial Aneurysms and Relevance to Antiplatelet Administration: A Systematic Review

BACKGROUND AND PURPOSE

Despite the increasing use of stent-assisted coiling for ruptured intracranial aneurysms, there is little consensus regarding the appropriate antiplatelet administration for this. The objectives of this systematic review were to provide an overview of complications and their association with the method of antiplatelet administration in stent-assisted coiling for ruptured intracranial aneurysms.

MATERIALS AND METHODS

A comprehensive search of the literature in the data bases was conducted to identify studies reporting complications of stent-assisted coiling for ruptured intracranial aneurysms. The pooled event rate of preprocedural thromboembolisms, hemorrhages, and mortality was estimated from the selected studies. Subgroup analyses were performed by the method of antiplatelet administration (pre-, postprocedural, and modified). Meta-analysis was conducted to compare periprocedural complications and mortality between ruptured intracranial aneurysms and unruptured intracranial aneurysms.

RESULTS

Of the 8476 studies identified, 33 with 1090 patients were included. The event rates of thromboembolism and intra- and postprocedural hemorrhage were 11.2% (95% CI, 9.2%-13.6%), 5.4% (95% CI, 4.1%-7.2%), and 3.6% (95% CI, 2.6%-5.1%), respectively. Subgroup analyses of thromboembolism showed a statistically significant difference between groups (P < .05). In the preprocedural and modified antiplatelet groups, the risk for thromboembolism in stent-assisted coiling for ruptured intracranial aneurysm was not significantly different from that for unruptured intracranial aneurysm, though this risk of the postprocedural antiplatelet group was significantly higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms.

CONCLUSIONS

On the basis of current evidence, complications of stent-assisted coiling for ruptured intracranial aneurysm may be affected by the method of antiplatelet administration.

Gadolinium enhancement of atherosclerotic plaque in the middle cerebral artery: relation to symptoms and degree of stenosis

BACKGROUND AND PURPOSE

High-resolution MR imaging can depict intracranial arterial atherosclerotic plaques. Our aim was to evaluate the relationship between the degree of enhancement of MCA plaques on contrast-enhanced high-resolution MR imaging and ischemic stroke and stenosis severity.

MATERIALS AND METHODS

This study enrolled 36 patients diagnosed with moderate-to-severe atherosclerotic MCA stenosis. A contrast-enhanced T1-weighted volume isotropic turbo spin-echo acquisition sequence was acquired for assessing plaque enhancement. Plaque-to-CSF contrast ratio was calculated after the signal intensity of plaques at the stenotic segment was measured. Univariate comparison and multivariate logistic regression analyses were performed for symptomatic and asymptomatic groups to assess the relationship between symptomatic stenosis and independent variables, including plaque-to-CSF contrast ratio, degree of stenosis, and clinical risk factors. Plaque-to-CSF contrast ratio was compared between the moderate and severe stenosis groups.

RESULTS

Twenty-one patients had symptomatic MCA stenosis, and 15 had asymptomatic stenosis. The plaque-to-CSF contrast ratio was significantly higher in the symptomatic group than in the asymptomatic group (63.6 ± 10.6% versus 54.1 ± 13.5%, respectively; P < .05). The degree of stenosis also differed significantly between the 2 groups (P < .05). Multivariate analysis revealed that the degree of stenosis was the only independent predictor of ischemic stroke symptoms. The plaque-to-CSF contrast ratio of severe stenosis was significantly higher than that of moderate stenosis (66.8 ± 8.7% versus 55.9 ± 12.8%, respectively; P < .05).

CONCLUSIONS

Plaque enhancement was significantly higher in patients with symptomatic plaques and may have been affected by the degree of stenosis. A difference in plaque enhancement according to the degree of stenosis has implications for understanding the development of intracranial atherosclerotic plaques.

Inguinal approach for the management of unilateral non-palpable testis: is diagnostic laparoscopy necessary?

OBJECTIVE

During the last decade laparoscopy has increasingly been advocated as the primary investigative procedure for the management of the non-palpable testis. We reviewed the medical records in a consecutive series of boys with non-palpable testis to examine the contribution of the initial inguinal approach in the management of unilateral non-palpable testis.

MATERIALS AND METHODS

Among the 183 consecutive patients with cryptorchidism from 2003 to 2012, there were 21 patients with unilateral and three with bilateral non-palpable testes. All unilateral patients then underwent inguinal and scrotal exploration through an inguinal incision. For those patients with an intra-abdominal peeping testis, the gonad was placed into the scrotum after meticulous cranial mobilization of the spermatic cord.

RESULTS

Patient age ranged from 11 months to 144 months (mean age: 23 months). Among the 21 unilateral cases, testicular absence or atrophy was confirmed in seven patients with a scrotal nubbin in six, and blind-ending vas and vessels at the external inguinal ring in one patient. Among the remaining 14 patients with sizeable testes, 12 testes were intra-abdominal peeping testes and two testicles were seen within the distal inguinal canal, which may be missed on physical examination owing to patient obesity. The intra-abdominal peeping testicle had the opened processus vaginalis entering the internal ring in which testicle was found. These were fixed into the scrotum successfully by cranial mobilization of spermatic vessel sometimes cutting the internal oblique muscle and by Prentiss and Fowler-Stephen's maneuver. Diagnostic laparoscopy was done on three patients with bilateral cases.

CONCLUSIONS

Given the result that most of nubbins are within the scrotum and testes with intra-abdominal peeping testes are fixed down safely into the scrotum, the inguinal approach may suffice for the management of unilateral non-palpable testis. Laparoscopy should be reserved for patients with bilateral non-palpable undescended testes.

Effective doses from panoramic radiography and CBCT (cone beam CT) using dose area product (DAP) in dentistry

OBJECTIVES

We compared the effective dose from panoramic radiography with that from cone beam CT (CBCT) using dose area product under adult and child exposure conditions.

METHODS

The effective doses of the cephalo, panorama, implant and dental modes of Alphard 3030 (Asahi Roentgen Ind., Co. Ltd, Kyoto, Japan) CBCT and the Jaw, Wide, Facial and temporomandibular joint modes of Rayscan Symphony (RAY Co., Ltd, Hwaseong, Republic of Korea) CBCT were compared with those of CRANEX(®) 3+ CEPH (Soredex Orion Corporation, Helsinki, Finland) panoramic radiography equipment under adult and child exposure conditions. Each effective dose was calculated using a conversion formula from dose area product meter measured values (VacuTec Messtechnik GmbH, Dresden, Germany). The conversion formulae used were suggested by Helmrot and Alm Carlsson and Batista et al, and they were applied with the tube voltage taken into consideration.

RESULTS

The maximum effective doses from the Alphard 3030 and Rayscan Symphony were 67 and 21 times greater than that from panoramic radiography, respectively. The ratios of the effective dose under the child setting to that under the adult condition were 0.60-0.62 and 0.84-0.95, and the maximum differences in effective doses between the adult and child exposure settings were equivalent to 27 and 4 times greater than a panoramic examination in the Alphard 3030 and Rayscan Symphony, respectively.

CONCLUSIONS

The effective CBCT doses were higher than those of panoramic radiography. The differences in effective doses between the adult and child CBCT settings were dependent on equipment type and exposure parameters. Therefore, adequate mode selection and control of exposure as well as further research are necessary to minimize the effective dose to patients, especially for radiosensitive children.

Is elective nodal irradiation beneficial in patients with pathologically negative lymph nodes after neoadjuvant chemotherapy and breast-conserving surgery for clinical stage II-III breast cancer? A multicentre retrospective study (KROG 12-05)

BACKGROUND

To evaluate the effects of elective nodal irradiation (ENI) in clinical stage II-III breast cancer patients with pathologically negative lymph nodes (LNs) (ypN0) after neoadjuvant chemotherapy (NAC) followed by breast-conserving surgery (BCS) and radiotherapy (RT).

METHODS

We retrospectively analysed 260 patients with ypN0 who received NAC followed by BCS and RT. Elective nodal irradiation was delivered to 136 (52.3%) patients. The effects of ENI on survival outcomes were evaluated.

RESULTS

After a median follow-up period of 66.2 months (range, 15.6-127.4 months), 26 patients (10.0%) developed disease recurrence. The 5-year locoregional recurrence-free survival and disease-free survival (DFS) for all patients were 95.5% and 90.5%, respectively. Pathologic T classification (0-is vs 1 vs 2-4) and the number of LNs sampled (<13 vs ≥13) were associated with DFS (P=0.0086 and 0.0012, respectively). There was no significant difference in survival outcomes according to ENI. Elective nodal irradiation also did not affect survival outcomes in any of the subgroups according to pathologic T classification or the number of LNs sampled.

CONCLUSIONS

ENI may be omitted in patients with ypN0 breast cancer after NAC and BCS. But until the results of the randomised trials are available, patients should be put on these trials.

Lipids, CHOs, proteins: can all macronutrients put a 'brake' on eating?

The gastrointestinal (GI) tract and specifically the most distal part of the small intestine, the ileum, has become a renewed focus of interest for mechanisms targeting appetite suppression. The 'ileal brake' is stimulated when energy-containing nutrients are delivered beyond the duodenum and jejunum and into the ileum, and is named for the feedback loop which slows or 'brakes' gastric emptying and duodeno-jejunal motility. More recently it has been hypothesized that the ileal brake also promotes secretion of satiety-enhancing GI peptides and suppresses hunger, placing a 'brake' on food intake. Postprandial delivery of macronutrients to the ileum, other than unavailable carbohydrates (CHO) which bypass absorption in the small intestine en route to fermentation in the large bowel, is an uncommon event and hence this brake mechanism is rarely activated following a meal. However the ability to place a 'brake' on food intake through delivery of protected nutrients to the ileum is both intriguing and challenging. This review summarizes the current clinical and experimental evidence for activation of the ileal brake by the three food macronutrients, with emphasis on eating behavior and satiety as well as GI function. While clinical studies have shown that exposure of the ileum to lipids, CHOs and proteins may activate GI components of the ileal brake, such as decreased gut motility, gastric emptying and secretion of GI peptides, there is less evidence as yet to support a causal relationship between activation of the GI brake by these macronutrients and the suppression of food intake. The predominance of evidence for an ileal brake on eating comes from lipid studies, where direct lipid infusion into the ileum suppresses both hunger and food intake. Outcomes from oral feeding studies are less conclusive with no evidence that 'protected' lipids have been successfully delivered into the ileum in order to trigger the brake. Whether CHO or protein may induce the ileal brake and suppress food intake has to date been little investigated, although both clearly have GI mediated effects. This review provides an overview of the mechanisms and mediators of activation of the ileal brake and assesses whether it may play an important role in appetite suppression.

Lipids, CHOs, proteins: can all macronutrients put a 'brake' on eating?

The gastrointestinal (GI) tract and specifically the most distal part of the small intestine, the ileum, has become a renewed focus of interest for mechanisms targeting appetite suppression. The 'ileal brake' is stimulated when energy-containing nutrients are delivered beyond the duodenum and jejunum and into the ileum, and is named for the feedback loop which slows or 'brakes' gastric emptying and duodeno-jejunal motility. More recently it has been hypothesized that the ileal brake also promotes secretion of satiety-enhancing GI peptides and suppresses hunger, placing a 'brake' on food intake. Postprandial delivery of macronutrients to the ileum, other than unavailable carbohydrates (CHO) which bypass absorption in the small intestine en route to fermentation in the large bowel, is an uncommon event and hence this brake mechanism is rarely activated following a meal. However the ability to place a 'brake' on food intake through delivery of protected nutrients to the ileum is both intriguing and challenging. This review summarizes the current clinical and experimental evidence for activation of the ileal brake by the three food macronutrients, with emphasis on eating behavior and satiety as well as GI function. While clinical studies have shown that exposure of the ileum to lipids, CHOs and proteins may activate GI components of the ileal brake, such as decreased gut motility, gastric emptying and secretion of GI peptides, there is less evidence as yet to support a causal relationship between activation of the GI brake by these macronutrients and the suppression of food intake. The predominance of evidence for an ileal brake on eating comes from lipid studies, where direct lipid infusion into the ileum suppresses both hunger and food intake. Outcomes from oral feeding studies are less conclusive with no evidence that 'protected' lipids have been successfully delivered into the ileum in order to trigger the brake. Whether CHO or protein may induce the ileal brake and suppress food intake has to date been little investigated, although both clearly have GI mediated effects. This review provides an overview of the mechanisms and mediators of activation of the ileal brake and assesses whether it may play an important role in appetite suppression.

Stage IE/IIE extranodal NK/T-cell lymphoma arising in the nasal cavity: analysis of CT findings and their prognostic value

AIM

To investigate the computed tomography (CT) findings in patients with stage IE/IIE extranodal natural killer/T-cell lymphoma (ENKTL) arising in the nasal cavity and to evaluate whether imaging findings revealed by CT have prognostic value.

MATERIALS AND METHODS

The CT findings of 62 patients diagnosed with IE/IIE ENKTL arising in the nasal cavity were retrospectively reviewed. Imaging findings were investigated, and evaluated imaging findings were analysed for the prognostic value of overall survival (OS) and disease-free survival (DFS).

RESULTS

Of the 62 patients, 21 (34%) presented with a superficial infiltrative, 38 (61%) with a mass forming, and three (5%) with a combined pattern. Of all imaging findings, local invasiveness (n = 26, 42%), including bony destruction, erosion, or soft-tissue involvement, was the only independent prognostic factor for OS [p = 0.008; hazard ratio (HR): 3.85; 95% confidence intervals (CI): 1.42-10.44] and DFS (p = 0.001; HR: 4.25; 95% CI: 1.72-10.47). In a subgroup analysis of 36 cases with no local invasiveness, a superficial infiltrative pattern in one nasal cavity was a positive prognostic factor for OS (p = 0.028) and DFS (p = 0.008).

CONCLUSION

Imaging findings at CT provided clinically useful predictions for treatment outcomes. Local invasiveness revealed by CT findings was a strong prognostic factor for poor OS and DFS. In addition, in patients with no local invasiveness, a superficial infiltrative pattern in one nasal cavity predicted favourable OS and DFS.

Treatment results of post-operative radiotherapy in patients with salivary duct carcinoma of the major salivary glands

OBJECTIVE

Salivary duct carcinoma (SDC) is a rare malignancy of high-grade pathological type. We evaluated clinical outcomes and prognostic factors in 35 patients with SDC treated post-operatively with adjuvant radiation.

METHODS

We retrospectively assessed overall survival, locoregional control and disease-free survival in 35 patients with SDC of the major salivary glands who underwent surgery and were subsequently treated with radiotherapy. The evaluated prognostic factors included gender, age, symptom duration, tumour site, tumour size, TNM classification, and the following pathological features: perineural invasion, lymphovascular invasion, extraparenchymal invasion and resection-margin status.

RESULTS

Of the 35 patients, 30 (85.7%) were male. Median age at initial diagnosis was 62 years (range 38-75 years). The parotid gland was the main site affected in 22 patients (62.9%). 18 patients (51.5%) had pathological T3/T4 tumours, and 26 (74.3%) showed pathological nodal involvement. Actuarial 5-year locoregional control, disease-free survival and overall survival rates were 63.3%, 47.4% and 55.1%, respectively. The cause-specific death rate was 31.4% (n=11). Pathological nodal involvement was correlated with distant metastasis (p=0.011). Lymphovascular invasion was significantly prognostic for distant metastasis-free survival (p=0.049), locoregional control (p=0.012) and overall survival (p=0.003) in a Cox proportional hazard model, whereas perineural invasion was only significantly prognostic for overall survival (p=0.005).

CONCLUSIONS

Surgery and post-operative radiotherapy were effective for locoregional control. Lymphovascular invasion and perineural invasion were significant prognostic factors in patients with SDC.

Effects of silver nanoparticles on biological nitrogen removal processes

The effects of silver (Ag) nanoparticles (NPs) on activated sludge in a biological nitrogen removal (BNR) process were investigated under aerobic and anoxic conditions. We show that nitrification was more vulnerable to Ag NPs exposure than denitrification at the same Ag NPs concentration. In continuous operation of the BNR process, a higher inhibitory effect on nitrification was attributed to a smaller size of Ag NPs. About 70-90% of the Ag NPs supplied were embedded in the sludge matrix but 10-30% of the Ag NPs remained in the supernatant. This indicates that significant amounts of Ag NPs could be discharged from wastewater treatment plants and potentially impact on aquatic ecosystems.

Application of PTFE membrane for ammonia removal in a membrane contactor

The feasibility of a membrane contactor system for ammonia removal was studied. The mass transfer coefficient was used to quantitatively compare the effect of various operation conditions on ammonia removal efficiency. Effective removal of ammonia was possible with a Polytetrafluoroethylene (PTFE) membrane contactor system at all tested conditions. Among the various operation parameters, contact time and solution pH showed significant effect on the ammonia removal mechanism. The overall ammonia removal rate was not affected by influent suspended solution concentration unlike other pressure driven membrane filtration processes. Also the osmotic distillation phenomena which deteriorate the mass transfer efficiency can be minimized by preheating of influent wastewater. A membrane contactor system can be a possible alternative to treat high strength nitrogen wastewater by optimizing operation conditions such as stripping solution flow rate, influent wastewater temperature, and influent pH.

Fate of nitrogen species in nitrate reduction by nanoscale zero valent iron and characterization of the reaction kinetics

This study investigates the fate of nitrogen species during nitrate reduction by nanoscale zero valent iron (NZVI) as well as the related kinetics. The NZVI used for the experiments was prepared by chemical reduction without a stabilizing agent. The pseudo first order kinetic constant of nitrate reduction at 30 degrees C with an NZVI/nitrate ratio of 1.25:1, which were the reference conditions of this study, was 4.08 h(-1) (R(2)=0.955). A nitrogen mass balance was established by quantitative analysis of aqueous-phase and gas-phase nitrogen species. The results confirm that the nitrate was converted to ammonium ion, that ammonia stripping subsequently occurred under a strong alkaline condition, and that the total amount of aqueous nitrogen was consequently reduced. The nitrate reduction rate also increased with a lower pH and a higher temperature when microscale ZVI was used. However, in contrast to the reaction by microscale ZVI, the nitrate reduction rate by NZVI was higher for an unbuffered condition, possibly due to the abundance of surface atoms and the smaller size.

Conversion of single-crystalline C60 nanodisks and nanorods into graphitic nanostructures via hydrogen thermal annealing

We have developed a process to convert C(60) nanostructures into graphitic nanostructures. Disk-shaped and wire-shaped C(60) nanostructures synthesized by the liquid-liquid interfacial precipitation method, the vapor-solid process, and solvent evaporation were successfully converted into graphitic structures by thermal annealing in hydrogen at 900 degrees C. Scanning electron and tunneling electron microscopic studies confirmed that the converted nanostructures were composed of multi-graphitic structures such as multi-walled carbon nanotubes, carbon nanofibers, and carbon onions. Fourier transform Raman spectroscopy and conductance measurements were carried out to further confirm the successful formation of graphitic layers. In the Raman spectra, the nanostructures converted from C(60) disks showed signature D, G, and G(') bands of graphitic structures, while the A(g) mode (1469 cm(-1)) of the original C(60) molecule disappeared. C(60) nanowire devices fabricated for the conductance measurements of the converted structures showed dramatically decreased resistance (R approximately 100 kOmega) compared to the pristine C(60) wire (R>100 MOmega). Further manipulation of the reaction environment, including the gas and the annealing temperature, may reveal a new way to attain diverse graphitic nanostructures economically.

Interaction of nitric oxide and renin angiotensin system in pulmonary arterial circulation of RHR

We investigated the interaction between nitric oxide and the renin angiotensin system in regulating isolated pulmonary arterial tension and pulmonary arterial pressure (PAP) in renal hypertensive rats (RHR) made by complete ligation of left renal artery. Losartan induced a depressor response that was smaller in RHR than in normotensive rats (NR) (3.3 and 7.0 mmHg, respectively, at 3.0 mg/kg, p<0.05), and the response was significantly reduced by N(G)-nitro-L-arginine methyl ester (L-NAME). Angiotensin II elevated the PAP (7.6 and 10.8 mmHg at 0.1 mug/kg; 20.3 and 23.6 mmHg at 1.0 mug/kg, respectively) and contracted the isolated pulmonary artery (pD(2): 8.79 and 8.71, respectively) from both NR and RHR with similar magnitude, and these effects were significantly enhanced by L-NAME in NR, but not in HRR. Acetylcholine lowered the PAP slightly less effectively in RHR than in NR (3.8 and 6.0 mmHg at 10 mug/kg, respectively) and relaxed the pulmonary artery precontracted with norepinephrine in both rats with similar magnitude (E(max): 60.8 and 63.6%, respectively), and the effect being completely abolished after pretreatment with L-NAME or removal of endothelial cells. These results suggest that nitric oxide interacts with renin angiotensin system to control the pulmonary vascular tension and pulmonary arterial circulation of RHR.

Enzymatic Hydrolysis of Heated Whey: Iron-Binding Ability of Peptides and Antigenic Protein Fractions

This study evaluated the influence of various enzymes on the hydrolysis of whey protein concentrate (WPC) to reduce its antigenic fractions and to quantify the peptides having iron-binding ability in its hydrolysates. Heated (for 10 min at 100 degrees C) WPC (2% protein solution) was incubated with 2% each of Alcalase, Flavourzyme, papain, and trypsin for 30, 60, 90, 120, 150, 180, and 240 min at 50 degrees C. The highest hydrolysis of WPC was observed after 240 min of incubation with Alcalase (12.4%), followed by Flavourzyme (12.0%), trypsin (10.4%), and papain (8.53%). The nonprotein nitrogen contents of WPC hydrolysate followed the hydrolytic pattern of whey. The major antigenic fractions (beta-lactoglobulin) in WPC were degraded within 60 min of its incubation with Alcalase, Flavourzyme, or papain. Chromatograms of enzymatic hydrolysates of heated WPC also indicated complete degradation of beta-lactoglobulin, alpha-lactalbumin, and BSA. The highest iron solubility was noticed in hydrolysates derived with Alcalase (95%), followed by those produced with trypsin (90%), papain (87%), and Flavourzyme (81%). Eluted fraction 1 (F-1) and fraction 2 (F-2) were the respective peaks for the 0.25 and 0.5 M NaCl chromatographic step gradient for analysis of hydrolysates. Iron-binding ability was noticeably higher in F-1 than in F-2 of all hydrolysates of WPC. The highest iron contents in F-1 were observed in WPC hydrolysates derived with Alcalase (0.2 mg/kg), followed by hydrolysates derived with Flavourzyme (0.14 mg/kg), trypsin (0.14 mg/kg), and papain (0.08 mg/kg). Iron concentrations in the F-2 fraction of all enzymatic hydrolysates of WPC were low and ranged from 0.03 to 0.05 mg/kg. Fraction 1 may describe a new class of iron chelates based on the reaction of FeSO4 x 7 H2O with a mixture of peptides obtained by the enzymatic hydrolysis of WPC. The chromatogram of Alcalase F-1 indicated numerous small peaks of shorter wavelengths, which probably indicated a variety of new peptides with greater ability to bind with iron. Alcalase F-1 had higher Ala (18.38%), Lys (17.97%), and Phe (16.58%) concentrations, whereas the presence of Pro, Gly, and Tyr was not detected. Alcalase was more effective than other enzymes at producing a hydrolysate for the separation of iron-binding peptides derived from WPC.

Taste and odour issues in South Korea's drinking water industry

This paper reviews taste and odour (T&O) issues of South Korea's water industry. For this purpose, an overview of the water supply systems and drinking water standards is presented and some results from citizen surveys for customer satisfaction are included. A case study is presented in which the water intake was shifted from inside a main reservoir to a downstream location due to T&O problems. It is true that the South Korean water industry has long relied on the tolerance of consumers for periodic T&O events. Recently the South Korean water industry has become aware that the T&O problems are at the centre of consumers' concerns and has taken several positive approaches. These include monitoring T&O events using sensory and instrumental methods, installation of a baffled-channel PAC contactor and application of advanced water treatment processes.

Effect of condensate of food waste (CFW) on nutrient removal and behaviours of intercellular materials in a vertical submerged membrane bioreactor (VSMBR)

The main objective of this study was to investigate the effect of condensate of food waste (CFW) on nutrient removal in a pilot-scale vertical submerged membrane bioreactor (VSMBR) treating municipal wastewater having total-chemical oxygen demand to total-nitrogen ratio (T-COD/T-N) of 5.5. In this reactor, the average removal efficiencies of T-COD, T-N, and T-P (total-phosphorus) were 96%, 74%, and 78%, respectively at 8-h hydraulic retention time (HRT), 60-day sludge retention time (SRT), and internal recycle rate of 400%. As the CFW was supplemented with 0.86% of the influent flow rate, the T-N and T-P removal efficiencies increased to 81% and 91%, respectively. Accordingly, in batch tests, it was concluded that the supply of CFW improved enhanced biological phosphorus removal (EBPR) activity of microorganisms resulting in improvement of nutrient removal efficiency. Under this condition, several kinds of poly-hydroxyalkanoates (PHAs) were detected inside the cells.

Development of an innovative vertical submerged membrane bioreactor (VSMBR) for simultaneous removal of organic matter and nutrients

A novel vertical submerged membrane bioreactor (VSMBR) composed of anoxic and oxic zones in one reactor was developed in an attempt to reduce the problems concerning effective removal of pollutants from synthetic wastewater including glucose as a sole carbon source as well as membrane fouling. The optimal volume ratio of anoxic zone/oxic zone was found as 0.6. The desirable internal recycle rate and hydraulic retention time (HRT) for effective nutrient removal were 400% and 8h, respectively. Under these conditions, the average removal efficiencies of total nitrogen (T-N) and total phosphorus (T-P) were 75% and 71%, respectively, at the total chemical oxygen demand (T-COD)/T-N ratio of 10. In addition, the VSMBR showed high specific removal rates of nitrogen and phosphorus while the biomass growth yield from the reactor was about 20% of the conventional activated sludge process.

Simultaneous treatment of sewage sludge and food waste by the unified high-rate anaerobic digestion system

This study aimed to evaluate the performance of the unified high-rate anaerobic digestion (UHAD) system treating co-substrate of sewage sludge and food waste. A 24-hr operating sequence consisted of four steps including fill, react, settle, and draw. The effects of co-substrate and organic loading rate (OLR) on the performance were investigated to verify the system applicability. In each OLR, the UHAD system showed higher CH4 recovery (> 70%), CH4 yield (0.3 L CH4/g VSadded) and CH4 production rate (0.6 L CH4/L/d) than the control system. In the specific methanogenic activity (SMA) tests on thermophilic biomass of the UHAD system, the average SMA of acetate (102 mL CH4/gVSS/d) was much higher than those of butyrate (85 mL CH4/g SS/d) and propionate (42 mL CH4/gVSS/d). It was demonstrated that the UHAD system for co-digestion resulted in higher methane yield and methane production rate due to sequencing batch operation, thermophilic digestion, and co-digestion. The enhanced performance could be attributed to longer retention time of active biomass, faster hydrolysis, higher CH4 conversion rate, and balanced nutrient conditions of co-substrate in the UHAD system. Consequently, this optimized unification could be a viable option for the simultaneous treatment of two types of OFMSW with high stability.

Effects of influent COD/N ratio and internal recycle ratio on nitrogen removal efficiency in the KNR process

In this study, with the KNR process that has many advantages, the nitrogen removal efficiency of KNR was experimentally investigated at various COD/N ratios of influent conditions. The optimal operating condition of internal recycle ratio was evaluated. The TN removal efficiencies were 59.1, 72.5 and 75.9% at the COD/N ratios of 3, 5 and 7, respectively. These high removal efficiencies resulted from high denitrification rate in UMBR with high microorganism concentration. Furthermore, specific endogenous denitrification at MLVSS of 10.3 g/L that is similar to MLVSS in UMBR was over two times higher than that at MLVSS of 2.06 g/L. This result suggests that endogenous denitrification rate in UMBR is so high that the requirement of an external carbon source can be saved. As the internal recycle ratio increased from 100 to 400%, the TN removal efficiency also improved from 69.5 to 82.9%, and the optimal internal recycle ratio was 300%.

Modeling of extracellular polymeric substances and soluble microbial products production in a submerged membrane bioreactor at various SRTs

Extracelluar polymeric substances (EPSs) and soluble microbial products (SMPs) produced by microbial cultures involved in membrane biofouling have been widely investigated. A mathematical model of EPS and SMP formation and degradation was established based on the activated sludge model no. 1 (ASM1) and was applied to the membrane bioreactor sludge with different sludge retention times (SRTs). The unified theory that the distinct products from the EPS and SMP overlapped each other was integrated into the ASM1. Two components, five processes and eight parameters were newly added to set up the model. To increase the accuracy of model simulation, microbial kinetic parameters were determined by respirometry method and applied to the model instead of microbial kinetic constant offered in ASM1. From the respirometry result, both of heterotroph and autotroph showed different yield value, growth rate and decay rate from activated sludge. There was no significant effect of SRT on SMP production and the experimental results showed good agreement with the predicted values by the model simulation. With the developed unified EPS and SMP model, EPS and SMP production could be simulated so well that it can be applied for the membrane biofouling control.

Single cell protein production of Euglena gracilis and carbon dioxide fixation in an innovative photo-bioreactor

The biological fixation using microalgae has been known as an effective and economical carbon dioxide reduction technology. Carbon dioxide (CO2) fixation by microalgae has been shown to be effective and economical. Among various algae, a species Euglena gracilis was selected as it has advantages such as high protein content and high digestibility for animal feed. A kinetic model was studied in order to determine the relationship between specific growth rate and light intensity. The half-saturation constant for light intensity in the Monod model was 178.7 micromol photons/m2/s. The most favorable initial pH, temperature, and CO2 concentration were found to be 3.5, 27 degrees C, and 5-10% (vol/vol), respectively. Light intensity and hydraulic retention time were tested for effects on cell yield in a laboratory-scale photo-bioreactor of 100l working volume followed by semi-continuous and continuous culture. Subsequently, an innovative pilot-scale photo-bioreactor that used sunlight and flue gas was developed to increase production of this bioresource. The proposed pilot-scale reactor showed improved cell yield compared with the laboratory-scale reactor.

Pilot-scale two-stage process: a combination of acidogenic hydrogenesis and methanogenesis

This study was performed to optimize both acidogenic hydrogenesis and methanogenesis, and then to develop a pilot-scale two-stage process producing not only CH4 but also H2. Firstly, acidogenic hydrogenesis of food waste was examined in pilot-scale leaching-bed reactors using dilution rate (D) as a tool to improve the environmental conditions. The maximum efficiency of 71.4% was obtained by adjusting D from 4.5 to 2.5 d(-1) depending on the state of degradation. Secondly, the wastewater from acidogenic hydrogenesis was converted to CH4 in a pilot-scale UASB reactor. The COD removal efficiency exceeded 95% up to the loading rates of 13.1 g COD/Ld, which corresponded to HRT of 0.25 d (6 h). Lastly, a pilot-scale two-stage process was devised based on a combination of acidogenic hydrogenesis and methanogenesis. Over 120 days, the pilot-scale process resulted in large VS reduction of 70.9% at the high loading rate of 12.5 kg VS/m3/d in a short SRT of 8 days.

Effect of internal recycle rate on the high-strength nitrogen wastewater treatment in the combined UBF/MBR system

An anaerobic/aerobic system combining an anaerobic upflow-sludge bed filter (UBF) and an aerobic membrane bioreactor (MBR) was operated to enhance organic and nitrogen removal efficiency. The internal recycle rate, which is one of the most important operation factors that affects overall removal efficiency, was varied from 100% to 300% of the influent flow. Under these conditions, the overall removal efficiencies of organic and nitrogen and characteristics of membrane fouling in the combined system treating the synthetic wastewater including high concentration of organics and nutrients were studied. As a result, nitrogen removal efficiency was increased to 67% when the internal recycle rate was 300% of influent flow rate. As the internal recycle ratio increased from 100% to 200%, protein content decreased by 17% and carbohydrate content increased by 12%. However, there was no remarkable difference in total extracellular polymeric substances (EPS) content. At the high recycle rate of 300%, the surface charge of sludge was decreased while hydrophobicity (specific ultraviolet absorbance, SUVA) was increased. The differences in SUVA and surface charge were 11% and 1%, respectively. It is concluded that SUVA and EPS composition were important parameters affecting membrane fouling in the combined system.

Simultaneous removal of organic and strong nitrogen from sewage in a pilot-scale BNR process supplemented with food waste

As the sewerage system is incomplete, sewage in Korea lacks easily biodegradable organics for nutrient removal. In this country, about 11,400 tons of food waste of high organic materials is produced daily. Therefore, the potential of food waste as an external carbon source was examined in a pilot-scale BNR (biological nutrient removal) process for a half year. It was found that as the supply of the external carbon increased, the average removal efficiencies of T-N (total nitrogen) and T-P (total phosphorus) increased from 53% and 55% to 97% and 93%, respectively. VFAs (volatile fatty acids) concentration of the external carbon source strongly affected denitrification efficiency and EBPR (enhanced biological phosphorus removal) activity. Biological phosphorus removal was increased to 93% when T-N removal efficiency increased from 78% to 97%. In this study, several kinds of PHAs (poly-hydroxyalkanoates) in cells were observed. The observed PHAs was composed of 37% 3HB (poly-3-hydroxybutyrate), 47% 3HV (poly-3-hydroxyvalerate), 9% 3HH (poly-3-hydroxyhexanoate), 5% 3HO (poly-3-hydroxyoctanoate), and 2% 3HD (poly-3-hydroxydecanoate).

Anaerobic co-digestion of sewage sludge and food waste using temperature-phased anaerobic digestion process

This study was performed to overcome the low efficiency of anaerobic digestion of sewage sludge and food waste by combining temperature-phased digestion, sequencing batch operation, and co-digestion technology. It was demonstrated that the temperature-phased anaerobic sequencing batch reactor (TPASBR) system for the co-digestion of sewage sludge and food waste resulted in enhanced volatile solids (VS) reduction and methane production rate. At the organic loading rate (OLR) of 2.7 g VS/l/d, the TPASBR system showed the higher VS reduction (61.3%), CH4 yield (0.28 l/g VS(added)) and CH4 production rate (0.41 l CH4/l/d) than those (0.29 l CH4/l/d) of the mesophilic two-stage ASBR (MTSASBR). In the specific methanogenic activity (SMA) tests on thermophilic biomass of the TPASBR system, the average SMA of acetate (93 ml CH4/gVSS/d) was much higher than those of propionate (46 ml CH4/g VSS/d) and butyrate (76 ml CH4/g VSS/d). Also, higher specific hydrolytic activity (SHA, 217 mg COD/g VSS/d) of the biomass supported fast hydrolysis under thermophilic conditions. The track study revealed that the most active period of the 24 h cycle was between 6 and 12 h. The enhanced performance of the TPASBR system could be attributed to longer solids retention time, fast hydrolysis, higher CH4 conversion rate, and balanced nutrient condition of co-substrate. It was verified that this combination could be a promising and practical alternative for the simultaneous recycling of two types of organic fraction of municipal solid waste (OFMSW) with high stability.

Characteristics of granular sludge in a single upflow sludge blanket reactor treating high levels of nitrate and simple organic compounds

Simultaneous denitrification and methanogenesis were accomplished in a single upflow sludge blanket (USB) reactor. More than 99% and 95% of nitrate and chemical oxygen demand (COD) removal rates were obtained at a loading of 600 mg NO3-N/L x d and 3,300 mg COD/L x d, respectively. The specific denitrification rate (SDR) increased as COD/NO3-N ratios decreased. Maximum SDR with acetate could reach 1.05 g NO3-N/gVSS x d. Significant sludge flotation was observed at the top of the reactor due to the change of microbial composition and the formation of hollow granules. Granules became fluffy and buoyant due to the growth of denitrifiers. Microscopic examination showed that granules exhibited layered structure and they were mainly composed of Methanosarcina sp., Pseudomonas sp., and rod-shaped bacteria.

Expression of HMGI(Y) associated with malignant phenotype of human gastric tissue

AIMS

We evaluated the association between HMGI(Y) expression and the detection of malignant cells by simple reverse transcriptase-polymerase chain reaction (RT-PCR) and correlated the level of HMGI(Y) expression and the clinicopathological data in gastric cancer.

METHODS AND RESULTS

We analysed HMGI(Y) expression in 62 gastric cancer tissues and 28 normal gastric tissues by RT-PCR and immunohistochemical study. HMGI(Y) expression evidenced by RT-PCR was observed in 42 (67.7%) of 62 gastric cancer samples, whereas eight (28.6%) of 28 normal gastric tissues were positive (P = 0.001). In immunohistochemical staining for HMGI(Y), 48 (77.4%) of 62 gastric cancers were positive for HMGI(Y), whereas four (6.5%) of 62 normal gastric mucosae around the tumour were weakly positive, particularly in cells of some hyperplastic glands (P < 0.001). There was no significant correlation between the levels of HMGI(Y) expression and stage, tumour size, histological grade, invasion depth, or lymph node metastasis.

CONCLUSIONS

Our results suggest that HMGI(Y) expression could be associated with malignant phenotype in human gastric tissue, and that HMGI(Y) may contribute to gastric tumorigenesis.

Nutrient removal using anaerobically fermented leachate of food waste in the BNR process

Nutrients removal efficiencies highly depend on the presence of biodegradable organic carbon in the biological nutrient removal (BNR) process but most domestic wastewater in Korea has shown a low C/N ratio and has a small amount of biodegradable COD (chemical oxygen demand). On the other hand, about 11,577 tons of food waste that contains a lot of organic material has been produced in Korea per day. The feasibility and applicability of anaerobically fermented leachate of food waste (AFLFW) as an external carbon source was examined in the laboratory-scale BNR process at different operation conditions with synthetic wastewater and domestic sewage. As the addition of AFLFW increased, the average removal efficiencies of SCOD, T-N, T-P changed from 96%, 60%, and 2% to 90%, 77%, and 67%, respectively. From anoxic nitrate utilization tests, it was observed that once the readily biodegradable COD (especially VFAs) was depleted, the denitrification rate reduced from 8.2 mg NO3-N/g VSS/hr to 0.7 mg NO3-N/g VSS/hr. From the molecular size distribution test, it was concluded that about 60% of soluble COD in effluent, which was considered to originate from AFLFW, had a large molecular size (> 30 kDa) that was not used by microorganisms.

Association of maspin expression with the high histological grade and lymphocyte-rich stroma in early-stage breast cancer

AIMS

Maspin is a recently described member of the serpin family or protease inhibitors that is known to be a tumour suppressor gene product. Loss of maspin expression has been found in most breast cancer cases and is correlated with cell motility and tumour invasiveness. However, its precise role in human breast cancer remains to be discovered. We aimed to evaluate the role of maspin in early-stage breast cancer.

METHODS AND RESULTS

We analysed the expression of maspin in 192 stage I and II primary breast cancers by immunohistochemistry. Of these cases, 34.4% showed maspin expression. Maspin expression was more frequently found in invasive ductal carcinoma (36.4%) than in invasive lobular carcinoma (7.1%). High maspin expression was demonstrated in breast cancers showing high histological grade or lymphocyte-rich stroma (P < 0.05). Maspin expression was not associated with overall and disease-free survival rate of breast cancer.

CONCLUSIONS

The results indicate that different biological mechanisms may be responsible for maspin expression in histologically distinct types of breast cancer. Our survey suggests that maspin expression in breast cancer might have a compensatory role rather than prognostic one.

Electrically enhanced ethanol fermentation by Clostridium thermocellum and Saccharomyces cerevisiae

Ethanol production by Clostridium thermocellum ATCC 35609 and Saccharomyces cerevisiae ATCC 26603 was improved in an electrochemical bioreactor system. It was increased by 61% with Cl. thermocellum and 12% with S. cerevisiae in the presence of -1.5 V of electric potential. These increases were attributed to high production rates due to regeneration and availability of increased reduced equivalents in the presence of electric potential. The electric current caused considerable shift in the metabolite concentrations on a molar basis in Cl. thermocellum fermentation but less in S. cerevisiae fermentation. Increasing electric potential in Cl. thermocellum fermentation resulted in less acetate and more lactate production. Acetate production was also reduced with increased electric potential in S. cerevisiae fermentation. The high electric potential of -5 V adversely affected the Cl. thermocellum fermentation, but not the S. cerevisiae fermentation even at a high electric potential of -10 V.

Novel anaerobic process for the recovery of methane and compost from food waste

Multi-step sequential batch two-phase anaerobic composting (MUSTAC) process was used to recover methane and composted material from food waste. The MUSTAC process consists of five leaching beds for hydrolysis, acidification and post-treatment, and an upflow anaerobic sludge blanket (UASB) reactor for methane recovery. This process involves the combined methods of sequential batch operation and two-phase anaerobic digestion for simple operation and high efficiency. Rumen microorganisms are inoculated due to their enhanced cellulolytic activity. Each leaching bed is operated in a sequential batch mode. Five leaching beds are operated in a multi-step mode with a two-day interval between degradation stages. Acidified products in the leachate from the leaching beds are converted to methane in the UASB reactor. The MUSTAC process demonstrated that it was capable of removing 84.9% of volatile solids (VS) and converting 85.6% of biochemical methane potential (BMP) into methane at 10.9 kg VS/m3 x d in 10 days. Methane gas production rate was 2.31 m3/m3 x d. The output from the post-treatment of residues in the same leaching bed without troublesome moving met the Korean regulation on compost, indicating that it could be used for soil amendment.

Denitrification of high NO3(-)-N containing wastewater using elemental sulfur; nitrogen loading rate and N2O production

The effects of both concentration and loading rates of nitrate on denitrification efficiency and N2O production during the autotrophic denitrification with elemental sulfur were evaluated. Experiments were conducted with three continuously fed sulfur packed bed reactors (SPBRs) with different influent nitrate concentrations. The loading rate at which nitrate removal efficiency was greater than 95% decreased from 2.46 to 1.64 kg NO3(-)-N m(-3) day(-1) as the influent NO3(-)-N concentration increased from 175 to 700 mg 1(-1). The nitrate removal rate per unit volume of sulfur layer can be expressed as alpha (ALR)n, where ALR is the applied loading rate. The range of alpha and n values were 0.72-0.83 and 0.91-0.94, respectively. The maximum nitrate removal rate was estimated as 3.9 to 4.5 kg NO3(-)-N m(-3) day(-1) depending on the influent NO3(-)-N concentration. The loading rate for complete denitrification without N2O production was 1.37 kg NO3(-)-N m(-3) day(-1) at the influent NO3(-)-N concentration of 175 mg 1(-1). N2O production became significant when the influent nitrate concentration increased while the loading rate remained the same. The batch test indicated that the amount of N2O production per unit mass of nitrogen was greater with nitrite than with nitrate showing that N2O production was directly related to the concentration of nitrite and nitrate.

Effects of transdermal nicotine on attention and memory in healthy elderly non-smokers

RATIONALE

Nicotine has been found to improve cognitive functions in patients with Alzheimer's disease, but little is known about its effects in the healthy non-smoking elderly.

OBJECTIVES

This study aimed to investigate the effects of nicotine on cognitive function in healthy non-smoking or nicotine-naïve elderly subjects.

METHODS

A transdermal patch containing either 5 mg nicotine or placebo was applied on the back of 63 healthy nicotine-naïve or non-smoking elderly Koreans. Cognitive functions were evaluated with the Short Blessed Test, Rey-Kim Memory Test, and digit span test of the Korean-WAIS, both before and 5.5 h after nicotine administration. The plasma level of nicotine after testing was measured using gas chromatography.

RESULTS

The subjects' memory functions in trial 5 of the Rey-Kim Memory Tests improved significantly. Furthermore, the effect on memory slope was significantly correlated with the higher plasma level of nicotine. However, the other tests did not reveal any correlation to a significant degree.

CONCLUSIONS

These results suggest that nicotine of lower plasma level can improve short-term verbal memory functions in non-smoking or nicotine-naïve healthy elderly people and that some effects are dependent on nicotine plasma levels.

A novel anti-ischemic ATP-sensitive potassium channel (K(ATP)) opener without vasorelaxation: N-(6-aminobenzopyranyl)-N'-benzyl-N' '-cyanoguanidine analogue

This paper describes the design, synthesis, and biological evaluation of a novel anti-ischemic compound, (2S,3S,4R)-N-(6-amino-3,4-dihydro-2-dimethoxymethyl-3-hydroxy-2-methyl-2H-benzopyranyl)-N'-benzyl-N"-cyanoguanidine (33), and the structure-activity relationships leading to the discovery of this compound. Compound 33 significantly reduced the myocardial infarct zone to area at risk (IZ/AAR) in the ischemic myocardium rat model with high cardioselectivity. Since the cardioprotective effect of compound 33 is reversed by ATP-sensitive potassium channel (K(ATP)) blockers, its anti-ischemic effect appears to be at least mediated by K(ATP) opening. In addition, compound 33 shows good protective activity on neuronal cells against oxidative stress, and therefore it is suggested that compound 33 may have therapeutic potential both in cardio- and in neuroprotection.

Development of the visual pathway is disrupted in mice with a targeted disruption of the calcium channel beta(3)-subunit gene

Refinement of the retinal pathways to the superior colliculus (SC) and dorsal lateral geniculate nucleus (dLGN) is mediated by nitric oxide (NO). Long-term depression (LTD) can also be induced in SC and LGN during the time at which these pathways are refined, and this LTD is partially dependent on NO and L-type Ca(2+) channel function. In an effort to determine whether NO-mediated pathway refinement is also mediated by Ca(2+) channel function, we have examined the refinement of the retinocollicular and retinogeniculate pathways in mice which lack the gene for the Ca(2+) channel beta(3) subunit (CCKO) and which have significantly reduced L-type Ca(2+) currents. Injections of the anterograde tracer cholera toxin subunit B/HRP were made into one eye of these knockout animals and in wild-type mice ages postnatal day (P) 13, P19, and P26. After 48 hours, mice were perfused and sections processed by using tetramethylbenzidine histochemistry. Labeling distribution in some animals was analyzed quantitatively. Obvious differences in the distribution of the ipsilateral retinocollicular pathway were observed at P15, with the pathway being more exuberant in CCKO mice. This difference was statistically significant. More subtle differences were seen at P21 and P28. Obvious differences were also seen in the contralateral retinogeniculate pathway which in CCKO mice filled most of the domain normally occupied by ipsilateral eye fibers. This difference was also statistically significant. We conclude that reduction in L-type Ca(2+) currents has an effect on axonal refinement similar to that which occurs in NO knockout mice, which supports the possibility that L-type Ca(2+) channel-dependent LTD mediates NO-dependent axonal refinement.