Ultrasonographic severity scoring of non-immune hydrops: a predictor of perinatal mortality

AIM

To develop an ultrasonographic severity scoring of non-immune hydrops in order to predict perinatal outcomes in women with non-immune hydrops.

METHODS

The study population consisted of pregnant women who were admitted and delivered with the diagnosis of fetal non-immune hydrops and singleton gestation. Cases were divided into "perinatal survivor" and "perinatal non-survivor" groups. Perinatal non-survivor cases were defined as those with stillbirth or neonatal death ≤28 completed days after birth. The presence of an abnormal fluid collection in each body compartment, such as subcutaneous edema, pleural effusion, pericardial effusion, or ascites was assigned a score of 1 point per each body compartment, and the absence of abnormal fluid collection was scored as 0 point. The total number of abnormal fluid collections was converted to a numeric score, which was called the ultrasonographic severity scoring of non-immune hydrops (USNIH).

RESULTS

Perinatal death occurred in 46.5% (20/43) of the cases of non-immune hydrops. USNIH in patients of the non-survivor group was significantly higher than that in those of the survivor group [non-survivor group 3 (2-4) vs. survivor 2 (2-3); median (range); P<0.05]. Perinatal mortality rates were higher in patients with USNIH ≥3 points than in those with USNIH of 2 points (67% vs. 13%, P<0.005). This difference remained significant after adjustment for confounding variables. When confining analysis to those with idiopathic non-immune hydrops, women in the perinatal non-survivor group had significantly higher USNIH score than those in the perinatal survivor group, and this difference remained significant after adjustment.

CONCLUSIONS

Our USNIH system may be a reliable predictive marker for perinatal outcomes in cases of non-immune hydrops, especially in idiopathic hydrops during the antenatal period.

Magnetic Resonance Imaging of Asians with Multiple Sclerosis was Similar to that of the West

Magnetic resonance imaging (MRI) of the brain is the most important paraclinical diagnostic test in multiple sclerosis (MS). The appearance of MRI in Asians with MS is not well defined. We retrospectively surveyed the first brain and spinal cord MRI in patients diagnosed to have MS, according to Poser's criteria in seven regions throughout Asia to define the MRI changes among Asians with MS. There were 101 patients with first brain, and 86 with first spinal cord MRI, 66 of whom had both. The brain MRI showed a mean of 17 lesions per patient in T2 weighted images, mostly asymptomatic. Almost all the lesions were in the white matter, particularly in the juxtacortical, deep and periventricular white matter. A third of the lesions were greater than 5 mm, 14% enhanced with gadolinium. There were more supratentorial than infratentorial lesions at a ratio of 7.5: 1. Ninety five percent of the spinal cord lesions were in cervical and thoracic regions, 34% enhanced with gadolinium. The lesions extended over a mean of 3.6 +/- 3.3 vertebral bodies in length. Fifty (50%) of the brain and 54 (63%) of the spinal MRI patients had the optic-spinal form of MS. The MRI of the optic-spinal and classical groups of patients were similar in appearance and distribution, except that the optic-spinal MS patients have fewer brain but longer and more severe spinal cord lesions. In conclusion, the brain and spinal cord MRI of Asian patients with MS was similar to that of the West, although, in this study, Asian MS patients had larger spinal cord lesions.

Usefulness of fetal urine production measurement for prediction of perinatal outcomes in uteroplacental insufficiency

OBJECTIVES

To evaluate whether fetal urine production measurement is useful for predicting adverse outcomes in patients with uteroplacental insufficiency.

METHODS

We enrolled patients with uteroplacental insufficiency at 24 to 40 weeks' gestation and normal pregnancies matched for gestational age and divided them into 3 groups according to perinatal outcomes: group 1 (n = 141), a control group of normal pregnancies; group 2 (n = 29), uteroplacental insufficiency without adverse outcomes; and group 3 (n = 18), uteroplacental insufficiency with adverse outcomes. An adverse outcome was defined as 1 or more of the following: (1) cesarean delivery because of fetal distress; (2) admission to the neonatal intensive care unit; (3) cord arterial pH less than 7.15 at birth; and (4) low 5-minute Apgar score (<7). The fetal urine production rate was obtained by serial bladder volume measurement using virtual organ computer-aided analysis. For bladder volume determination, we scanned the bladder in the 3-dimensional mode and defined the bladder surface contour in the reference plane, repeating the rotation of the reference plane with an angle of 30° and determining the surface contour on each plane. Statistical methods, including the Mann-Whitney U test, Fisher exact test, χ(2) test, and Kruskal-Wallis analysis of variance, were used.

RESULTS

Group 3 had a lower mean fetal urine production rate than groups 1 and 2, whereas the urine production rate was not different between groups 1 and 2 (group 1, 49.0 mL/h; group 2, 59.4 mL/h; group 3, 20.7 mL/h; P < .001 between groups 1 and 3 and between groups 2 and 3). This difference between groups 2 and 3 remained significant after adjusting for the amniotic fluid index, umbilical artery Doppler pulsatility index, and presence of fetal growth restriction.

CONCLUSIONS

Uteroplacental insufficiency cases with adverse perinatal outcomes had a lower fetal urine production rate than those without adverse outcomes. This difference might be used to predict adverse perinatal outcomes in uteroplacental insufficiency.

Improved methods for selective cryolipolysis results in subcutaneous fat layer reduction in a porcine model

BACKGROUND/AIMS

Cryolipolysis is a noninvasive method for the selective reduction of localized fat tissues. It has demonstrated efficacy in both clinical and preclinical trials; however, despite its popularity, its mechanisms of action and evaluation methods are not yet fully defined. The purpose of this study was to improved methods for cryolipolysis using a porcine model.

METHODS

The abdomens of female PWG micro-pigs were treated with a cooling device (CRYOLIPO II(™)), and we examined the treatment effects using photography, three-dimensional photography, ultrasound, gross, and microscopic pathology, and serum lipid level analyses in order to determine the mechanism of action, efficacy, and safety of CRYOLIPO II(™).

RESULTS

CRYOLIPO II(™) successfully reduced abdominal fat in our porcine model. Gross and microscopic histological results confirmed the noninvasive cold-induced selective subcutaneous fat destruction, and showed increases in pre-adipocyte differentiation and in the activation of lipid catabolism. In particular, we found that CRYOLIPO II(™) may increase PPARδ (delta) levels in adipose tissue at 30-60 days post-treatment.

CONCLUSION

Fat reduction by cryolipolysis was successfully achieved in our porcine model. Thus, our findings indicate that CRYOLIPO II(™) may be a promising fat reduction device for body contouring and fat reduction in humans, and that cryolipolysis exerts its effects, at least partly, by targeting the PPARδ signaling pathway. These results show that both investigative and diagnostic potentials capacity.

Au transport in catalyst coarsening and Si nanowire formation

The motion of Au between AuSi liquid eutectic droplets, both before and during vapor-liquid-solid growth, is important in controlling tapering and diameter uniformity in Si nanowires. We measure the kinetics of coarsening of AuSi droplets on Si(001) and Si(111), quantifying the size evolution of droplets during annealing in ultrahigh vacuum using in situ transmission electron microscopy. For individual droplets, we show that coarsening kinetics are modified when disilane or oxygen is added: coarsening rates increase in the presence of disilane but decrease in oxygen. Matching droplet size measurements on Si(001) with coarsening models confirms that Au transport is driven by capillary forces and that the kinetic coefficients depend on the gas environment present. We suggest that the gas effects are qualitatively similar whether transport is attachment limited or diffusion limited. These results provide insight into manipulating nanowire morphologies for advanced device fabrication.

Persistent non-metallic behavior in Sr2IrO4 and Sr3Ir2O7 at high pressures

Iridium-based 5d transition-metal oxides are attractive candidates for the study of correlated electronic states due to the interplay of enhanced crystal-field, Coulomb and spin-orbit interaction energies. At ambient pressure, these conditions promote a novel Jeff = 1/2 Mott-insulating state, characterized by a gap of the order of ~0.1 eV. We present high-pressure electrical resistivity measurements of single crystals of Sr2IrO4 and Sr3Ir2O7. While no indications of a pressure-induced metallic state up to 55 GPa were found in Sr2IrO4, a strong decrease of the gap energy and of the resistance of Sr3Ir2O7 between ambient pressure and 104 GPa confirm that this compound is in the proximity of a metal-insulator transition.

Real time observation of ZnO nanostructure formation via the solid-vapor and solid-solid-vapor mechanisms

We report in situ transmission electron microscopy studies of the formation of ZnO nanostructures--nanoscale depressions, nanoholes, nanoribbons, and nanosheets--and the phase stability and kinetics of Au catalysts on ZnO. During annealing, the ZnO layer produces hexagonally shaped, vertical nanoscale depressions, which increase in size along the 〈 0001 〉 growth direction through preferential dissociation from the {101[combining macron]0} facet and which subsequently form hexagonal islands at their six-fold junctions. Real time observations of the annealing of Au deposited on ZnO show that the catalysts remain solid up to 900 °C, an observation that has implications regarding ZnO nanowire growth via the vapor-solid-solid mechanism (VSS). The Au also creates hexagonal nanoscale holes only at the location of solid Au catalysts, via the solid-solid-vapor (SSV) mechanism. Importantly, coarsening of the Au particles is negligible due to limited Au diffusion on the side facets of the nanoscale depressions, suggesting an approach to the growth of uniform hybrid nanowires with control over both diameter and location. Furthermore, we directly monitor the evolution of the transformation of a nanoribbon into a nanosheet with {101[combining macron]0} facets. This process takes place through a periodic, kinetic roughening transition of the surface, which is controlled by the kinetic competition between surface growth and the transfer of evaporated gases. In total, these observations give new insights into multiple growth processes occurring in this important materials system.

Roles of obstetricians in quality management of cord blood collection and informing potential donors: a survey on obstetricians' understanding of cord blood in Korea

BACKGROUND

The obstetrician's role in vitalizing cord blood (CB) banking is important in both informing donors and beginning CB processing. The aim of the study was to investigate obstetricians' understanding of CB and their roles in informing donors and collection management.

STUDY DESIGN AND METHODS

Questionnaires examining the management and awareness of CB were distributed to collection centers, and we analyzed 57 respondents who had collection experience.

RESULTS

All respondents were experienced, and 82.5% had CB collection experience of at least 4 years. If patients asked for information, one-third provided information about CB themselves, and two-thirds provided CB banks' (CBBs') contact information. Less than half of the respondents knew the legal regulations and had a collection manual. Regarding the awareness of transportation and storage of CB, 58% rated their knowledge as minimal, and respondents who knew the legal regulations rated their knowledge at a higher level. One-fifth of the participants felt that CB collection distracted the labor process, and 16% were concerned about delayed bleeding control. The probability of autologous CB transplantation was overestimated, and the matching probability in public CBBs was underestimated. Approximately 82.7% of the respondents correctly rated the therapeutic use of CB, and 54% rated their knowledge level about CB usefulness as average.

CONCLUSION

Obstetricians' understanding of CB was lower than expected, considering that they are associated with CB collection centers. Obstetricians who provide information and recognize regulations seem to collect CB in compliance with the regulations better. These results will be helpful in CB collection management and education planning for obstetricians.

Superconductivity. Fermi arcs in a doped pseudospin-1/2 Heisenberg antiferromagnet

High-temperature superconductivity in cuprates arises from an electronic state that remains poorly understood. We report the observation of a related electronic state in a noncuprate material, strontium iridate (Sr2IrO4), in which the distinct cuprate fermiology is largely reproduced. Upon surface electron doping through in situ deposition of alkali-metal atoms, angle-resolved photoemission spectra of Sr2IrO4 display disconnected segments of zero-energy states, known as Fermi arcs, and a gap as large as 80 millielectron volts. Its evolution toward a normal metal phase with a closed Fermi surface as a function of doping and temperature parallels that in the cuprates. Our result suggests that Sr2IrO4 is a useful model system for comparison to the cuprates.

Efficacy and safety of topical glycopyrrolate in patients with facial hyperhidrosis: a randomized, multicentre, double-blinded, placebo-controlled, split-face study

BACKGROUND

Although facial hyperhidrosis has been frequently associated with a diminished quality of life, various conservative modalities for its management are still far from satisfactory.

OBJECTIVE

To evaluate the antiperspirant efficacy and safety of the topical glycopyrrolate on facial hyperhidrosis at specified posttreatment intervals.

METHODS

Thirty-nine patients with facial hyperhidrosis were enrolled and treated with 2% topical glycopyrrolate on one-half of the forehead, whereas the other half of the forehead was treated with a placebo. All patients applied topical glycopyrrolate or placebo once a day for nine successive days. Each evaluation included weighing sweat and assessing the Hyperhidrosis Disease Severity Scale (HDSS) score and any adverse effects.

RESULTS

Compared with the placebo-treated sides, topical glycopyrrolate-treated sides showed a reduction in the rate of sweat production at the forehead of 25.16 ± 10.30% (mean ± SD) at 90 min after the first application (day 1), 29.63 ± 7.74% at 24 h after the first application (day 2) and 36.68 ± 11.41% at 24 h after eight additional successive daily applications (day 10) (all P < 0.025). There was a little more decrease in HDSS score with the topical glycopyrrolate-treated half of the forehead, but the difference was not statistically significant (P > 0.025). No serious adverse events were reported during the course of this study. Only one patient developed a transient headache after treatment.

CONCLUSION

Topical glycopyrrolate application appears to be significantly effective and safe in reducing excessive facial perspiration.

Quality of cord blood cryopreserved for up to 5 years

Background

Although cord blood (CB) is a well-known source of hematopoietic stem cells, uncertainties exist regarding the quality of cryopreserved CB. We investigated the changes in quality of CB units according to the duration of cryopreservation.

Methods

We analyzed CB units that were rejected from the Seoul Metropolitan Government Public Cord Blood Bank inventory after conventional processing, because of unsuitability for allogeneic transplantation. Two hundred CB units that were cryopreserved from 1 year to 5 years were selected. After thawing the cryopreserved CB units, the total nucleated cell (TNC) count, CD34+ cell count, number of colony-forming units (CFU), aldehyde dehydrogenase (ALDH) level, cell viability, and apoptosis were analyzed. We conducted a comparative analysis to identify the presence of statistically significant differences in the recovery rates of the TNC and CD34+ cell counts and to compare the results of ALDH level, the cell viability test, the apoptosis test, and CFU analysis among groups according to the duration of cryopreservation.

Results

The recovery rates of the TNC count, the CD34+ cell count, and cell viability did not differ significantly according to the duration of cryopreservation. ALDH analysis, the cell viability test, and the apoptosis test did not reveal any increasing or decreasing trend according to the duration of cryopreservation. Further, the numbers of CFU-granulocyte/macrophage and CFU-granulocyte/erythrocyte/macrophage/megakaryocyte did not differ significantly according to the duration of cryopreservation.

Conclusion

These results suggest that the quality of CB is not affected by cryopreservation for up to a period of 5 years.

Successful conservative management of ruptured ovarian cysts with hemoperitoneum in healthy women

Study Objective

To determine the success rate of the “intended conservative management strategy” of ruptured ovarian cysts with hemoperitoneum and the risk factors for surgical interventions in healthy women of reproductive age.

Methods

Patients who visited the emergency department with abdominal pain and were diagnosed with a ruptured ovarian cyst with hemoperitoneum between August 2008 and June 2013 were included in this retrospective study. The diagnosis of the ruptured ovarian cysts and hemoperitoneum was based on the clinical symptoms, physical examination and ultrasound and CT imaging. The rate of surgical interventions and the risk factors for surgical intervention were determined.

Results

A total of 78 women were diagnosed with a ruptured ovarian cyst with hemoperitoneum. Most patients (80.8%, 63/78) were managed conservatively, and 19.2% of the patients (15/78) required a surgical intervention. In the multiple logistic regression analysis, the diastolic blood pressure (dBP) (odds ratio [OR] of 0.921 with 95% confidence interval [CI] of 0.855–0.993) and the depth of the total pelvic fluid collection in CT (DTFC_CT) (OR 1.599 with 95% CI 1.092–2.343) were the significant determining factors of surgical intervention after adjustment. The rate of surgical intervention was 6.5% vs. 15.8% vs. 77.8% in the patients with neither dBP≤70 mmHg nor DTFC_CT≥5.6 cm, those with only one of those features, and those with both, respectively.

Conclusion

Most cases of ruptured ovarian cysts with hemoperitoneum can be managed conservatively. A low diastolic blood pressure and a large amount of hemoperitoneum suggest the need for surgical intervention.

Double-blind, randomized non-inferiority trial of a novel botulinum toxin A processed from the strain CBFC26, compared with onabotulinumtoxin A in the treatment of glabellar lines

BACKGROUND

Botulinum toxins have been widely used in cosmetic dermatology. Neurotoxin from the CBFC26 strain (NTC) is a recently developed botulinum toxin type A product manufactured through refined procedures.

OBJECTIVE

A double-blinded, randomized, multicentre-designed, phase III trial to investigate the non-inferiority of NTC to existing botulinum toxin A, onabotulinumtoxin A in the treatment of moderate to severe glabellar lines.

METHODS

A total of 272 subjects were randomized in a 1 : 1 ratio to receive 20 U of NTC or onabotulinumtoxin A. The primary endpoint was the response rate of physicians' assessment (PA) using the Facial Wrinkle Scale at week 4. The secondary endpoints included the response rate of PA at weeks 8, 12 and 16, and photographic assessment at weeks 4, 8, 12 and 16. Subjects' improvement assessment and subjective self-satisfaction levels were also investigated.

RESULTS

Response rates for maximum frown were 89.3% in the NTC group and 81.9% in the onabotulinumtoxin A group at week 4. NTC also resulted in comparable results for both the response rates of the other evaluation points and incidence of adverse events compared to those of onabotulinumtoxin A. In subjects' improvement assessment and photographic evaluations, NTC even demonstrated better results compared with onabotulinumtoxin A in the early phase after treatment. Analysis of these results strongly supports the non-inferiority of NTC to onabotulinumtoxin A in the efficacy and safety.

CONCLUSION

NTC is as effective as onabotulinumtoxin A in the treatment of glabellar lines, and both products were well tolerated.

Spin and orbital contributions to magnetically ordered moments in 5d layered perovskite Sr2IrO4

The ratio of orbital (L) and spin (S) contributions to the magnetically ordered moments of a 5d transition metal oxide, Sr2IrO4 was evaluated by nonresonant magnetic x-ray diffraction. We applied an improved experimental setting that minimized the experimental error, in which we varied only the linear polarization of incident x ray at a fixed scattering angle. Strong polarization dependence of the intensity of magnetic diffraction was observed, from which we conclude that the ordered moments contain substantial contribution from the orbital degree of freedom with the ratio of <L>/<S>∼5.0, evidencing the pronounced effect of spin-orbit coupling. The obtained ratio is close to, but slightly larger than the expected value for the ideal J(eff) = 1/2 moment of a spin-orbital Mott insulator, |<J(1/2)|L(z)|J(1/2)>|/|<J(1/2)|S(z)|J(1/2)>| = 4, which cannot be accounted for by the redistribution of orbital components within the t(2g) bands associated with the elongation of the IrO6 octahedra.