The impact of COVID-19 on hospitalization outcomes of patients with acute myocardial infarction in the USA

Background/study objective

The effect of the COVID-19 pandemic affected health care delivery, as it led to variable outcomes in different disease states including cardiovascular diseases. In this study, we evaluated the impact of coexisting COVID-19 on Acute Myocardial Infarction (AMI).

Design/setting

We analyzed discharge records of AMI patients from the National Inpatient Sample (NIS) in the year 2020.

Main outcome measures

Using propensity score matching, we assessed the impact of COVID-19 infection on the in-hospital outcomes of patients presenting with AMI.

Results

There were 1154 patients with concomitant COVID-19 infection and AMI who were matched with 109,990 patients with AMI and without COVID-19. We found that patients with COVID-19 who had AMI were less likely to have dyslipidemia (64.6 % vs. 70.4 %, p < 0.001), peripheral vascular disease (2.4 % vs. 3.8 % p = 0.0017), smoking history (23.5 % vs. 28.2 % p < 0.0001) and hypertension (37.1 % vs. 40.1 % p = 0.004).COVID-19 was associated with higher hospital mortality rates (Adjusted odds ratio aOR: 2.72, CI: 2.23-3.30, p < 0.001), cardiac arrest (aOR: 1.65, 95 % CI: 1.26-2.15, p < 0.001), cardiogenic shock (aOR:1.36,95 % CI: 1.10-1.68, p = 0.004) and respiratory failure (aOR:1.81, 95 % CI: 1.55-2.11 p < 0.001) compared to AMI patients without COVID-19. There was also a significant association between coexisting COVID-19 and longer duration of hospital stay (Adjusted mean differences:1.40, 95 % CI: 1.31-1.59 p < 0.0001) in AMI patients.

Conclusion

COVID-19 infection is associated with worse in-hospital mortality and cardiorespiratory complications in patients with AMI.

An unusual cause of acute abdomen and acute renal failure: Djenkolism

The djenkol bean (Archidendron pauciflorum) is a native delicacy in Southeast Asia, though consumption can sometimes lead to djenkolism. Clinical features of djenkolism include acute abdominal pain, hematuria, urinary retention, and acute kidney injury (AKI). The pain can be severe, which often leads to a misdiagnosis of acute abdomen. In this paper, we report the case of an Indonesian migrant with djenkolism. Due to the short history and severity of the abdominal pain, medical professionals suspected acute abdomen and proceeded with a negative exploratory laparotomy. However, djenkolism was suspected once relatives informed the professionals that the patient had consumed djenkol beans hours earlier. The patient recovered through aggressive hydration and urine alkalinization with bicarbonate infusion. We highlight the importance of being aware of this rare cause of AKI, especially in Southeast Asia, in order to provide early diagnoses and prompt treatments.

Hepatitis B virus infection among children of hepatitis B surface antigen positive mothers in a Malaysian hospital

INTRODUCTION

There have been no published data on the transmission of hepatitis B virus (HBV) infection among children of hepatitis B surface antigen (HBsAg) positive mothers in Malaysia.

METHODS

This is a cross-sectional study of all the children of HBsAg-positive mothers who delivered at the University of Malaya Medical Centre between 1993 and 2000.

RESULTS

A total of 60 HBsAg-positive mothers and their 154 children participated in the study. HBsAg was detected in four children (2.6%) while IgG antibody to the hepatitis B core antigen (anti-HBc IgG) was detected in seventeen children (11.0%). The mother's age at childbirth was significantly lower in the children with detectable HBsAg (22.5±6.1 years vs. 29.7±4.5 years, p=0.043) and anti-HBc IgG (26.6±6.1 years vs. 30.0±4.3 years, p=0.004). Children born in the 1980s were significantly more likely to have detectable HBsAg (18.8% vs. 0.7%, p=0.004) and anti-HBc IgG (37.5% vs. 8.0%, p=0.000) compared with those born later. All children with detectable HBsAg were born via spontaneous vaginal delivery, and hepatitis B immunoglobulin was either not given or the administration status was unknown. The majority of mothers with chronic HBV infection (70.4%) were not under any regular follow-up for their chronic HBV infection and the main reason was the lack of awareness of the need to do so (47.4%).

CONCLUSION

Transmission of HBV infection among children of HBsAg-positive mothers in Malaysia is low. However, attention needs to be given to the high rate of HBsAgpositive mothers who are not on any regular follow-up.

Epigenetic Control of Early Mouse Development

Although the genes sequentially transcribed in the mammalian embryo prior to implantation have been identified, understanding of the molecular processes ensuring this transcription is still in development. The genomes of the sperm and egg are hypermethylated, hence transcriptionally silent. Their union, in the prepared environment of the egg, initiates their epigenetic genomic reprogramming into a totipotent zygote, in which the genome gradually becomes transcriptionally activated. During gametogenesis, sex-specific processes result in sperm and eggs with disparate epigenomes, both of which require drastic reprogramming to establish the totipotent genome of the zygote and the pluripotent inner cell mass of the blastocyst. Herein, we describe the factors, DNA and histone modifications, activation and repression of retrotransposons, and cytoplasmic localizations, known to influence the activation of the mammalian genome at the initiation of new life.

A Study of Agastachis Herba on Ovalbumin-induced Asthma in the Mouse

Agastachis Herba is one of the well-known medicinal herbs in Korean traditional medicine. This study was taken up to examine the beneficial effects of Agastachis Herba on a mice model of asthma. BALB/c mice were sensitized and challenged with ovalbumin to produce a murine model of asthma. Methanol extracts of Agastachis Herba were orally administered to the ovalbumin-induced asthmatic mice. The effects of methanol extract of Agastachis Herba on airway hyper responsiveness, immune cell distributions in bronchoalveolar lavage fluid, ovalbumin-specific immunoglobulin E in serum, and histopathological changes were evaluated. Mice treated with the methanol extract of Agastachis Herba showed reduction of airway hyper responsiveness as well as inhibited immune cell infiltration in bronchoalveolar region. Also ovalbumin-specific immunoglobulin E levels in bronchoalveolar lavage fluid significantly decreased in extract treated mice. Histopathological findings showed significant beneficial changes in inflammatory cell infiltration.

Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI): lessons from exploration of cultural variations in visual-motor integration performance of preschoolers

BACKGROUND

Visual-motor integration (VMI) is important in children's development because it is associated with the performance of many functional skills. Deficits in VMI have been linked to difficulties in academic performance and functional tasks. Clinical assessment experience of occupational therapists in Singapore suggested that there is a potential difference between the VMI performance of Singaporean and American children. Cross-cultural studies also implied that culture has an influence on a child's VMI performance, as it shapes the activities that a child participates in. The purpose of this study was to (1) explore if there was a difference between the VMI performance of Singaporean and American preschoolers, and (2) determine if there were ethnic differences in the VMI performance of Singaporean preschoolers.

METHODS

The Beery-VMI, which was standardized in America, is commonly used by occupational therapists in Singapore to assess the VMI ability of children. We administered the Beery-VMI (fifth edition) full form test (excluding the supplemental tests) to 385 preschoolers (mean age = 63.3 months) from randomly selected schools in Singapore. We compared the scores of Singaporean preschoolers with those of the American standardization norms using the one-sample t-test. Scores of different ethnic groups among the Singapore population were also compared using a one-way anova, followed by the Bonferroni post-hoc test.

RESULTS

Singaporean preschoolers and the standardization sample of American children performed significantly differently in all age groups (P < 0.05). Among the Singapore population, the scores were also significantly different (P < 0.05) between the (i) Chinese and Malay and (ii) Chinese and Indians ethnic groups.

CONCLUSION

Preschoolers from different cultural and ethnic groups had different VMI performance. Certain cultural beliefs and practices may affect VMI performance. Clinicians should exercise caution when using an assessment in communities and cultures outside the ones on which it was standardized.

Various musculoskeletal manifestations of chronic renal insufficiency

Musculoskeletal manifestations in chronic renal insufficiency are caused by complex bone metabolism alterations, now described under the umbrella term of chronic kidney disease mineral- and bone-related disorder (CKD-MBD), as well as iatrogenic processes related to renal replacement treatment. Radiological imaging remains the mainstay of disease assessment. This review aims to illustrate the radiological features of CKD-MBD, such as secondary hyperparathyroidism, osteomalacia, adynamic bone disease, soft-tissue calcifications; as well as features associated with renal replacement therapy, such as aluminium toxicity, secondary amyloidosis, destructive spondyloarthropathy, haemodialysis-related erosive arthropathy, tendon rupture, osteonecrosis, and infection.

A weekly administered sustained-release growth hormone reduces visceral fat and waist circumference in abdominal obesity

Administration of recombinant human growth hormone (rhGH) in obesity has been known to lead to a decrease in visceral adiposity and an increase in lean body mass. Most studies have used supraphysiological doses of rhGH, which were administered daily or every other day. We aimed to evaluate whether weekly administered low dose of sustained-release rhGH (SR-rhGH) could play a therapeutic role in the treatment of abdominal obesity. Prospective, single-arm, open-label, multicenter pilot study was carried out. Participants were 26 adults aged 40-65 years old with abdominal obesity (male: waist circumference >90 cm, female: waist circumference >85 cm). The subjects were given 3 mg of SR-rhGH, administered subcutaneously, weekly for 26 weeks. SR-rhGH treatment for 26 weeks increased the IGF-1 level by 56.53±76.09 μg/l (SDS 0.77±1.12) compared to the baseline (p=0.0022). After 26 weeks, SR-rhGH treatment reduced abdominal visceral adipose tissue (VAT) (140.35±75.97 to 128.43±73.85 cm2, p=0.0038). Average waist circumference decreased from 96.25±6.41 to 91.93±6.13 cm (p<0.0001) after treatment. However, body weight or lean body mass did not show any significant change. In conclusion, SR-rhGH treatment for 26 weeks reduced abdominal visceral fat and waist circumference without severe adverse events. Further studies may be considered on the role of weekly administered SR-rhGH as a treatment for abdominal obesity.

Measurement of lymphedema using ultrasonography with the compression method

Lymphedema is swelling of soft tissues by accumulation of lymphatic fluid due to failure of the lymphatic drainage system. Although most measures for lymphedema focus on change of volume or size of the extremity, the physical properties of the tissue such as resistance to compression are also of clinical importance because they affect the quality of life of lymphedema patients. In this study, we aimed to compare the thickness and resistance to compression of the skin and subcutis between the affected and unaffected arms of patients with lymphedema by using ultrasonography together with the compression technique, and we also investigated the factors that have an influence on the results. Thirty-nine patients with post-mastectomy lymphedema participated in this study. All ultrasonographically-assessed thicknesses of skin and subcutaneous tissue in affected upper arms and forearms were significantly larger than the contralateral (p < 0.05) while all resistances to compression values were significantly lower (p < 0.05). These results suggest that measuring the resistance to compression and thickness using the compression method with ultrasonography may be a valuable tool for evaluating lymphedema after breast cancer surgery.

A review of elderly injuries seen in a Singapore emergency department

INTRODUCTION

The elderly population in Singapore is steadily increasing, thus increasing the stress on healthcare provision and financing. Elderly injuries result in significant mortality and morbidity. This study aimed to identify the injury patterns, specific risk factors involved and needs of the elderly so that the current emergency model of care for the injured elderly can be improved and injury prevention strategies devised.

METHODS

We conducted a retrospective study of all elderly aged 65 years and older seen for trauma in an emergency department over six months. Data captured in the real-time computer system was studied with regard to patient profile, mechanism of injury and patient disposition.

RESULTS

720 patients aged 65 years and older were seen for trauma in the first six months of 2005, accounting for 10.4 percent of the total attendance for that age group. Home injuries (67.9 percent) were the most common, followed by road-related injuries (21.2 percent). 85.3 percent of the injuries were due to falls. 49.9 percent of the patients were admitted to hospital. We also examined the underlying causes of the injuries and the common injuries sustained.

CONCLUSION

Injuries in the elderly is a significant problem. Most of the injuries occur at home and falling is the commonest cause. Many of the injuries are potentially preventable. Several possible injury prevention strategies and improvements to the current emergency model of care of the injured elderly are discussed. The establishment of a national elderly injury surveillance database is advocated.

Highly enantioselective synthesis of alpha,beta-diaminopropanoic acid derivatives using a catalytic asymmetric hydrogenation approach

Rh-DuPhos-catalyzed asymmetric hydrogenation of alpha,beta-diamidoacrylates provides a highly efficient and enantioselective route to chiral alpha,beta-diaminopropanoic acid derivatives. The mechanistic course of the hydrogenation was studied using isotopically enriched enamide complexes and phosphorus and carbon NMR. Addition of methyl alpha-N-benzoyl-beta-N-acetyl-diaminopropenoate to the solvated catalyst gave a single 1:1 enamide complex and demonstrated the binding of the olefin and alpha-amide carbonyl group; the carboxylate and beta-N-acyl groups did not bind to the metal. Changes to the electronic and steric properties of the beta-N-acyl group were well tolerated; however, small changes to the binding alpha-N-acyl group were found to significantly affect hydrogenation yields.

Volume reduction surgery for end-stage heart failure: experience in Korea

Partial left ventriculectomy (PLV) is regarded as one of the alternatives to heart transplantation for idiopathic dilated cardiomyopathy (d-CMP). Between June 1996 and March 2000, 20 patients underwent left ventricular volume reduction surgery at five major cardiac centers in Korea. PLV was performed in 16 patients with d-CMP and in 1 patient with ischemic CMP. The modified Dor procedure was performed in three patients; two patients with d-CMP and one patient with ischemic CMP. Median age was 35 years (range 3-64 years). There were 13 male and 7 female patients; there were 4 patients in Class III and 16 patients in Class IV. Among the 16 patients in Class IV, 5 patients were inotropic dependent, 2 patients were resuscitated from cardiac arrest or shock in hospital, and 1 patient was treated with intra-aortic balloon pumping. Operative technique for PLV was the same as described by Batista and colleagues. For the modified Dor procedures, the apical left ventricle was opened and a circumferential pursestring suture was placed at the base of both papillary muscles to reduce the diameter of the left ventricle concomitant with mitral annuloplasty. Mitral valve repair was performed in 15 patients and mitral valve replacement was performed in 1 patient. Moderate-to-severe tricuspid regurgitation was noted in 12 patients (with tricuspid annuloplasty in 11 of these patients and replacement in 1 patient). Postoperatively, there were seven operative deaths after PLV and one death after the modified Dor procedure. Cause of death after PLV was right heart failure in four of the seven cases, sepsis in one case, and ventricular tachyarrhythmia in the remaining two cases. After the modified Dor procedure, there was one operative death with left ventricular failure. Postoperatively, mean ventricular end-diastolic dimension markedly decreased from 75.3 mm to 50.9 mm. However, this dimension had increased slightly to 58.2 mm, an average observed 22 months later. Mean left ventricular ejection fraction (LVEF) improved significantly from 20.6% to 33.5% (p < 0.0001), but decreased to 28.5% on average 22 months later (p = 0.058). Eleven patients were discharged from the hospital and followed-up for a mean of 20.2 months (range 1-41 months). During the early postoperative period, most were in good condition. However, heart failure progressed with mitral regurgitation in four patients, two of whom underwent heart transplantation. In conclusion, PLV for d-CMP seems to be an effective alternative surgical procedure to heart transplantation in Korea. The modified Dor procedure may be another alternative to transplantation for left ventricular volume reduction. However, in patients showing progression of heart failure, early intervention with ventricular assist or heart transplantation will be necessary. Also, further studies will be necessary for selection criteria and for prevention of ventricular tachyarrhythmia.

Odontogenic keratocyst: Review of 256 cases for recurrence and clinicopathologic parameters

Odontogenic keratocyst (OKC) is of particular interest because of its high recurrence rate and aggressive behavior. Two hundred fifty-six cases of OKC were reviewed for the age of the patient at diagnosis, sex of the patient, OKC location, and radiographic findings, and 132 patients with OKC were observed to estimate recurrence, which was analyzed for age, sex, location, and several histopathologic findings. OKCs occurred more frequently in men (58.6%) than in women (41.4%), and they occurred in patients within a wide age range, most commonly in patients in the third decade of life (28.9%), followed by those in the second decade (25.0%); the mean age of patients with OKC was 30.8 years. One hundred ninety-six of the 256 cases (76.5%) occurred in the mandible, and the other 60 cases (23.5%) occurred in the maxilla. The mandibular molar and the premolar areas (51.2%) were the most common sites, and the most frequent clinical manifestations at first admission were swelling, pain, or both (82.4% of total cases). Radiographic impressions included dentigerous cyst (27.3%), OKC (25.4%), primordial cyst (14.8%), ameloblastoma (11.7%), residual cyst (9.8%), and radicular cyst (3.1%). The frequency of recurrence at the follow-up examination was 58.3%. There was no significant difference in the recurrence rate on the basis of the sex of the patient. However, OKCs had a significantly higher recurrence rate in patients in the fifth decade of life than in patients in the other age groups (P = .005).Recurrence rates were significantly dependent on the sites of involvement, and OKCs in the mandibular molar region had significantly higher recurrence rates than those in other sites (P = .001). The histopathologic presence of one or more daughter cysts was significantly related to recurrence (P = .03).

Topographic expression of p21WAF1/SDI1/CIP1, bcl2, and p53 is altered at the early stage of colorectal carcinogenesis

We analyzed the expression of p21, bcl2, and p53 in normal and different pathologic mucosa of the human colorectum using immunohistochemistry and cold polymerase chain reaction-single strand conformation polymorphism. The topography of normal mucosa showed; bcl2 and p53 expression restricted to basal epithelial cells and p21 expressed only in superficial epithelial cells. This topographic expression was altered in hyperplastic polyps and adenomas. Hyperplastic polyps revealed absence of or weak bcl2 expression and strong p21 expression without topography. In adenomas, whereas bcl2 expression increased and extended to parabasal and superficial dysplastic epithelium, the increase of p21 expression was limited to surface dysplastic epithelium. p53 was weakly expressed throughout the full thickness of dysplastic epithelium. Bcl2 expression in adenomas was stronger than in carcinomas; p53 expression was converse and p21 expression was variable. In carcinomas, this topographic expression was largely abrogated but p53 mutation (36%) was more frequent than in adenomas (2%). In carcinomas, p21 and p53 expression correlated inversely, but there was no relationship with bcl2. These results suggest that there is precisely ordered topographic pattern of p21, bcl2, and wild p53 expression in normal colorectal cells, but this becomes disordered during the early stage of colorectal carcinogenesis.

Quantitative approach in the study of adhesion of lactic acid bacteria to intestinal cells and their competition with enterobacteria

To describe the phenomena of bacterial adhesion to intestinal cells and the competition for adhesion between bacteria, mathematical equations based on a simple dissociation process involving a finite number of bacterial receptors on intestinal cell surface were developed. The equations allow the estimation of the maximum number of Lactobacillus sp. and Escherichia coli cells that can adhere to Caco-2 cells and intestinal mucus; they also characterize the affinity of the bacteria to Caco-2 cells and intestinal and fecal mucus and the theoretical adhesion ratio of two bacteria present in a mixed suspension. The competition for adhesion between Lactobacillus rhamnosus GG and E. coli TG1 appeared to follow the proposed kinetics, whereas the competition between Lactobacillus casei Shirota and E. coli TG1 may involve multiple adhesion sites or a soluble factor in the culture medium of the former. The displacement of the adhered Lactobacillus by E. coli TG1 seemed to be a rapid process, whereas the displacement of E. coli TG1 by the Lactobacillus took more than an hour.

Expression of matrix metalloproteinase-2 and -9 in oral squamous cell carcinomas with regard to the metastatic potential

In order to evaluate the significance of matrix metalloproteinases (MMPs) in predicting the metastatic potential of oral squamous cell carcinomas (SCCs), we compared MMP-2 and -9 expression in 19 metastasizing oral SCCs with that in 25 non-metastasizing cases by immunohistochemistry and gelatin zymography. Immunohistochemistry showed that increased MMP-2 expression was not significantly related to metastasis; increased MMP-9 expression found in oral SCCs was, however, statistically significant (oral SCCs with metastasis, 73.7%; those without metastasis, 36.0%; P<0.05). Gelatin zymography revealed no significant difference in the activated form of MMP-2 between metastasizing and non-metastasizing oral SCCs. In metastasizing SCCs, on the other hand, increases in the activated form of MMP-9 were significant. These results suggest that oral SCCs express MMP-2 and -9, and that MMP-9 may play a more important role than MMP-2 in the metastasis of oral SCCs to adjacent tissue. An analysis of MMP-9 expression may be useful for predicting the metastatic potential of oral SCCs.

Diagnostic imaging of pigmented villonodular synovitis of the temporomandibular joint associated with condylar expansion

Pigmented villonodular synovitis (PVNS) is a rare lesion of the temporomandibular joint. We report a case which was initially misdiagnosed as a parotid tumor. CT revealed a well-defined mass demonstrating higher attenuation than the adjacent soft tissue with marked expansion of the mandibular condyle. MRI clearly delineated the extent of the lesion which had very low signal intensity on both T1W and T2W sequences due to the effect of hemosiderin. The usefulness of these imaging procedures in diagnosis of PVNS is discussed.

Immunohistochemical study of lymphoid tissue in human fetal salivary gland

Immunoreactivity of lysozyme (LY), lactoferrin (LF), alpha 1-antichymotrypsin (alpha 1-ACT), alpha 1-antitrypsin (alpha 1-AT), keratin proteins KL1, PKK1, K8.12, S-100 protein, MAM-3, MAM-6, and epithelial membrane antigen (EMA) were evaluated in lymphoid and glandular tissues of developing salivary gland of human fetus (gestational age ranging from 17 to 40 wk to investigate the role of lymphoid tissue in developing salivary glands. In a total of 79 cases, lymphoid cell aggregations were noted in parotid (57 cases), submandibular (21 cases) and sublingual (5 cases) glands. Mononuclear cells showing intense activity of LY, alpha 1-ACT and alpha 1-AT were present in the lymphoid aggregation. The glandular ducts embedded in lymphoid tissue were negative to MAM-3, MAM-6, EMA and S-100 protein, but showed positive PKK1 and KL1 reaction during early stages of development, and showed degeneration and effacement upon increase in number and LY activity of the mononuclear cells. The lymphoid aggregations progressively emerged as lymph nodes.

Prenatal growth pattern of the human maxilla

Regarding maxillofacial morphogenesis there has been a long debate on the growth of the maxillary structure. Using 120 normal fetal maxillae of gestational ages from 16 to 41 weeks, palatal radiograms and frontal histologic sections were made. We have observed two pairs of accentuated growth areas in the fetal maxillae and named them primary growth centers to formulate the maxillary trapezoid (MT) by radiologic image. The MT is formed by four primary growth centers that are best demonstrated by palatal radiograms of the fetal maxilla as well as by frontal histologic sections. The dimensional increase in the MT during the fetal period is documented and statistically analyzed. From this series of results, we have suggested that the growth centers which demarcate the MT are the basic structures of the developing human maxilla. It was also found that the four primary growth centers are the most active sites for maxilla formation until 20 weeks of gestation and thereafter the growth of the maxilla is enhanced by the participation of the intramembranous bone formation along the periphery. This was in contrast to the central primary growth centers that have already finished maturation in the early fetal period and remain only as a peripherally radiating arrangement of thick trabecular bones.

Immunohistochemical distribution of MAM-3 and MAM-6 antigens in developing salivary glands of the human fetus

The immunohistochemical expression of MAM-3 and MAM-6 antigens was studied developing human fetal salivary gland removed at autopsy of 22 normal fetuses of varying maturity (10-40 weeks of gestation). The onset of functional maturation in the fetal gland was seen at 21 weeks of gestational maturity. The acini and ducts then underwent distinct alterations in antigen expression with growth and maturation until the late developmental stage (33-40 weeks of gestation) when they resemble the adult salivary gland. The role of maturing duct cells in histogenesis of salivary gland tumours is discussed.

Prenatal development of human major salivary glands and immunohistochemical detection of keratins using monoclonal antibodies

The major salivary glands were examined from 69 human fetuses ranging from 10 to 40 weeks of gestation. Prenatal growth curves of developing salivary glands could be established by histological scoring, and development was divided into the early developmental stage (EDS) from 10 to 18 weeks, early intermediate developmental stage (EIDS) from 19 to 24 weeks, late intermediate developmental stage (LIDS) from 15 to 32 weeks, late developmental stage (LDS) from 33 to 40 weeks. Characteristic morphogenesis and cytodifferentiation occurred in glandular duct cells during the period of EIDS and LIDS. In the LDS, acini and ducts of the salivary glands histologically developed into a mature state similar to adult glands. Immunohistochemical staining with monoclonal antibodies (MoAbs) PKK1, KL1, K8.12, K8.13, K4.62, RPN 1160, 1162, 1163, 1164, and 1165 was performed. During the fetal period, keratin expression as revealed by MoAbs PKK1, KL1, K8.12 was well established, and the staining pattern for each of these antibodies was comparable. Other antibodies showed rare or negative staining except K8.13 which had a diffuse, non-specific staining pattern. Accordingly, the proliferation and cytodifferentiation of fetal stage keratin staining in ductal cells as revealed by MoAbs PKK1, KL1, and K8.12 showed a heterogenic distribution in both luminal and basal cells. It is a characteristic finding that the cytodifferentiation of ductal luminal cells precedes ductal basal cells. Ductal basal cells stained with MoAb K8.12 and show heterogeneity of keratin distribution continuously until the full term of gestation. The keratin staining of oral epithelium was also examined to compare with distribution of salivary gland ductal cells and oral epithelial cells. In the present study, the developmental sequence of salivary gland cells and the immunohistochemical properties of keratin proteins in these cells were described in relation to the histogenesis of salivary gland tumours.

Immunohistochemical localization of lysozyme, lactoferrin, alpha 1-antichymotrypsin, and alpha 1-antitrypsin in salivary gland of human fetuses

26 human fetuses were examined to elucidate the immunohistochemical distributions of lysozyme, lactoferrin, alpha 1-antichymotrypsin, and alpha 1-antitrypsin in prenatal salivary glands. Development of fetal salivary glands was divided into 4 stages: The early developmental stage (EDS), the early intermediate developmental stage (EIDS), the late intermediate developmental stage (LIDS), and the late developmental stage (LDS) and were used to compare antigen localization during salivary gland development. Lysozyme (LY) staining was prominent in serous or demilune cells of the mucous acinar compartment. Lactoferrin (LF) was rarely seen in the fetal glands; only trace amounts were seen in serous cells, alpha 1-antichymotrypsin (alpha 1-ACT) was diffusely positive particularly in glandular ducts, alpha 1-antitrypsin (alpha 1-AT) was also diffusely distributed in all salivary gland elements and was more abundant in ductal cells than acinar cells. During the EDS, immunohistochemical staining of LY, LF, alpha 1-ACT, and alpha 1-AT could be observed with glandular intensity increases corresponding to the advance of cytodifferentiation of granular epithelium occurring in the subsequent EIDS and LIDS. Staining intensities were continuous during the LDS even though the amount of those materials in the fetal salivary glands was not of the extent seen in the adult salivary gland. These results suggest that production of LY, LF, alpha 1-ACT, and alpha 1-AT was positive during prenatal development of human salivary glands. The present study discusses the protective roles and defense mechanisms of LY, LF, alpha 1-ACT, and alpha 1-AT in developing human salivary glands.

[A pathological consideration of ankyloglossia and lingual myoplasty]

Despite the curious role of tongue in the development of oro-facial structures the tongue remains as rather quiescent organ without bony skeleton. But it is said that neuro-muscular complex of tongue is important in the developmental and functional process. Ankyloglossia and macroglossia are occasionally implicated in the oral diseases. Many authors supposed that the ankyloglossia and macroglossia might produce various abnormal oro-facial growth, such as bimaxillary or mandibular protrusion and anterior open bite, etc. We have designed the classification of ankyloglossia by measuring the median lingual frenum length with lingual frenum ruler. It is well known that every people has a lingual frenum to some degree. So we analyse that the group showing less than 10mm of median frenum length is belong to mild ankyloglossia, the group showing from 10mm to 15mm of median frenum length is belong to moderate ankyloglossia, the group showing more than 15mm of median frenum length is belong to type 1 severe ankyloglossia, and the group showing clinically severe ankyloglossia but having less than 15mm of median frenum length is belong to type 2 severe ankyloglossia. We have experienced that the mild ankyloglossia usually causes no clinical complication to receive dental treatments. In the present study we investigated different clinical complications under this classification. We also recognized that the most retracted tongue position is a comparable criterion of tongue movement. The severer ankyloglossia showing thick lingual frenum is the more frequently associated with macroglossia and occlusal disharmony, and its most retracted tongue position is prone to locate high-anterior direction. Among 130 cases receiving lingual myoplasty 106 cases (81.5%) showed various malocclusions, 37 cases (28.5%) showed conspicuous speech problem, and 14 cases (19.8%) showed severe oro-facial deformity. The lingual myoplasty consists of two steps, the first is the same with frenectomy, and the second is the procedure of re-equilibrium of extrinsic tongue muscles mainly between genioglossus muscle and hyoglossus muscle. 130 cases which were belong to the group of moderate and severe ankyloglossia were selected for the lingual myoplasty, and the patients were ordered to keep on self training by the method of Dr. Lim's tongue movement. In three months after lingual myoplasty there was no relapse of ankyloglossia and the most retracted tongue position changed to inferior and posterior direction effectively (Tab. 6, 7, 8), and on gross finding the size of tongue seems to be decreased.(ABSTRACT TRUNCATED AT 400 WORDS)

Malignant tumors among Koreans-relative frequency study on 19,140 cases during 1978 to 1986

A statistical analysis was made on 19,140 primary malignant tumors histopathologically diagnosed at Seoul National University Hospital during 9 year period from 1978 to 1986. The study was performed to understand the recent trend of the relative frequency of the primary malignant tumors among Koreans and to compare it with the previous studies using same hospital materials, twice presented in 1968 and 1978, respectively. Sex distribution of the cases was 10,025 (52.38%) males and 9,115 (47.62%) females. Among males the frequency rank was stomach (33.88%), lung and bronchus (8.73%), leukemia (7.02%), liver (4.79%) and oral cavity (4.70%). And among females it was uterine cervix (24.48%), stomach (20.45%), thyroid (7.87%), breast (6.48%) and leukemia (4.78%). The relative frequency of malignant tumors in this study was generally similar to the previous data published in 1978 at this department, except for the fact that stomach and lung cancers were more commonly seen in both sexes during this study period than the previous periods of years.

Melanotic neuroectodermal tumor of infancy

A case of melanotic neuroectodermal tumor of infancy was presented. This tumor occurred in the right maxillary alveolar ridge of 3-month-old female infant, showing bluish enlargement of alveolar mucosa with the displacement of central deciduous incisor. We described the gross, microscopic, and ultrastructural findings of this tumor. This case appears to be the first case of MNTI, reported in a Korean.

Epidemiologic study of hepatitis B in pregnant Korean women

The positive rates of hepatitis B viral markers according to many epidemiologic factors were analyzed in 2,873 pregnant women who delivered at St. Columban’s Hospital in Mokpo City from April 1st, 1985 to March 31st, 1986.

The following results were obtained: The overall HBsAg positivity in all pregnant women was 8.3%. The positive rate of HBsAg was unrelated to age. It was 13.2% in the 11–20 year age group. 12.5% in the 31–40 year age group, 7.8% in the 21–30 year age group and 0.0% in the 41–50 year age group. The positive rate of HBsAg was slightly related to locality. It was a little higher in women who grew up in rural areas (8.6%) than in urban areas (7.7%). The positive rate of HBsAg was unrelated to educational background. The positive rate of HBsAg was unrelated to economic status. It was 8.7% in the highest income group and 8.6% in the lowest income group. The positive rate of HBsAg was higher in cases who had injections more than four times. The positive rate of HBsAg was higher, but not significantly, in cases who had received blood transfusion. The positive rate of HBsAg was higher, but not significantly, in cases who had more than three siblings (0.05

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