Comparison of Acceptance and Commitment Therapy (ACT) and Cognitive Behavior Therapy (CBT) for Chronic Insomnia: A Pilot Randomized Controlled Trial

Purpose

Acceptance and Commitment Therapy (ACT) is part of the third wave of cognitive behavior therapy, and has six core components: acceptance, cognitive defusion, self as context, being present, values, and committed behavior. This study aimed to examine the efficacy of ACT for insomnia compared with cognitive behavior therapy for insomnia (CBT-I) in patients with chronic primary insomnia.

Methods

The study recruited patients with chronic primary insomnia from a university hospital between August 2020 and July 2021. Thirty patients were enrolled and randomly assigned to receive either ACT (n = 15) or CBT-I (n = 15). Interventions were performed over four weeks, with four sessions of face-to-face therapy and four sessions of online therapy. The outcomes were measured using a sleep diary and a questionnaire.

Results

Post-intervention, the ACT and CBT-I groups had significantly improved sleep quality, insomnia severity, depression, beliefs about sleep, sleep onset latency (SOL), and sleep efficacy (SE) (p < 0.05). However, anxiety was significantly reduced in the ACT group (p = 0.015), but not in the CBT-I group.

Conclusion

ACT had a significant effect on primary insomnia and secondary symptoms, especially anxiety related to insomnia. These findings suggest that ACT could be a potential intervention for individuals who do not respond to CBT-I, who have high anxiety regarding sleep problems.

Development and effects of an internet-based family resilience-promoting program for parents of children with cancer: A randomized controlled trial

PURPOSE

The diagnosis of cancer in children can negatively impact their parents, owing to the complex treatment processes. Families with high levels of resilience can overcome these difficulties and thus perform higher family functions. We aimed to develop an internet-based family resilience-promoting program for parents of children with cancer and evaluate its effect on the levels of family resilience, depression, and family function.

METHODS

This prospective, parallel-group, randomized-controlled study that was conducted at Yonsei Cancer Center from June to October 2021 included 41 parents of children with cancer. In total, four sessions of the internet-based family resilience-promoting program, led by a nurse, were conducted individually for parents. Levels of family resilience, depression, and family function were measured before, immediately after, and 4 weeks after the program. The data were analyzed using the linear mixed-effect model, and program satisfaction was evaluated through an internet-based questionnaire and interview.

RESULTS

The experimental group (the family resilience-promoting program participants) differed more significantly from the control group in the level of change in family resilience (β = 13.214, p = 0.003, effect size = 0.374) and family function (β = 1.256, p = 0.018, effect size = 0.394). However, there was no significant difference between the groups in the level of depression (β = 2.133, p = 0.187, effect size = 0.416). All the program participants showed a high program satisfaction score of 4.75 out of 5.00 points overall.

CONCLUSIONS

The applicability of the internet-based family resilience-promoting program as an appropriate nursing intervention was verified. Its application can help the families of children with cancer adapt to the stressful situation of their children's cancer diagnosis and treatment.

Overcoming the coupled climate and biodiversity crises and their societal impacts

Earth's biodiversity and human societies face pollution, overconsumption of natural resources, urbanization, demographic shifts, social and economic inequalities, and habitat loss, many of which are exacerbated by climate change. Here, we review links among climate, biodiversity, and society and develop a roadmap toward sustainability. These include limiting warming to 1.5°C and effectively conserving and restoring functional ecosystems on 30 to 50% of land, freshwater, and ocean "scapes." We envision a mosaic of interconnected protected and shared spaces, including intensively used spaces, to strengthen self-sustaining biodiversity, the capacity of people and nature to adapt to and mitigate climate change, and nature's contributions to people. Fostering interlinked human, ecosystem, and planetary health for a livable future urgently requires bold implementation of transformative policy interventions through interconnected institutions, governance, and social systems from local to global levels.

Improving mental health and daytime function in adult insomnia patients predict cognitive behavioral therapy for insomnia effectiveness: A case-control study

Objective

This study investigated demographic, sleep related symptoms and mental health status as predictors of clinically significant treatment responses to cognitive behavioral therapy in adults who have good adherence for the cognitive behavioral therapy for insomnia (CBT-I) program in primary insomnia.

Methods

A total of 42 adults with primary insomnia disorder were treated with CBT-I at a university hospital from June 2020 to January 2021. Demographic variables were surveyed and sleep-related symptoms were measured using self-reported questionnaires before and after the intervention, comprising a 6-week interval. The treatment responder group was defined as patients with an Insomnia Severity Index change score >7 compared to baseline. Logistic regression and paired t-test examined whether these factors predicted treatment outcomes for CBT-I.

Results

Demographic variables did not predict treatment outcomes. Higher levels of anxiety were associated with a higher likelihood of treatment response (odds ratio [OR] = 1.234; confidence interval [CI]: 1.008-1.511). More severe insomnia at baseline was associated with a greater likelihood of treatment response (OR = 1.450; CI: 1.121-1.875). The lesser the dysfunctional beliefs and attitudes about sleep, the more effective the treatment response (OR = 0.943; CI: 0.904-0.984). Unlike the group of treatment responders, daytime function, depressive mood, and anxiety status did not improve in the group of treatment non-responders after CBT-I intervention.

Conclusions

Patients with severe insomnia and anxiety at baseline should be treated more aggressively with CBT-I. During treatment, patients' mental health problems and daytime activities should be continuously monitored, in order to help improve these problems which might strengthen the effectiveness of CBT-I.

Unconventional supercurrent phase in Ising superconductor Josephson junction with atomically thin magnetic insulator

In two-dimensional (2D) NbSe₂ crystal, which lacks inversion symmetry, strong spin-orbit coupling aligns the spins of Cooper pairs to the orbital valleys, forming Ising Cooper pairs (ICPs). The unusual spin texture of ICPs can be further modulated by introducing magnetic exchange. Here, we report unconventional supercurrent phase in van der Waals heterostructure Josephson junctions (JJs) that couples NbSe₂ ICPs across an atomically thin magnetic insulator (MI) Cr₂Ge₂Te₆. By constructing a superconducting quantum interference device (SQUID), we measure the phase of the transferred Cooper pairs in the MI JJ. We demonstrate a doubly degenerate nontrivial JJ phase (ϕ), formed by momentum-conserving tunneling of ICPs across magnetic domains in the barrier. The doubly degenerate ground states in MI JJs provide a two-level quantum system that can be utilized as a new dissipationless component for superconducting quantum devices. Our work boosts the study of various superconducting states with spin-orbit coupling, opening up an avenue to designing new superconducting phase-controlled quantum electronic devices.

Van der Waals structures provide a new platform to explore novel physics of superconductor/ferromagnet interfaces. Here, NbSe₂ Josephson junction with Cr₂Ge₂Te₆ enables non-trivial Josephson phase by spin-dependent interaction, boosting the study of superconducting states with spin-orbit coupling and phase-controlled quantum electronic device.

Factors Influencing Resilience among Korean adolescents and young adult survivors of childhood cancer

PURPOSE

The number of childhood cancer survivors has been steadily increasing because of improved cancer treatment outcomes. We aimed to examine the level of cancer stigma, coping, spirituality, hope, family communication, social support and resilience in adolescent and adult childhood cancer survivors and identify factors associated with resilience.

METHOD

This study is a descriptive survey conducted on 139 childhood cancer survivors aged 15-29 years who had been diagnosed with cancer prior to the age of 19 years at a general hospital in Seoul. The questionnaire consisted of the Cancer Stigma Scale, Jalowiec Coping Scale, Functional Assessment of Chronic-Illness Therapy-Spirituality (FACIT-Sp), Hearth Hope Index (HHI), Parent-Adolescent Communication Inventory (PACI), Multidimensional Scale of Perceived Social Support (MSPSS), and Haase Resilience in Illness Scale (HARS). Collected data were analyzed using multiple linear regression analysis with SPSS 23.0.

RESULTS

Resilience positively correlated with courageous coping, spirituality, hope, family communication and social support, and negatively correlated with cancer stigma and defensive coping. Regression analyses revealed that courageous coping (β = 0.303, p < .001), hope (β = 0.317, p = .001), and solid tumor diagnosis (β = -0.144, p = .012) were significantly predictive of resilience among childhood cancer survivors, and these factors explained 65.2% of the variance.

CONCLUSIONS

Resilience among childhood cancer survivors was higher with increasing courageous coping and hope and lower with solid tumors. These results suggest that coping and hope management should be included in the strategies to enhance the resilience of AYA cancer survivors.

Factors Affecting the Timing of a Central Line Associated Bloodstream Infection Onset in Children with Cancer

PURPOSE

The purpose of this study is to identify controllable treatment-environment-related factors affecting the timing of a central line-associated bloodstream infection (CLABSI) onset in children with cancer with central venous catheters (CVC).

DESIGN

This study is a secondary data analysis with the data extracted from electronic medical records in a tertiary hospital in South Korea. This study was conducted by reviewing electronic medical records of 470 pediatric cancer patients younger than the age of 18 years from 2010 to 2016.

METHOD

The timing of a CLABSI onset was identified through the onset of CLABSI and the duration of catheterization. Cox proportional hazards regression analysis was used to estimate the impact of variables on the timing of CLABSI onset. The duration of catheterization was estimated using the Kaplan-Meier method.

FINDING

Multivariable analysis by Cox proportional model analysis showed that there are six independent variables affecting the timing of a CLABSI onset: length of stay in hospital, catheter insertion location, use of antibiotics on day of catheter insertion, catheter function, number of blood transfusions per 100 days, and number of blood tests per 100 days.

CONCLUSIONS

The findings of this study provide a foundation for the development of EBP-based CVC guidelines to effectively reduce CLABSIs and maintain a long-term CVC without a CLABSI.

Subclinical Hypothyroidism in Childhood Cancer Survivors

PURPOSE

In childhood cancer survivors, the most common late effect is thyroid dysfunction, most notably subclinical hypothyroidism (SCH). Our study evaluated the risk factors for persistent SCH in survivors.

MATERIALS AND METHODS

Survivors (n=423) were defined as patients who survived at least 2 years after cancer treatment completion. Thyroid function was assessed at this time and several years thereafter. Two groups of survivors with SCH were compared: those who regained normal thyroid function during the follow-up period (normalized group) and those who did not (persistent group).

RESULTS

Overall, 104 of the 423 survivors had SCH. SCH was observed in 26% of brain or nasopharyngeal cancer survivors (11 of 43) and 21.6% of leukemia survivors (35 of 162). Sixty-two survivors regained normal thyroid function, 30 remained as persistent SCH, and 12 were lost to follow-up. The follow-up duration was 4.03 (2.15-5.78) years. Brain or nasopharyngeal cancer and Hodgkin disease were more common in the persistent group than in the normalized group (p=0.002). More patients in the persistent group received radiation (p=0.008). Radiation to the head region was higher in this group (2394±2469 cGy) than in the normalized group (894±1591 cGy; p=0.003). On multivariable analysis, lymphoma (p=0.011), brain or nasopharyngeal cancer (p=0.039), and head radiation dose ≥1800 cGy (p=0.039) were significant risk factors for persistent SCH.

CONCLUSION

SCH was common in childhood cancer survivors. Brain or nasopharyngeal cancer, lymphoma, and head radiation ≥1800 cGy were significant risk factors for persistent SCH.

Symptom Interval and Patient Delay Affect Survival Outcomes in Adolescent Cancer Patients

PURPOSE

Unique features of adolescent cancer patients include cancer types, developmental stages, and psychosocial issues. In this study, we evaluated the relationship between diagnostic delay and survival to improve adolescent cancer care.

MATERIALS AND METHODS

A total of 592 patients aged 0-18 years with eight common cancers were grouped according to age (adolescents, ≥10 years; children, <10 years). We retrospectively reviewed their symptom intervals (SIs, between first symptom/sign of disease and diagnosis), patient delay (PD, between first symptom/sign of disease and first contact with a physician), patient delay proportion (PDP), and overall survival (OS).

RESULTS

Mean SI was significantly longer in adolescents than in children (66.4 days vs. 28.4 days; p<0.001), and OS rates were higher in patients with longer SIs (p=0.001). In children with long SIs, OS did not differ according to PDP (p=0.753). In adolescents with long SIs, OS was worse when PDP was ≥0.6 (67.2%) than <0.6 (95.5%, p=0.007). In a multivariate analysis, adolescents in the long SI/PDP ≥0.6 group tended to have a higher hazard ratio (HR, 6.483; p=0.069) than those in the long SI/PDP <0.6 group (HR=1, reference).

CONCLUSION

Adolescents with a long SI/PDP ≥0.6 had lower survival rates than those with a short SI/all PDP or a long SI/PDP <0.6. They should be encouraged to seek prompt medical assistance by a physician or oncologist to lessen PDs.

Rapid enlargement of endometrial stromal sarcoma after uterine fibroid embolization for presumed adenomyosis: a case report and literature review

Uterine sarcomas have rarely been diagnosed after uterine artery embolization. It remains unclear whether the diagnostic work-up is required prior to such embolization to prevent a missed diagnosis of sarcomas and a delay in providing definitive treatment. Because of the rarity and heterogeneity of endometrial stromal neoplasms, little is known about their epidemiology, pathogenesis, and molecular pathology. The authors report a case of low-grade endometrial stromal sarcoma (ESS) diagnosed after uterine fibroid embolization. Although they performed laparoscopic biopsy of the rapidly growing uterine mass, they could not detect the ESS. Although rare, ESS should be considered in the differential diagnosis of uterine fibroid enlargement. It is essential to assess the risk of malignancy by taking into account the patient's clinical symptoms, results of the physical exam, and imaging findings prior to uterine artery embolization. Pathologic diagnosis should include an adequate biopsy sample and the use of molecular genetic testing.

Poor bone health at the end of puberty in childhood cancer survivors

BACKGROUND

Although the survival rate following childhood cancer is >80%, late effects are a major concern. We aimed to determine the clinical factors affecting bone health after puberty in childhood cancer survivors at risk for low bone mineral density (BMD).

PROCEDURES

We performed dual-energy X-ray absorptiometry at the lumbar spine, femoral neck, and total hip regions for survivors with the following bone densitometry indications (BDIXs): brain or nasopharyngeal cancer, head or neck area radiotherapy, or corticosteroid treatment (N = 92). Additionally, we evaluated 16 survivors without these BDIXs but with other clinical factors that could affect bone health. We assessed the effects of these factors on BMD using univariate and logistic regression analyses. Moderate BMD deficit was defined as a Z-score of <-1.0 and ≥-2.0, and severe BMD deficit was defined as <-2.0.

RESULTS

Severe BMD deficits were found in 18 survivors (16.7%) and moderate BMD deficits were in 39 (36.1%) in at least one bone region. BMD deficits tended to increase as the number of BDIXs increased (P < 0.010). There were no severe BMD deficits in survivors without BDIXs. The duration since cancer treatment completion was correlated with higher BMD (P < 0.05). Endocrine dysfunction was a significant risk factor for decreased BMD in univariate and multivariate analyses (P < 0.05 for both).

CONCLUSIONS

Decreased BMD was prevalent in our study cohort. Endocrine dysfunction was found to be a significant risk factor, and it should be managed in survivors to ensure future bone health.

Suppression of creep-regime dynamics in epitaxial ferroelectric BiFeO3 films

Switching dynamics of ferroelectric materials are governed by the response of domain walls to applied electric field. In epitaxial ferroelectric films, thermally-activated ‘creep’ motion plays a significant role in domain wall dynamics, and accordingly, detailed understanding of the system’s switching properties requires that this creep motion be taken into account. Despite this importance, few studies have investigated creep motion in ferroelectric films under ac-driven force. Here, we explore ac hysteretic dynamics in epitaxial BiFeO₃ thin films, through ferroelectric hysteresis measurements, and stroboscopic piezoresponse force microscopy. We reveal that identically-fabricated BiFeO₃ films on SrRuO₃ or La_0.67Sr_0.33MnO₃ bottom electrodes exhibit markedly different switching behaviour, with BiFeO₃/SrRuO₃ presenting essentially creep-free dynamics. This unprecedented result arises from the distinctive spatial inhomogeneities of the internal fields, these being influenced by the bottom electrode’s surface morphology. Our findings further highlight the importance of controlling interface and defect characteristics, to engineer ferroelectric devices with optimised performance.

Increasing and worsening late effects in childhood cancer survivors during follow-up

Recent advances in childhood cancer treatment have increased survival rates to 80%. Two out of three survivors experience late effects (LEs). From a group of 241 survivors previously described, 193 were followed at the long-term follow-up clinic (LTFC) of Severance Hospital in Korea; the presence of LEs was confirmed by oncologists. We reported the change in LEs during 3 yr of follow-up. The median follow-up from diagnosis was 10.4 yr (5.1-26.2 yr). Among 193 survivors, the percentage of patients with at least one LE increased from 63.2% at the initial visit to 75.1% at the most recent visit (P = 0.011). The proportion of patients having multiple LEs and grade 2 or higher LEs increased from the initial visit (P = 0.001 respectively). Forty-eight non-responders to the LTFC were older and had less frequent and severe LEs than responders at initial visit (all P < 0.05). In multivariate analysis, younger age at diagnosis, older age at initial visit, a diagnosis of a brain tumor or lymphoma, and use of radiotherapy were significant risk factors for LEs (all P < 0.05). Adverse changes in LEs were seen among the survivors, regardless of most clinical risk factors. They need to receive comprehensive, long-term follow up.

Feasibility of sequential high-dose chemotherapy in advanced pediatric solid tumors

The purpose of this study was to evaluate the feasibility and tumor response of 3 cycles of sequential high-dose chemotherapy (HDCT) in advanced pediatric solid tumor patients. Medical records of 11 children who underwent 2 consequent courses of reduced conditioning HDCT followed by final HDCT with autologous HSC infusion were reviewed in a retrospective manner. Each median time to an absolute neutrophil count > 0.5 x 10(9)/L was 12, 13, and 12 days. Major toxic reactions were fever, infection, and vomiting. One patient experienced transplantation-related mortality. Nine patients showed complete and partial responses to the therapy at 6 months follow-up after final HDCT. Finally, 6 patients are alive without evidence of disease at median follow-up of 24 months. Even though it is a preliminary result, the authors think that this treatment could be a feasible treatment option for advanced pediatric solid tumor patients.

Comprehensive clinical follow-up of late effects in childhood cancer survivors shows the need for early and well-timed intervention

BACKGROUND

Due to recent advances in treatment, nearly 80% of childhood cancer patients become long-term survivors. Studies on the late effects of survivors are under way worldwide. However, data on Asian survivors remain limited.

METHODS

Data on 241 survivors at the Long-term Follow-up Clinic in Severance Hospital, South Korea, were collected and late effects were confirmed by oncologists.

RESULTS

The median follow-up from diagnosis was 7.8 years. Late effects were identified in 59.8% of survivors and 23.2% had two or more late effects. Grade 3 or higher late effects were present in 10.8%. The most common late effects involved endocrine system (29.0%). Late effects were present in 95.7% of brain tumor survivors and 36.0% of Wilms' tumor survivors. Chemotherapy, hematopoietic stem-cell transplantation and radiotherapy were significant factors associated with the number and severity of late effects (P < 0.05). Brain tumor survivors had more severe late effects (P < 0.001), whereas Wilms' tumor survivors had fewer and milder late effects (P < 0.05).

CONCLUSION

The observation that over 50% of cancer survivors suffered from late effects during the short follow-up period and that a high frequency of endocrine late effects was present indicates the need for early and well-timed intervention of the survivors.

Circulating osteoprotegerin levels are elevated and correlated with antiphospholipid antibodies in patients with systemic lupus erythematosus

Patients with antiphospholipid syndrome (APS) have an increased risk for the development of thrombotic complications. Recent studies indicate that osteoprotegerin (OPG) acts as an important molecule in the development of vascular diseases. The aim of the present study was to examine the association between serum OPG levels and APS manifestations in patients with SLE. Seventy-nine patients with SLE and ninety-two healthy controls, matched for age and sex, were included in this study. Serum levels of OPG, monocyte chemoattractant protein(MCP)-1 and soluble E-selectin were determined by ELISA. At the time of serum sampling, various clinical and laboratory parameters were assessed. We found that serum levels of OPG were significantly higher in patients with SLE than in healthy controls (1236 ± 82 vs 967 ± 37 pg/mL, P = 0.003). Particularly, serum OPG levels were significantly higher in SLE patients with APS than those without (1615 ± 191 vs 1171 ± 91 pg/mL, P = 0.006). Serum OPG levels correlated with titres of IgG anti-cardiolipin antibody ( P = 0.026) and anti-β2-glycoprotein I antibody ( P < 0.001). Moreover, serum OPG also correlated with serum levels of sE-selectin ( P = 0.002), which is an endothelial cell activation marker, and MCP-1 ( P = 0.003), a well known chemokine implicated in thrombogenesis. Collectively, serum OPG levels were increased in SLE patients with APS and correlated with titres of antiphospholipid antibodies, suggesting that OPG might be linked to the development of APS.

Structures of monomeric, dimeric and trimeric PCNA: PCNA-ring assembly and opening

DNA sliding clamps form an oligomeric ring encircling DNA and serve as a moving platform for DNA-processing proteins. The opening and closing of a sliding-clamp ring is essential to load the clamp onto DNA in order to perform its functions. The molecular details of how clamp rings open and enclose DNA are still not clear. Three PCNA homologues have been found in Sulfolobus solfataricus which form a heterotrimer. Taking advantage of their hetero-oligomeric nature, the structures of the PCNAs in monomeric PCNA3, dimeric PCNA1-PCNA2 and trimeric PCNA1-PCNA2-PCNA3 forms were determined at resolutions of 2.6-1.9 A. The distinct oligomeric structures represent different stages in ring formation, which were verified in solution by ultracentrifugation analysis. The heterodimer opens in a V-shape of 130 degrees , while the heterotrimers form a ring with a 120 degrees rotation between monomers. The association of a rigid PCNA3 monomer with an opened PCNA1-PCNA2 heterodimer closes the ring and introduces a spring tension in the PCNA1-PCNA2 interface, thus bending the nine-stranded intermolecular beta-sheet to fit the 120 degrees rotation. The release of the spring tension as PCNA3 dissociates from the ring may facilitate ring opening. The structural features in different assemblies present a molecular model for clamp ring assembly and opening.

Fabrication of transparent capacitive structure by self-assembled thin films

An approach to fabricating transparent electronic devices by using nanomaterial and nanofabrication is presented in this paper. A see-through capacitor is constructed from self-assembled silica nanoparticle layers that are stacked on the transparent substrate. The electrodes are made of indium tin oxide. Unlike the traditional processes used to fabricate such devices, the self-assembly approach enables one to synthesize the thin film layers at lower temperature and cost, and with a broader availability of nanomaterials. The vertical dimension of the self-assembled thin films can be precisely controlled, as well as the molecular order in the thin film layers. The shape of the capacitor is generated by planar micropatterning. The monitoring by quartz crystal demonstrates the steady growth of the silica nanoparticle multilayer. In addition, because the material synthesis and the device fabrication steps are separate, the fabrication is not affected by the harsh conditions required for the material synthesis. As a result, a clear pattern is allowed over a large area on the substrate. The prepared capacitive structure has an optical transparency higher than 92% over the visible spectrum. The capacitive impedance is measured at different frequencies and fit the theoretical results. As one of the fundamental components, this type of capacitive structure can serve in the transparent circuits, interactive media and sensors, as well as being applicable to other transparent devices.

Relationship between the change in overweight status from childhood to adolescence and metabolic syndrome phenotypes: a 9-year retrospective study

OBJECTIVE

To evaluate how the changes in overweight status from childhood to adolescence are related to metabolic syndrome phenotypes in adolescents.

SUBJECTS AND METHODS

A total 375 adolescents aged 16 years. The overweight status from childhood to adolescence (from 7 years of age to 16 years) was determined by body mass index (BMI, kg/m(2)) calculated from records of the School Physical Examination data. The change in body weight was classified into four groups: normal weight to normal weight (NW-NW); overweight to normal (OW-NW); normal to overweight (NW-OW); overweight to overweight (OW-OW). Metabolic syndrome phenotypes were examined from a cross-sectional survey.

RESULTS

The mean values of all phenotypes except for body fatness (BMI and waist) and the cluster score of phenotypes at 16 years of age were not different between the NW-NW group and the OW-NW group, nor between the NW-OW group and the OW-OW group. However, the score as well as the level of body fatness and blood glucose were significantly different between current overweight and normal adolescents regardless of overweight status during childhood (P<0.05).

CONCLUSION

There was a linear relationship between overweight status during childhood and metabolic syndrome phenotypes in adolescence but current overweight status (adolescence overweight) was more closely related to the adolescent risk of metabolic syndrome than childhood overweight status.

Clusterin induces differentiation of pancreatic duct cells into insulin-secreting cells

AIMS/HYPOTHESIS

We recently reported that expression of the gene encoding clusterin (Clu) is upregulated in the regenerating pancreas, particularly in tissues undergoing differentiation. This led us to propose that clusterin participates in the cytodifferentiation of pancreatic tissue, particularly the endocrine islet cells. The aim of this study was to investigate whether clusterin induces the differentiation of duct-lining cells into insulin-secreting cells.

METHODS

We isolated ductal tissue from rat pancreas and cultured it to develop epithelial cell explants for transfection of the Clu cDNA as well as for treatment of clusterin protein.

RESULTS

The number of newly differentiated insulin cells increased 6.9-fold upon Clu overexpression compared with controls. Ins1 mRNA and peptide levels were also increased. Furthermore, glucose-stimulated insulin secretion was observed in the differentiated insulin cells. These cells were immunoreactive for insulin and C-peptide, but negative for other islet hormones and for cytokeratin-20, which indicates a fully differentiated state. Insulin cell differentiation was also increased in a dose-dependent manner by treating duct cells in culture with clusterin, indicating a growth-factor-like action of clusterin in insulin cell differentiation.

CONCLUSIONS/INTERPRETATION

These results suggest that clusterin can be considered as a potential morphogenic factor that promotes differentiation of pancreatic beta cells.

Comparison of one-step RT-PCR and a nested PCR for the detection of canine distemper virus in clinical samples

OBJECTIVE

To develop a rapid and sensitive method for the detection of canine distemper virus (CDV) by nested PCR using clinical specimens.

DESIGN

A nested PCR was developed, compared to a one-step RT-PCR and validated.

PROCEDURE

Two sets of specific primers for a one-step RT-PCR and a nested PCR, targeting a 640 bp fragment and a 297 bp fragment, respectively, were selected from the highly conserved region of the nucleocapsid protein (NP) gene of CDV. The nested PCR and the one-step RT-PCR were used to amplify a part of the CDV NP gene of a CDV vaccinal strain and samples of urine, blood, nasal discharge and saliva from 29 dogs suspected of suffering CD.

RESULTS

Both the one-step RT-PCR and the nested PCR reacted with the CDV vaccinal strain, but not with canine parvovirus. The expected 640 bp fragment of the NP gene was detected in 11/22 (50.0%) blood, 10/20 (50.0%) urine, 5/25 (20.0%) saliva and 6/27 (22.2%) nasal swab samples by one-step RT-PCR, whereas the nested PCR amplified an expected 297 bp fragment of the NP gene in 18/22 (81.8%) blood, 15/20 (75.0%) urine, 14/25 (56%) saliva and 19/27 (70.3%) nasal swab samples.

CONCLUSION

The nested PCR detected CDV in blood, urine, nasal swab and saliva more frequently than did the one-step RT-PCR. Therefore, this assay should be a useful aid to antemortem diagnosis of CDV infections in dogs.

Rubella antibody loss rates in Korean children

We followed students in eight elementary schools for rubella antibody from 1993 to 1996 (602 pairs) and 1996-9 (588 pairs) in Gyeonggi Province, Korea. We tested rubella IgG and administered rubella vaccine to the children with the titres < 10 IU/ml. The loss rates of rubella IgG during the follow-up periods were 14.3 and 15.8%, respectively. Among vaccinated groups, the loss rate was 18.8%, which was significantly higher than 13.8% of the mixture of natural and vaccine-induced immunity groups. The group that had the lower preceding antibody titre had a higher loss rate of 24.8% compared to 7.2% for the group whose titre was 40 IU/ml or above. In a multivariate analysis, age and gender were not related to antibody loss rate. Under this higher rubella antibody loss rate, in order to prevent congenital rubella syndrome, the immunization for women at childbearing age appears necessary until rubella can be eliminated or controlled.

[Ambulatory surgery of otosclerosis: retrospective study of 102 cases]

A retrospective study of 102 selected patients operated for otosclerosis (34 outpatient surgery, 68 hospitalised), having all of them the inclusion criteria of the ambulatory surgery, treated as outpatient in a traditional health sector or hospitalised, depending on their own choice, has been lead. We analysed the results of the pure tone audiometric tests two to six months after surgery. No significative difference was found between the two groups on audiometric results as for the postoperative complications. On the other side, it seems that young patients are more interested by the one-day surgery. The failure of the ambulatory surgery could be explained by the vertigo or dizziness per- or postoperatively. Finally, the evaluation of the cost-benefit shows that the ambulatory surgery in a traditional health sector could lead a budgetary saving policy. A saving way that will grow in a specialized sector devoted to the ambulatory practice.

Antisense Bcl2 oligonucleotide in cisplatin-resistant bladder cancer cell lines

OBJECTIVE

To determine the change of expression of Bcl2 in cisplatin-resistant bladder cancer cell lines and the reversibility of chemoresistance to cisplatin with antisense oligonucleotide against Bcl2, as higher expression of Bcl2 is associated with drug resistance in many different cancer cell lines.

MATERIALS AND METHODS

In the cisplatin-resistant bladder tumour cell lines T24R1 and T24R2, the expression of Bcl2 was determined by reverse transcription-polymerase chain reaction and Western blot assay, and antisense oligonucleotide targeting of the Bcl2 coding sequence was administered with lipofectin.

RESULTS

The expression of Bcl2 mRNA and protein was greater in T24R1 and T24R2 cells than in the parent T24 cells. Short-term exposure to cisplatin up-regulated Bcl2 mRNA and protein expression in parent T24 cells. Treatment with antisense oligonucleotide down-regulated Bcl2 protein expression and significantly enhanced the cytotoxicity of cisplatin.

CONCLUSIONS

Up-regulation of Bcl2 protein expression might be one of the mechanisms of cisplatin resistance in bladder cancer cells, and antisense Bcl2 oligonucleotide may be helpful in chemotherapy for bladder cancer by reversing cisplatin resistance.

[Reliability of CT scan in the diagnosis of conductive hearing loss with normal tympanic membrane]

The goal of this study was to assess the reliability of CT-Scan in the cases of conductive hearing losses with normal tympanic membrane. A computed tomography of the temporal bone (CT-Scan) has been performed in a prospective manner in all patients who underwent surgery for a conductive hearing loss with a normal tympanic membrane in our department. Out of 474 cases, 437 cases (92.2%) presented with otosclerosis. In 25 cases a minor malformation (5.3%) was found at surgery, and in 12 cases (2.5%), another diagnosis was made. Sensitivity of CT-Scan was 91.3% in otosclerosis and 57% in minor malformations. In 8.7% of cases, a superficial and beginning surgical focus was put in evidence whereas CT-Scan was normal. Theses cases represent infra-radiological cases of otosclerosis. In case of radiological otosclerosis, fenestral otosclerosis was found in 83.5% of the cases. CT-Scan was found specific on the operated and deaf side, but in 11.3% of the cases, a radiologic focus did not have a clinical consequence on the controlateral side. A radiological focus is not systematically responsible for a hearing loss. Finally, CT-Scan remains a reliable, sensitive and specific exam in the diagnosis of cases of conductive hearing losses with normal tympanic membrane.

Therapeutic trial in the first three Asian cases of ethylmalonic encephalopathy: response to riboflavin

Three Korean girls with ethylmalonic encephalopathy, the first Asian cases, were identified. In all three cases, we observed slight improvement in motor functions, cognitive behaviours and chronic mucoid diarrhoea after treatment with riboflavin and/or coenzyme Q10 treatment. The precise pathogenesis of ethylmalonic encephalopathy has not been fully elucidated, but riboflavin treatment may be helpful.

Clusterin expression during regeneration of pancreatic islet cells in streptozotocin-induced diabetic rats

AIMS/HYPOTHESIS

Beta-cell regeneration has been reported after islet injury in an animal model for diabetes. Recently, we showed up-regulation of clusterin after islet injury and suggested that clusterin might be involved in cytoprotection and in the regeneration of islet cells. The aim of this study was to investigate the correlation of clusterin expression with islet regeneration and its effect on islet cell replication.

METHODS

Streptozotocin was administrated to rats to induce various types of diabetes. Islet regeneration and clusterin expression were examined after islet injuries. Clusterin cDNA was transfected to MIN6 cells and their proliferation activity was measured by a [3H]thymidine-incorporation assay.

RESULTS

A diabetogenic dose of streptozotocin injected in rats provoked an immediate degeneration of beta cells. In this model, islets showed increased clusterin expression with extensive proliferation of alpha cells but showed poor beta-cell replication. A subdiabetogenic dose of streptozotocin, however, led to the proliferation of beta cells with clusterin up-regulation. In streptozotocin-treated neonatal rats, up-regulation of clusterin was noted during beta-cell proliferation. In all experimental models, clusterin was expressed in alpha cells in close correlation with islet cell proliferation, higher transcription of insulin mRNA and MAPKs activation. Cell replication was increased by 31 % in the MIN6 cells transfected by the clusterin cDNA.

CONCLUSION/INTERPRETATION

Up-regulation of clusterin in alpha cells might induce beta-cell proliferation and thus restore their population after islet injury. We suggest that clusterin could be considered as a growth factor-like molecule stimulating islet-cell proliferation by paracrine action.

Correlations between computed tomography findings and family history in otosclerotic patients

BACKGROUND

Otosclerosis is a heritable disease affecting the otic capsule. Its genetics have been studied since the 19th century, but several issues remain controversial.

OBJECTIVE

The goals of this study were to assess the prevalence of sporadic and familial forms of otosclerosis in a population of otosclerotic patients and to compare the radiologic findings between both groups.

STUDY DESIGN AND SETTING

This retrospective study was conducted in a single institution.

PATIENTS

This study included 211 patients operated on for otosclerosis.

MAIN OUTCOME MEASURES

Clinical data, including pure tone audiograms, were available from patients' charts. A questionnaire assessing family history of otosclerosis and deafness was mailed to the otosclerotic patients. A relative was considered otosclerotic if surgery confirmed the disease. The family history was correlated with the computed tomography results. This examination was performed before surgery in all patients.

RESULTS

A family history of otosclerosis was found in 24.2% of the patients. The radiologic findings differed between patients with a sporadic form of otosclerosis and those with a familial form. The lesions were more often detectable, bilateral, and severe in the familial forms (p < 0.05).

CONCLUSION

These findings lead to the assumption that fenestral radiologic otosclerosis occurs more in sporadic forms, whereas more extensive lesions on computed tomography seem to indicate the familial forms. Hereditary forms demonstrated to be familial seem to lead to more severe disease. The search for a genome locus of otosclerosis may be enlightened by these findings.

New chiral crown ether stationary phase for the liquid chromatographic resolution of alpha-amino acid enantiomers

A new chiral stationary phase (CSP) for the liquid chromatographic separation of enantiomers was prepared by bonding a novel enantiopure (diphenyl-substituted 1,1'-binaphthyl) crown ether to 5 microm silica gel. The resulting CSP was applied to the separation of the enantiomers of various natural and unnatural alpha-amino acids. All alpha-amino acids tested were resolved very well on the new CSP, with the exception of proline, which does not contain a primary amino group. The resolution of alpha-amino acid enantiomers on this new CSP was found to be dependent on the type and amounts of organic and acidic modifiers, and on column temperature.

Sensorineural hearing loss and otosclerosis: a clinical and radiologic survey of 437 cases

The aim of this study was to determine if a relationship exists between bone level thresholds and the extension of otosclerotic foci within the otic capsule. The study consisted of a retrospective case review in a university hospital. We included patients who underwent surgery for otosclerosis in our department and who had a CT scan prior to surgery. We analyzed the data charts and CT scans of 437 cases (386 patients). On CT scan, we distinguished patients with fenestral otosclerosis and/or with a pericochlear focus. A pericochlear focus could be extended (Group 2) or not (Group 1) to the cochlear endosteum. Data for Groups 1 and 2 were compared with those for the control group of all patients for whom CT scan showed no cochlear focus (Group 3). Of the 437 CT scans, 399 were positive (91.3%). An anterior focus was reported in 305 cases (69.8%), a footplate thickening in 21 cases (4.8%) and both anomalies were encountered in 60 cases (13.7%). A pericochlear focus was reported in 53 examinations. This focus was extended to the endosteum in 14 cases (26.4% of the pericochlear foci). In Group 1, preoperative air conduction (AC) thresholds were significantly lower than in the control group (p < 0.05). The air--bone gap was also significantly larger in Group 1 (p < 0.05). Bone conduction (BC) thresholds were lower in Group 1 than in the control group but the difference was not significant. In Group 2, preoperative AC thresholds were significantly lower than in the control group (p < 0.05). BC thresholds were also lower in Group 2 than in the control group and the difference was significant (p < 0.05). As a result of this study, we assume that there may be a relationship between bone level thresholds and the radiological extension of otosclerosis within the otic capsule.

Effectiveness of conservative management of acoustic neuromas

OBJECTIVE

The goal of this study was to assess the effectiveness of the conservative management in patients with acoustic neuroma (vestibular schwannoma).

STUDY DESIGN

This retrospective study was performed in a university hospital.

PATIENTS

Patients were selected for this wait-and-see policy on the basis of age, general condition, audiometric results, tumor size, and patient preference. The study group included 97 patients, 87 of whom had at least two neuroradiologic examinations. The mean age of this population was 63 years (29 to 89 years). The mean length of follow-up of this population was 31 months. Eighty-seven of these patients had at least two radiologic examinations (magnetic resonance imaging or computed tomography). The mean interval between the initial and follow-up radiologic examinations was 15 months.

MAIN OUTCOME MEASURES

Tumor size was measured by use of two-dimensional data in all patients. The mean tumor size was 12 mm. The growth rate of the tumor was estimated by comparison of the results of the measurements from the initial and follow-up neuroradiologic examinations.

RESULTS

Of the 97 patients studied, 6 patients required surgery and 6 required radiotherapy. Sixty patients (62%) were still being treated conservatively at the end of the study period. Three patients of 28 who were classified as candidates for hearing preservation surgery lost their candidacy during the observation period. The mean annual tumor growth rate was 1.52 mm/year. The tumor was stable in size in 36% of patients, regressed in 11% of patients, or grew in 53% of patients. The growth patterns of the acoustic neuroma fell into five categories: continuous growth in 15% of patients, negative growth in 5%, growth followed by negative growth in 40%, negative growth followed by growth in 20%, and no variation of tumor size in 20%.

CONCLUSION

Conservative management of acoustic neuromas carries difficulties: long-term follow-up of the patients and unpredictability of the tumor growth pattern. A reliable and reproducible radiologic method for evaluating tumor size is of great importance.

Overexpression of protein kinase C delta represses expression of proliferin in NIH3T3 cells that regulates cell proliferation

Protein kinase C (PKC) delta is known to inhibit proliferation of many cell types. In this study we found that overexpression of PKCdelta reduced proliferation of NIH3T3 cells. To identify specific genes regulated by PKCdelta in regulation of cell proliferation, we used differential display-polymerase chain reaction in PKCdelta-overexpressing NIH3T3 cells and found that the expression of proliferin, a secreted protein known to stimulate cell proliferation, was significantly repressed. Transient transfection study indicated that the repression of proliferin expression was inversely proportional to the expression levels of PKCdelta. Addition of an anti-proliferin antibody to culture medium to neutralize the secreted proliferin decreased cell proliferation in a dose-dependent manner. Our results, therefore, suggest that overexpression of PKCdelta induces transcriptional repression of proliferin, thereby resulting in inhibition of cell proliferation.

Pure sensorineural hearing loss and otosclerosis. An imaging case report

Pure sensorineural hearing loss is not a rare finding in otological practice. Numerous aetiologies could be at the origin of such a deficit. However, otosclerosis is very rarely cited as a cause of pure sensorineural hearing loss. We present one such case of pure sensorineural hearing loss linked to otosclerosis in a 30-year old caucasian male and underline the high contribution of computed tomography to confirm such a diagnosis. Pure sensorineural hearing loss due to otosclerosis is a rare event and can be misdiagnosed. The clinical diagnosis of such a disease may be difficult. In these cases, CT-Scan is the exam of choice to confirm the diagnosis.

Retinoic acid and its geometrical isomers block both growth and fusion of L6 myoblasts by modulating the expression of protein kinase A

All-trans retinoic acid (RA) and its geometrical isomers, such as 9-cis RA, 13-cis RA, and 9,13-di-cis RA, strongly inhibited both growth and fusion of L6 myoblasts. However, illumination of white light diminished their inhibitory activity on membrane fusion with little effect on cell growth. During myogenic differentiation, the intracellular level of cAMP decreased whereas the total activity of protein kinase A as well as the protein level of its regulatory subunit Ialpha (RIalpha) and catalytic subunit (Calpha) increased. RAs raised the intracellular level of cAMP by over 3-fold, but decreased the total activity of protein kinase A. Like RAs, dibutyryl-cAMP inhibited myoblast fusion and reduced the expression of both RIalpha and Calpha subunits. These results suggest that RAs negatively modulate the differentiation of L6 myoblasts by increasing the intracellular level of cAMP, which may in turn down-regulate the expression of protein kinase A and hence its activity.

Benefits of cochlear implantation in elderly patients

Cochlear implantation in elderly patients is a questionable subject. The purpose of this study was to evaluate the procedure and its outcome, the postoperative course, and the audiologic and social benefits of cochlear implantation in this population. Twenty-seven patients older than 60 years were compared with a control group of 15 adult patients. This retrospective study analyzed data concerning the outcome of the procedure, postoperative course, postoperative orthophonic test results, and answers of a questionnaire assessing the changes in communication, perception, and social outcomes. The procedure was uneventful in both groups. Minor complications were not more frequent in elderly patients. Orthophonic test results were comparable in both groups. At 12 months, 83% of the elderly patients had an open-set speech discrimination score above 60%. The benefits of cochlear implantation in terms of the quality of life are not statistically different with younger patients. Cost-utility analysis might support these findings.

Analysis of the precore and core promoter DNA sequence in liver tissues from patients with hepatocellular carcinoma

To investigate the role of mutant hepatitis B virus (HBV) in the development of hepatocellular carcinoma (HCC), 20 patients with HCC were studied for precore and core promoter mutations in tumorous and nontumorous tissues. The precore and core promoter region was amplified and analyzed by direct sequencing. Among the 20 tumorous and nontumorous tissues, precore mutant HBV was found in 12 (60%) and 18 (90%), respectively. Of the 12 tumorous tissues with precore mutant, nine tissues had a single mutation (1896) and one tissue had another single mutation (1899). The remaining two tissues had a double mutation (1896 and 1899). A single mutation (1896) and a single mutation (1899) were found in 11 and two of the 18 nontumorous tissues with precore mutant, respectively. Among 20 tumorous and nontumorous tissues, HBV with a C to T mutation at nucleotide (nt) 1846 was detected in six and eight, respectively, and was associated with the virus carrying a mutation (1896 or 1899) except in two tumorous tissues. Mutations at nt 1762 and 1764 in core promoter were observed in 16 (80%) tumorous tissues and 18 (90%) nontumorous tissues. Mutations in the precore and core promoter region were found frequently in nontumorous tissue and in tumorous tissue (18/20 and 12/20 in precore region, 18/20 and 16/20 in core promoter respectively). The high prevalence of precore and core promoter mutations in liver tissue from patients with HCC suggests that these mutations may contribute to the development of HCC.

Comparison of Korean-American adoptees and biological children of their adoptive parents: a pilot study

This study compared a small group of Korean-American adoptees with their adoptive siblings who are biological children of the adoptive parents with respect to their psychosocial adjustment. Eighteen Korean-American adoptees were compared with nine biological children by a structured demographic, medical, clinical survey form and the Child Behavior Checklist-Parent Form (CBCL-P). The parents did not raise any more concerns about the adjustment of adopted children than their biological children. On the CBCL-P, the two groups did not differ significantly in competence T-scores, total behavioral problems, broad and T-scores and the total number of problem behaviors except for lower social competence in adopted children and a higher internalization score in biological children. In conclusion, the international adoptees, the Korean-American children have adjusted well during their early childhood after early adoption. Further studies employing a larger sample are warranted to better understand the international adoption practice.

Perfusion impairments in infantile autism on technetium-99m ethyl cysteinate dimer brain single-photon emission tomography: comparison with findings on magnetic resonance imaging

The neuro-anatomical substrate of autism has been the subject of detailed investigation. Because previous studies have not demonstrated consistent and specific neuro-imaging findings in autism and most such studies have been performed in adults and school-aged children, we performed a retrospective review in young children in search of common functional and anatomical abnormalities with brain single-photon emission tomography (SPET) using technetium-99m ethyl cysteinate dimer (ECD) and correlative magnetic resonance imaging (MRI). The patient population was composed of 23 children aged 28-92 months (mean: 54 months) who met the diagnostic criteria of autism as defined in the DSM-IV and CARS. Brain SPET was performed after intravenous injection of 185-370 MBq of 99mTc-ECD using a brain-dedicated annular crystal gamma camera. MRI was performed in all patients, including T1, T2 axial and T1 sagittal sequences. SPET data were assessed visually. Twenty patients had abnormal SPET scans revealing focal areas of decreased perfusion. Decreased perfusion of the cerebellar hemisphere (20/23), thalami (19/23), basal ganglia (5/23) and posterior parietal (10/23) and temporal (7/23) areas were noted on brain SPET. By contrast all patients had normal MRI findings without evidence of abnormalities of the cerebellar vermis, cerebellar hemisphere, thalami, basal ganglia or parietotemporal cortex. In conclusion, extensive perfusion impairments involving the cerebellum, thalami and parietal cortex were found in this study. SPET may be more sensitive in reflecting the pathophysiology of autism than MRI. However, further studies are necessary to determine the significance of thalamic and parietal perfusion impairment in autism.

[Adenoid cystic carcinoma of the larynx. A case report and review of the literature]

Laryngeal adenoïd cystic carcinoma (ACC) is a rare disease due to the poor distribution of the accessory salivary glands in this area. The authors describe a case of ACC arising from the sus glottic area and underline the difficulty of such a diagnosis, which is in fact an histologic finding. The signs of discovery of a laryngeal ACC are not different from other tumors of the area, except pain frequently evoked in these tumors. Laryngeal ACC arises exceptionally before the age of 20 years and no risk factor is known. The most frequent localization is in the sub-glottic area, but sus glottic and glottic localizations have been reported. Evolution is marked by the onset of cervical lymph adenopathies and systemic metastasis most often located in the lung. The treatment comprises wide surgical exerisis followed by radiotherapy. Other reports seem to indicate that the pronostic of the laryngeal location of this disease is worse than in other areas of the head and neck.

Hearing restoration in posterior fossa tumors

OBJECTIVE

This study aimed to assess the results of hearing restoration with a cochlear or a brainstem implant in posterior fossa tumors.

PATIENTS

Six patients were selected. Two patients with an acoustic neuroma in the only-hearing ear (cases 1 and 2), one patient with a posterior fossa meningioma (case 3), one patient with bilateral facial neuroma (case 4), and two patients with bilateral acoustic neuroma (cases 5 and 6) participated.

INTERVENTION

In cases 1 and 2, the patients had a cochlear implant inserted on the only-hearing ear opposite the acoustic neuroma. In case 3, the patient presented with total deafness on the left side and a 10-mm meningioma on the right side. A cochlear implantation was performed after removal of the meningioma on the right side. In case 4, the patient was operated on on both sides with bilateral postoperative deafness. A cochlear implantation was performed on the better hearing ear. In cases 5 and 6, patients underwent an auditory brainstem implantation after the exeresis of the second tumor.

RESULTS

Promontory test results were positive for patients 1, 2, 3, and 4. After implantation, patients 1, 2, 3, and 4 scored 98%, 13%, 70%, and 30%, respectively, in open-set sentence recognition tests, whereas patients 5 and 6 scored 0% and 20%, respectively.

CONCLUSIONS

In case of nonfunctional cochlear nerve, in acoustic neuroma, either bilateral and in the only-hearing ear, promontory test should be performed. If positive results, a cochlear implantation should be performed, because successful results could be expected. Overall results of cochlear implantation on speech discrimination are better than those obtained with a brainstem implant.

Localization of hepatitis B virus DNA in hepatocellular carcinoma by polymerase chain reaction in situ hybridization

The polymerase chain reaction in situ hybridization (PCR-ISH) is a new technique that combines the sensitivity of PCR with the localizing ability of ISH. To investigate the expression pattern of hepatitis B virus (HBV) in the tissue of hepatocellular carcinoma (HCC), we detected HBV-DNA with PCR-ISH in paraffin-embedded tumor and corresponding non-tumor tissues from 11 HCC patients. HBV-DNA was detected in 4 of 11 tumor tissues and in 7 of 10 non-tumor tissues. In tumor tissues, positive signals were scattered in the tissue with occasional clustering, and were found mainly in the cytoplasm of HCC cells rather than in the nucleus. In non-tumor tissues, the number of positive signals was higher than in tumor tissues and they were found in regenerating nodules with differing patterns and intensities. When we compared the detection rate of PCR-ISH with nested PCR among 10 tissue samples, HBV-DNA was detected in 5 tissue samples by PCR-ISH, but the S gene was detected in 10, precore gene in 9 and X gene in 8 by nested PCR. The findings suggest that PCR-ISH is a sensitive technique for localizing HBV in tissue sections and that the low level of HBV replication persists in HCC cells.

[Conservation of residual hearing after cochlear implantation]

Indications for cochlear implantation have been expanded to include severely hearing impaired adults and may increase the number of patients presenting with preoperative residual hearing. Conservation of residual hearing may allow better performance with an implant. However, conventional thought is that implantation destroys auditory structures involved in residual hearing. This study was undertaken to assess if there are general or surgical factors intervening in the conservation of residual hearing in a sample of multichannel implant recipients. A retrospective study on 50 adult cochlear recipients with preoperative residual hearing has been undertaken. Sixteen of 50 implanted subjects (32%) were found to have conserved their residual hearing. Among them, seven patients have clinically non-significant changes of hearing. Age, side of implantation, gender and etiology did not influence the outcome of residual hearing. Round window ossification, ossification of the cochlea, length of insertion, approach and site of insertion (scala tympani vs.scala vestibuli) were not found to be statistically significant between the population having lost and the population having conserved residual hearing. This study emphasizes the need to undertake a larger multicenter longitudinal study to determine the existence of factors related to the conservation of residual hearing.

[Cochlear implants in the elderly]

The authors present a retrospective and multicenter study of 18 elderly patients aged above 60 years-old who underwent a cochlear implantation by comparing them with a population of adult patients. The purpose of this study is to evaluate the utility and benefits of cochlear implantation in the elderly by analyzing the clinical data and the results of a questionnaire assessing the use of the implant and the consequences of implantation on the quality of life. The results of this study indicate that the improvement of quality of life in the elderly is similar compared to a control group of adult patients.

Toxoplasma antibody titers by ELISA and indirect latex agglutination test in pregnant women

The seroepidemiologic studies on anti-Toxoplasma antibody titers were carried out using ELISA and indirect latex agglutination test. Among 899 sera prepared from pregnant women, 39 cases (4.3%) revealed positive reaction and 218 sera from middle school students showed 4 positive reaction (1.8%) by ELISA. By LAT (newly established by National Veterinary Research Institute. Korea), the sera of 7 pregnant women (0.8%) showed positive reaction. When 80 sera showing > or = 1:8 by LAT were used for comparing the results obtained from LAT and Toxotest-MT (Eiken Chemical Co., Japan), 7 cases and 8 sera were positive, respectively. All of 11 sera of proven toxoplasmosis patients showed positive reaction in both tests. Overall proportion of agreement between LAT kit and Toxotest-MT was 0.94 (kappa-index = 0.632, p < 0.011, and LAT was considered to be useful for the screening of toxoplasmosis.