Subclavian Artery Pseudoaneurysm Following Bedside Temporary Hemodialysis Catheter Insertion: A Case Report

A pseudoaneurysm of the subclavian artery following central venous catheter placement is a rare but potentially fatal complication that often requires surgical intervention. However, surgical repair of the subclavian artery remains challenging. Herein, we report the case of a male patient undergoing hemodialysis who developed a pseudoaneurysm of the subclavian artery after a bedside central vein catheter placement. Hemostasis was successfully achieved by selecting the pseudoaneurysm using a microcatheter. At the 10-month follow-up, the pseudoaneurysm was completely excluded, and the patient was in a stable condition. The patient underwent native arteriovenous fistula creation and hemodialysis. Endovascular treatment could be an effective nonsurgical treatment for subclavian artery pseudoaneurysms and has been attempted as a first-line treatment option.

Microcatheter-Directed Thrombolysis Using Recombinant Tissue Plasminogen Activator for the Treatment of Acute Superior Mesenteric Artery Embolism: A Case Report

Background: Acute mesenteric ischemia (AMI) is a life-threatening condition, and in 50% of patients, AMI is caused by acute superior mesenteric artery (SMA) embolism. Endovascular treatment is increasingly being considered the primary modality in selected cases. Many studies have reported that percutaneous aspiration embolectomy using a guiding catheter and thrombolysis with recombinant tissue plasminogen activator (rtPA) are effective in treating SMA embolism. However, no reports on treating SMA embolism using rtPA administered via a microcatheter exist. Case presentation: A 64-year-old man with underlying atrial fibrillation presented with acute SMA embolism revealed using computed tomography (CT). rtPA (total 3 mg) was carefully administered into the occluded SMA through a microcatheter. No complications occurred, and complete revascularization of the SMA was revealed on follow-up CT. Conclusions: Compared with previous reports, this case report reveals that successful revascularization can be achieved using rtPA administered via a microcatheter, with a low dose of rtPA and a short duration of thrombolysis.

Relationship between Perceived Stress, Obesity, and Hypertension in Korean Adults and Older Adults

BACKGROUND

Perceived stress has a significant effect on metabolic diseases, including obesity and hypertension. However, the association between stress levels, obesity, and hypertension according to age and sex is not fully understood. Therefore, this study investigated the relationship between stress levels and obesity and hypertension in Korean adults and older adults.

METHODS

We analyzed data from the 2015 survey of the Korea National Physical Fitness Project conducted by the Korea Institute of Sports Science and the Korea Ministry of Culture, Sports, and Tourism. Of the 3457 participants, 2829 were adults (20-64 years old) and 628 were older adults (≥65 years old). The correlation between obesity and hypertension according to the degree of perceived stress (low, medium, and high) was analyzed using the chi-square test. Binary logistic regression analysis was used to investigate the influence of perceived stress levels on obesity and hypertension. Age, body mass index (BMI), blood pressure, exercise frequency, smoking, breakfast, and sleeping hours were included as covariates.

RESULTS

In adult males, perceived stress levels, age, and diastolic blood pressure were found to have a significant impact on obesity rates, whereas age and breakfast had a significant effect on hypertension rates. In adult females, age and systolic blood pressure were found to significantly influence obesity rates, whereas age, BMI, and exercise frequency had a significant impact on hypertension rates. In older adult females, perceived stress levels and systolic blood pressure were found to significantly impact obesity rates, and sleep duration influenced the rates of hypertension. The effect of perceived stress level on obesity and hypertension rates was less pronounced in the elderly population than in the adult population.

CONCLUSIONS

This study revealed age and sex differences in the relationship between perceived stress, obesity, and hypertension among Koreans. These findings contribute to a better understanding of the complex relationship between perceived stress and metabolic disorders and emphasize the need for a deeper understanding of the specific factors involved in the prevention and management of metabolic diseases.

A Case of Biliary Cast Syndrome with Cholangiocarcinoma-like Lesion in a Patient with No History of Liver Transplantation

Background and Objectives: Biliary cast syndrome, which was first reported in 1975, is a rare disease that occurs after liver transplantation. The incidence is even lower in patients who have not undergone liver transplantation. This study reports a rare case of biliary cast syndrome with cholangiocarcinoma-like lesions in a patient who did not undergo liver transplantation. Case Report: Herein, we report a case of a 69-year-old man with right upper quadrant pain and elevated levels of alkaline phosphatase and gamma-glutamyl transferase, who had a history of total gastrectomy for gastric cancer and laparoscopic cholecystectomy for acute cholecystitis. Computed tomography (CT) revealed longitudinal bile stones in the extrahepatic and intrahepatic bile ducts and abrupt narrowing of the left main bile duct accompanied by a narrowing of the upstream bile duct in the left lobe of the liver. Based on the CT findings, the removal of the bile stones in the bile duct and additional examinations of the suspected cholangiocarcinoma were performed. The patient's symptoms improved, and examinations for suspected cholangiocarcinoma showed no abnormal findings, and he was discharged one month later. Conclusions: The purpose of this case report is to share a rare case of Biliary Cast Syndrome (BCS) occurring without liver transplantation. Additionally, the report aims to share image findings that mimic cancer in BCS, with the goal of reducing unnecessary repetitive biopsies, minimizing patient discomfort, and decreasing unnecessary costs by aiding in the diagnosis of BCS.

Added Value of Cone-Beam Computed Tomography for Detecting Hepatocellular Carcinomas and Feeding Arteries during Transcatheter Arterial Chemoembolization Focusing on Radiation Exposure

Background and Objectives: This study aimed to evaluate the added value of cone-beam computed tomography (CBCT) for detecting hepatocellular carcinomas (HCC) and feeding arteries during transcatheter arterial chemoembolization (TACE). Material and methods: Seventy-six patients underwent TACE and CBCT. We subcategorized patients into groups I (61 patients: possible superselection of tumor/feeding arteries) and II (15 patients: limited superselection of tumor/feeding arteries). We evaluated fluoroscopy time and radiation dose during TACE. Two blinded radiologists independently performed an interval reading based on digital subtraction angiography (DSA) imaging only and DSA combined with CBCT in group I. Result: The mean total fluoroscopy time was 1456.3 ± 605.6 s. The mean dose-area product (DAP), mean DAP of CBCT, and mean ratio of DAP of CBCT to total DAP was 137.1 ± 69.2 Gy cm², 18.3 ± 7.1 Gy cm², and 13.3%, respectively. The sensitivity for detecting HCC increased after the additional CBCT reading, from 69.6% to 97.3% and 69.6% to 96.4% for readers 1 and 2, respectively. The sensitivity for detecting feeding arteries increased from 60.3% to 96.6% and 63.8% to 97.4% for readers 1 and 2, respectively. Conclusions: CBCT can increase sensitivity for detecting HCCs and feeding arteries without significantly increasing the radiation exposure.

Significant contribution of coastal fish-farm activities to the inventory of trace elements in coastal waters: Traced by ammonia and rare earth elements

In this study, we investigated the influence of fish-farm activities on the inventory of trace elements (Mn, Fe, Co, Ni, and Cu) in the coastal waters off the fish-farm plants on Jeju Island, Korea. NH₄⁺ and rare earth elements (REEs) were used as tracers to examine the production and removal processes. Relatively higher concentrations of trace elements were observed in the coastal waters and significantly correlated with NH₄⁺. Our results suggest that the excess dissolved trace elements in the coastal waters could be mainly produced inside fish farms, together with the production of NH₄⁺ and light-REEs (La to Nd). Although dissolved trace elements were found to be partially scavenged onto particles in the fish-farm rearing waters, indicated by the significant removal of particle-reactive Ce, these particles would be eventually discharged into the coastal ocean and release the dissolved trace elements back into the water columns.

Transcatheter Arterial Embolization for Spontaneous Hepatic Rupture Associated with HELLP Syndrome: A Case Report

Background: Spontaneous hepatic rupture associated with the syndrome characterized by hemolysis, elevated liver enzymes, and a low platelet count (HELLP syndrome) is a rare and life-threatening condition, and only a few cases regarding the management of this condition through transcatheter arterial embolization (TAE) have been previously reported. Case summary: Herein, we report a case involving a 35-year-old pregnant woman who presented at 28 weeks of gestation with right upper quadrant pain, hypotension, and elevated levels of liver enzymes. Transabdominal ultrasound revealed fetal death. She required an emergency cesarean section, and hepatic rupture was identified after the fetus had been delivered. Hepatic packing and TAE were performed. The postprocedural course was uneventful, and the patient was discharged 14 days after she had been admitted to our hospital. Conclusions: Spontaneous hepatic rupture associated with HELLP syndrome is a very serious condition that requires prompt and decisive management. The high maternal and fetal mortality rates associated with this condition can be reduced through early accurate diagnosis and adequate management. The findings in the reported case indicate that TAE may be an attractive alternative to surgery for the management of spontaneous hepatic rupture associated with HELLP syndrome.

Spatiotemporal change in coastal waters caused by land-based fish farm wastewater-borne nutrients: Results from Jeju Island, Korea

We investigated spatiotemporal distributions of dissolved inorganic nutrients and organic carbon (DOC) and nitrogen (DON) in coastal waters and land-based fish farm wastewater to determine effects of wastewater on seawater of Jeju Island, Korea. The nutrient concentrations in seawater were lower than in wastewater with negative correlations against salinity, indicating a terrestrial source. Wastewater-derived DOC and DON were transported offshore while wastewater-derived inorganic nutrients were effectively removed, likely via biological production, and this was closely linked to decline in N:P ratios. The correlations between DOC, DON, and colored dissolved organic matter suggest that organic matters likely originate from the fish farm wastewater. Quantitatively, the estimated wastewater-derived DOC flux was equivalent to that through submarine groundwater, which is a significant water source on the island. Our results will be able to trace contaminant sources and support assessments of seawater quality for appropriate regulation of fish farm wastewater discharge into coastal zones.

TUBB3 M323V Syndrome Presents with Infantile Nystagmus

Variants in the TUBB3 gene, one of the tubulin-encoding genes, are known to cause congenital fibrosis of the extraocular muscles type 3 and/or malformations of cortical development. Herein, we report a case of a 6-month-old infant with c.967A>G:p.(M323V) variant in the TUBB3 gene, who had only infantile nystagmus without other ophthalmological abnormalities. Subsequent brain magnetic resonance imaging (MRI) revealed cortical dysplasia. Neurological examinations did not reveal gross or fine motor delay, which are inconsistent with the clinical characteristics of patients with the M323V syndrome reported so far. A protein modeling showed that the M323V mutation in the TUBB3 gene interferes with αβ heterodimer formation with the TUBA1A gene. This report emphasizes the importance of considering TUBB3 and TUBA1A tubulinopathy in infantile nystagmus. A brain MRI should also be considered for these patients, although in the absence of other neurologic signs or symptoms.

Autism-linked gene FoxP1 selectively regulates the cultural transmission of learned vocalizations

Autism spectrum disorders (ASDs) are characterized by impaired learning of social skills and language. Memories of how parents and other social models behave are used to guide behavioral learning. How ASD-linked genes affect the intertwined aspects of observational learning and behavioral imitation is not known. Here, we examine how disrupted expression of the ASD gene FOXP1, which causes severe impairments in speech and language learning, affects the cultural transmission of birdsong between adult and juvenile zebra finches. FoxP1 is widely expressed in striatal-projecting forebrain mirror neurons. Knockdown of FoxP1 in this circuit prevents juvenile birds from forming memories of an adult song model but does not interrupt learning how to vocally imitate a previously memorized song. This selective learning deficit is associated with potent disruptions to experience-dependent structural and synaptic plasticity in mirror neurons. Thus, FoxP1 regulates the ability to form memories essential to the cultural transmission of behavior.

Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment

BACKGROUND AND PURPOSE

The long scan time of MR imaging is a major drawback limiting its clinical use in neuroimaging; therefore, we aimed to investigate the clinical feasibility of a 1-minute full-brain MR imaging using a multicontrast EPI sequence on a different MR imaging scanner than the ones previously reported.

MATERIALS AND METHODS

We retrospectively reviewed the records of 146 patients who underwent a multicontrast EPI sequence, including T1-FLAIR, T2-FLAIR, T2WI, DWI, and T2*WI sequences. Two attending neuroradiologists assessed the image quality of each sequence to compare the multicontrast EPI sequence with routine MR imaging protocols. We used the Wilcoxon signed rank test and McNemar test to compare the 2 MR imaging protocols.

RESULTS

The multicontrast EPI sequence generally showed sufficient image quality of >2 points using a 4-point assessment scale. Regarding image quality and susceptibility artifacts, there was no significant difference between the multicontrast EPI sequence DWI and routine DWI (P > .05), attesting to noninferiority of the multicontrast EPI, whereas there were significant differences in the other 4 sequences between the 2 MR imaging protocols.

CONCLUSIONS

The multicontrast EPI sequence showed sufficient image quality for clinical use with a shorter scan time; however, it was limited by inferior image quality and frequent susceptibility artifacts compared with routine brain MR imaging. Therefore, the multicontrast EPI sequence cannot completely replace the routine MR imaging protocol at present; however, it may be a feasible option in specific clinical situations such as screening, time-critical diseases or for use with patients prone to motion.

High tuberculosis transmission rate in children with nursery exposure to undetected pulmonary tuberculosis

SETTING

Nursery for newborns in Busan, Republic of Korea.

OBJECTIVE

To evaluate tuberculosis (TB) transmission from a health care worker with active pulmonary TB to neonatal contacts.

DESIGN

For the first investigation, infants who had been in the nursery 3 months before the index patient was diagnosed with pulmonary TB were enrolled. After a child who had stayed in the nursery 10 months before the diagnosis of the index patient was diagnosed with tuberculous meningitis, a second contact investigation was conducted.

RESULTS

Respectively 315 and 1334 children participated in the first and second investigations. The mean age of the contacts was 66.3 days; the rate of latent tuberculous infection (LTBI) at the first investigation was 42.5% (134/315). Only one infant had an abnormal chest X-ray, and was thought to have pulmonary TB. In the second investigation, the mean age of the participants was 17.6 months. The proportion of children with LTBI was 18.7% (249/1334).

CONCLUSIONS

The LTBI rate in the present study was much higher than that estimated from other contact investigations. To minimise the risk of nosocomial TB transmission to neonates, screening and management of TB in health care workers should be strengthened.

Abstract P3-03-02: Redo sentinel lymph node biopsy for ipsilateral breast tumor recurrence after breast conserving surgery with negative sentinel nodes: A pooled analysis from a systematic review and two institutes

Background:Cases of redo sentinel lymph node biopsy (SLNB) are growing according to the increase of ipsilateral breast tumor recurrence (IBTR) after breast-conservative surgery (BCS). To evaluate a feasibility of redo SLNB in patients with IBTR after negative SLN, we conveyed a pooled analysis using data from a systematic review and two institutes.

Materials and methods:A systematic search of PubMed was conducted to identify data of patient level from publications evaluating redo SLNB for cases with IBTR. Eligible patients who underwent BCS and were confirmed as negative axilla after SLNB were identified. An identification rate (IR) and a false-negative rate (FNR) were calculated. To identify FNR, we only included cases with back-up axillary node dissection (ALND) from retrieved data.

Results:In a systematic review, a total of 197 peer-reviewed publications were retrieved, of which 19 papers included patients who met eligibility criteria. Data from 464 patients were collected. In two-institutes, 38 cases with same criteria were identified. A total of 502 patient's data were pooled. The IR of redo-SLNB was 71.7% (360/502) in pooled data. For the FNR, data from 147 patients with back-up ALND after SLNB was analyzed. The FNR and accuracy of redo-SLNB were 9.8% (5/51) and 97% (142/147).

Conclusions:We found that the IR and the FNR of redo SLNB were 71.7% and 9.8%, respectively. Redo SLNB is reliable procedure for axillary staging in patients with IBTR after negative SLNB.

Citation Format: Yoon C-i, Bae SJ, Choi JE, Cha CH, Park SE, Ahn SG, Jeong J. Redo sentinel lymph node biopsy for ipsilateral breast tumor recurrence after breast conserving surgery with negative sentinel nodes: A pooled analysis from a systematic review and two institutes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-02.

Analysis of Pre-transplant Resuscitation Factors Influencing Immediate Graft Function After Deceased Donor Kidney Transplantation

BACKGROUND

The management of a deceased donor in the intensive care unit before organ transplantation is important for the outcome of the recipient. Herein, we analyze the pre-transplant resuscitation factors managed before procurement that could influence graft function immediately after deceased-donor kidney transplantation (DDKT).

METHODS

A total of 271 DDKTs performed at Seoul St. Mary's Hospital, Korea, from January 2009 to March 2016 were reviewed. We divided the patients into a delayed graft function (DGF) group and a non-DGF group, and compared postoperative outcomes between the 2 groups. We also analyzed the predisposing factors of DGF using multivariate analysis.

RESULTS

A total of 36 cases developed DGF while 235 patients did not, and the demographic characteristics of the recipients in the two groups had no significant difference. Of the pre-transplant resuscitation factors, preoperative polyuria, the maximal levels of serum sodium and BUN, and transfer times were significantly higher in the DGF group (P < .001). In a multivariable analysis, preoperative polyuria (odds ratio 4.835, P = .036), elevated preoperative level of sodium (odds ratio 1.227, P = .001), and extended transfer times (odds ratio 1.001, P < .001) were the independent risk factors of the donor in pre-transplant resuscitation management associated with DGF.

CONCLUSIONS

Polyuria, high levels of sodium before procurement, and prolonged transfer times are independent risk factors for DGF after a DDKT. Active intervention and early implementation of the intensivist can help in managing these factors effectively and thus ultimately improve graft function.

Student performance in a flipped classroom dental anatomy course

PURPOSE

The purpose of this study was to assess dental student learning in a dental anatomy module between traditional lecture and flipped classroom cohorts.

METHODS

Two cohorts of predoctoral dental students (N = 70 within each cohort) participated in a dental anatomy module within an Introduction to the Dental Patient (IDP) course ([traditional/lecture cohort: academic year (AY) 2012, 2013] and [flipped classroom cohort: AY 2014, 2015]). For the dental anatomy module, both cohorts were evaluated on pre-clinical tooth waxing exercises immediately after each of five lectures and tooth identification after all lectures were given. Additionally, the cohorts' performance on the overall IDP course examination was compared.

RESULTS

The flipped classroom cohort had statistically significant higher waxing scores (dental anatomy module) than students in the traditional classroom. There was no statistically significant difference for tooth identification scores and the overall IDP course examination between the traditional vs flipped approach cohorts. This is due to the latter two assessments conducted at the end of the course gave all students enough time to review the lecture content prior to the assessment resulting in similar scores for both cohorts.

CONCLUSION

The flipped classroom cohort promoted students' individual learning and resulted in improved students' performance on immediate evaluation but not on the end of the course evaluation. Redesign of courses to include a new pedagogical approach should be carefully implemented and evaluated for student's educational success.

Pharmacokinetic comparison of a fixed-dose combination versus concomitant administration of fimasartan, amlodipine, and rosuvastatin using partial replicated design in healthy adult subjects

Objective

The aim of this study was to compare the pharmacokinetics (PK) and safety profiles of a fixed-dose combination (FDC) formulation of fimasartan, amlodipine, and rosuvastatin with the co-administration of the two products by using a replicated crossover study design in healthy male subjects.

Results

This was an open-label, randomized, three-sequence, three-period replicated crossover study in healthy male subjects. The replicated crossover design was done because of high coefficient of variation of PK parameter for fimasartan, that is, >30%. With a 14 days washout period, an FDC tablet containing 60 mg fimasartan, 10 mg amlodipine, and 20 mg rosuvastatin was administered only once, and separate formulations of fimasartan/amlodipine 60 mg/10 mg FDC tablet and 20 mg rosuvastatin tablet administered twice. Blood samples were collected up to 72 hours following drug administration. The plasma concentrations of fimasartan, amlodipine, and rosuvastatin were measured by liquid chromatography tandem mass spectrometry. Safety was assessed by evaluating vital signs, clinical laboratory parameters, physical examinations, and medical interviews.

Results

The geometric mean ratios and 90% confidence intervals (CIs) for the maximum plasma concentration (C_max) and area under the curve from time zero to the last measurable sampling time (AUC_t) were 1.0776 (0.9201-1.2622) and 0.9978 (0.9538-1.0439) for fimasartan, 1.0038 (0.9782-1.0301) and 1.0055 (0.9828-1.0288) for amlodipine, and 1.0006 (0.9290-1.0776) and 0.9986 (0.9532-1.0461) for rosuvastatin, respectively. A total of 22 adverse events (AEs) were reported by 60 subjects; there were no significant differences in the incidence of AEs between the two groups.

Conclusion

The 90% CI of the C_max of fimasartan was within the widened acceptance limit, ln(0.6984)-ln(1.4319). The 90% CIs of the other PK parameters for drugs were between ln(0.8) and ln(1.25). These results suggest that the FDC formulation is pharmacokinetically bioequivalent and has a similar safety profile, to the co-administration of its three constituent drugs.

Comparative pharmacokinetics of a fixed-dose combination vs concomitant administration of telmisartan and S-amlodipine in healthy adult volunteers

Objective

This study compared the pharmacokinetic (PK) and safety profiles of a fixed-dose combination (FDC) formulation of telmisartan and S-amlodipine with those of concomitant administration of the two drugs.

Materials and methods

This was an open-label, randomized, crossover study in healthy male Koreans. All subjects were administered an FDC tablet containing 40 mg telmisartan and 5 mg S-amlodipine and were also coadministered the same dose of both drugs given separately. The crossover study design included a 14-day washout period between the two treatments. Blood samples were collected up to 168 h following drug administration. The plasma concentrations of telmisartan and S-amlodipine were determined by liquid chromatography tandem mass spectrometry. PK parameters and plasma concentration–time curves were compared. Safety was assessed by measuring vital signs, clinical laboratory tests, physical examinations, and patient interviews.

Results

The geometric mean ratios and 90% CIs for the maximum plasma concentration (C_max) and area under the curve from time zero to the last sampling time (AUC_t) were 0.8782 (0.8167–0.9444) and 0.9662 (0.9210–1.0136) for telmisartan and 1.0069 (0.9723–1.0427) and 1.0324 (0.9969–1.0690) for S-amlodipine, respectively. A total of 36 adverse events (AEs) were reported by 23 subjects, but no statistical differences were observed between the two treatments. The most frequently reported AE was a mild-to-moderate headache that was generally self-limiting.

Conclusion

For both telmisartan and S-amlodipine, the C_max and AUC_t 90% CIs were between ln (0.8) and ln (1.25). These results suggest that the FDC formulation is pharmacokinetically bioequivalent and has a similar safety profile to the coadministration of these drugs.

Pharmacokinetics of atorvastatin and sustained-release metformin fixed-dose combination tablets: two randomized, open-label, 2-way crossover studies in healthy male subjects under fed conditions

Two separate studies were conducted to establish bioequivalence (BE) for two doses of atorvastatin/metformin sustained-release (SR) fixed dose combination (FDC) versus the same dosage of the individual component (IC) tablets in healthy male subjects under fed conditions (study 1, BE of atorvastatin/metformin SR 20/500 mg FDC; study 2, BE of atorvastatin/metformin SR 20/750 mg FDC). Each study was a randomized, open-label, single oral dose, two-way crossover design. Serial blood samples were collected pre-dose and up to 36 hours post-dose for atorvastatin and 24 hours for metformin. Plasma concentrations of atorvastatin, 2-OH atorvastatin and metformin were analyzed using a validated liquid chromatography tandem mass-spectrometry. A non-compartmental analysis was used to calculate pharmacokinetic (PK) variables and analysis of variance was performed on the lognormal-transformed PK variables. A total of 75 subjects completed the study 1 (36 subjects) and study 2 (39 subjects). The 90% confidence intervals for the adjusted geometric mean ratio of Cmax and the AUC0-t were within the predefined 0.80 to 1.25 range. The number of subjects reporting at least one adverse event following FDC treatments was comparable to that following IC treatments. The two treatments were well tolerated. Therefore, atorvastatin/metformin SR 20/500 mg and 20/750 mg FDC tablets are expected to be used as alternatives to IC tablets to decrease the pill burden and increase patient compliance.

Sun Exposure, Tanning Beds, and Herbs That Cure: An Examination of Skin Cancer on Pinterest

Skin cancer is the most common cancer affecting the U.S.

POPULATION

Pinterest.com, a virtual bookmarking social media site, has the potential to disseminate skin cancer-related information among young women, the group with the fastest increase in skin cancer diagnosis. This article presents a quantitative content analysis of pins about skin cancer on Pinterest guided by agenda-setting theory and the health belief model. Overall, sun exposure and tanning beds were most frequently discussed as the causes of skin cancer, and alternative therapies such as herbal medicine were discussed more than traditional biomedical treatment or prevention. Highly repinned pins tend to include more information than regular pins. Different types of skin cancer (melanoma, squamous-cell carcinoma, and basal-cell carcinoma) received the same amount of coverage; however, pins about nonmelanoma skin cancer (such as squamous-cell carcinoma and basal-cell carcinoma) were often information-poor. They were less likely to include information on the causes, prevention, and the biomedical treatment of skin cancer and were less likely to include health belief constructs associated with the promotion of skin cancer prevention and treatment.

Droplet evaporation characteristics on transparent heaters with different wettabilities

Evaporation characteristics of a droplet on the surface of a transparent heater depend on the surface wettability.

Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)

STUDY DESIGN

Validation study.

OBJECTIVES

To describe the development and validation of a computerized application of the international standards for neurological classification of spinal cord injury (ISNCSCI).

SETTING

Data from acute and rehabilitation care.

METHODS

The Rick Hansen Institute-ISNCSCI Algorithm (RHI-ISNCSCI Algorithm) was developed based on the 2011 version of the ISNCSCI and the 2013 version of the worksheet. International experts developed the design and logic with a focus on usability and features to standardize the correct classification of challenging cases. A five-phased process was used to develop and validate the algorithm. Discrepancies between the clinician-derived and algorithm-calculated results were reconciled.

RESULTS

Phase one of the validation used 48 cases to develop the logic. Phase three used these and 15 additional cases for further logic development to classify cases with 'Not testable' values. For logic testing in phases two and four, 351 and 1998 cases from the Rick Hansen SCI Registry (RHSCIR), respectively, were used. Of 23 and 286 discrepant cases identified in phases two and four, 2 and 6 cases resulted in changes to the algorithm. Cross-validation of the algorithm in phase five using 108 new RHSCIR cases did not identify the need for any further changes, as all discrepancies were due to clinician errors. The web-based application and the algorithm code are freely available at www.isncscialgorithm.com.

CONCLUSION

The RHI-ISNCSCI Algorithm provides a standardized method to accurately derive the level and severity of SCI from the raw data of the ISNCSCI examination. The web interface assists in maximizing usability while minimizing the impact of human error in classifying SCI.

SPONSORSHIP

This study is sponsored by the Rick Hansen Institute and supported by funding from Health Canada and Western Economic Diversification Canada.

Knowledge translation and implementation in spinal cord injury: a systematic review

OBJECTIVE

To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes.

METHODS

MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation.

RESULTS

A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively.

CONCLUSION

The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.

Cortical thickness and hippocampal shape in pure vascular mild cognitive impairment and dementia of subcortical type

BACKGROUND AND PURPOSE

The progression pattern of brain structural changes in patients with isolated cerebrovascular disease (CVD) remains unclear. To investigate the role of isolated CVD in cognitive impairment patients, patterns of cortical thinning and hippocampal atrophy in pure subcortical vascular mild cognitive impairment (svMCI) and pure subcortical vascular dementia (SVaD) patients were characterized.

METHODS

Forty-five patients with svMCI and 46 patients with SVaD who were negative on Pittsburgh compound B (PiB) positron emission tomography imaging and 75 individuals with normal cognition (NC) were recruited.

RESULTS

Compared with NC, patients with PiB(-) svMCI exhibited frontal, language and retrieval type memory dysfunctions, which in patients with PiB(-) SVaD were further impaired and accompanied by visuospatial and recognition memory dysfunctions. Compared with NC, patients with PiB(-) svMCI exhibited cortical thinning in the frontal, perisylvian, basal temporal and posterior cingulate regions. This atrophy was more prominent and extended further toward the lateral parietal and medial temporal regions in patients with PiB(-) SVaD. Compared with NC subjects, patients with PiB(-) svMCI exhibited hippocampal shape deformities in the lateral body, whilst patients with PiB(-) SVaD exhibited additional deformities within the lateral head and inferior body.

CONCLUSIONS

Our findings suggest that patients with CVD in the absence of Alzheimer's disease pathology can be demented, showing cognitive impairment in multiple domains, which is consistent with the topography of cortical thinning and hippocampal shape deformity.

Fabrication of ordered bulk heterojunction organic photovoltaic cells using nanopatterning and electrohydrodynamic spray deposition methods

Organic photovoltaic cells with an ordered heterojunction (OHJ) active layer are expected to show increased performance. In the study described here, OHJ cells were fabricated using a combination of nanoimprinting and electrohydrodynamic (EHD) spray deposition methods. After an electron donor material was nanoimprinted with a PDMS stamp (valley width: 230 nm, period: 590 nm) duplicated from a Si nanomold, an electron acceptor material was deposited onto the nanoimprinted donor layer using an EHD spray deposition method. The donor-acceptor interface layer was observed by obtaining cross-sectional images with a focused ion beam (FIB) microscope. The photocurrent generation performance of the OHJ cells was evaluated with the current density-voltage curve under air mass (AM) 1.5 conditions. It was found that the surface morphology of the electron acceptor layer affected the current and voltage outputs of the photovoltaic cells. When an electron acceptor layer with a smooth thin (250 nm above the valley of the electron donor layer) surface morphology was obtained, power conversion efficiency was as high as 0.55%. The electrohydrodynamic spray deposition method used to produce OHJ photovoltaic cells provides a means for the adoption of large area, high throughput processes.

Increased B-type natriuretic peptide during liver transplantation: relationship to invasively measured hemodynamic parameters

BACKGROUND

The role of B-type natriuretic peptide (BNP) concentration in predicting cardiac dysfunction has been extensively investigated in many clinical conditions. Little is known, however, about its relationships with hemodynamic parameters from right heart catheterization in patients undergoing liver transplant surgery.

METHODS

We retrospectively evaluated 525 patients who underwent liver transplantation. Hemodynamic variables from a Swan-Ganz catheter and BNP concentrations were measured 1 hour after induction of general anesthesia. Patients were stratified by quintiles of BNP concentrations. Univariate and multivariate logistic regression analysis were used to identify hemodynamic parameters associated with BNP ≥ 135 pg/mL, a cutoff point for the 5th quintile.

RESULTS

Univariate analysis showed that factors significantly associated with BNP ≥ 135 pg/mL included model for end-stage liver disease (MELD) score, diastolic blood pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), cardiac index, right ventricular end-diastolic volume index (RVEDVI), systemic vascular resistance index, pulmonary vascular resistance index (PVRI), and right ventricular stroke work index. Multivariate analysis revealed that MELD score (odds ratio [OR] = 1.059, P < .001), PCWP (OR = 1.116, P = .026), RVEDVI (OR = 1.010, P = .009), and PVRI (OR = 1.009, P = .002) were independent determinants of BNP ≥ 135 pg/mL.

CONCLUSIONS

Severity of liver disease, preload dependent hemodynamic parameters, and pulmonary vascular resistance were found to be significantly associated with increased BNP concentration, reinforcing the utility of BNP as a marker of cardiac strain and ventricular volume overload in liver failure patients undergoing liver transplant surgery.

Serum 1,5-anhydroglucitol is associated with diabetic retinopathy in Type 2 diabetes

AIMS

To determine whether there is a relationship between 1,5-anhydroglucitol (1,5-AG), a marker of postprandial hyperglycaemia and glycaemic variability, and the presence of diabetic retinopathy and albuminuria in patients with Type 2 diabetes.

METHODS

Five hundred and sixty-seven patients with Type 2 diabetes (serum creatinine < 133 μmol/l), who were enrolled in the Seoul Metro-City Diabetes Prevention Program (SMC-DPP), were cross-sectionally assessed by multivariate logistic regression analysis.

RESULTS

After controlling for age, sex, binary HbA(1c) levels, duration of diabetes, triglyceride, systolic blood pressure, smoking status, history of hypertension and dyslipidaemia, and the use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker medication, the odds ratios (95% CI) of diabetic retinopathy were 2.86 (1.12-7.25) for the first (lowest) quartile of 1,5-anhydroglucitol, 2.87 (1.25-6.61) for the second quartile and 0.88 (0.35-2.22) for the third quartile compared with the fourth quartile (P for trend = 0.010). Conversely, the associations between 1,5-anhydroglucitol and clinical albuminuria were non-significant after adjustment. Subjects with low 1,5-anhydroglucitol (< 10.0 μg/ml) were more likely to experience diabetic retinopathy than those with high 1,5-anhydroglucitol (≥ 10.0 μg/ml) under moderate glucose control (HbA(1c) < 8%, 64 mmol/mol) and there were no significant differences in the prevalence of diabetic retinopathy between the subgroup with HbA(1c) < 8% (64 mmol/mol) and low 1,5-anhydroglucitol and the subgroup with HbA(1c) ≥ 8% (64 mmol/mol).

CONCLUSIONS

1,5-Anhydroglucitol levels show close associations with diabetic retinopathy, especially among patients under moderate glucose control, but not with albuminuria. These results suggest that 1,5-anhydroglucitol might be a complementary marker for targeting higher risk group.

Effects of clopidogrel and clarithromycin on the disposition of sibutramine and its active metabolites M1 and M2 in relation to CYP2B6*6 polymorphism

Plasma concentrations of sibutramine and its two active metabolites after single oral dose of sibutramine were determined in Korean healthy male subjects with different CYP2B6 genotypes (CYP2B6*1/*1, *1/*6 and *6/*6), either alone or after four-day pretreatment with clopidogrel or clarithromycin. The pretreatment with clopidogrel and clarithromycin raised the mean area under the concentration-time curve (AUC) of sibutramine by 163% and 255%, respectively. Co-administration of clarithromycin, combined with CYP2B6*6/*6 genotype, led to highest concentration of sibutramine. The molar sum AUC (M1 + M2) was raised by 35% in the clopidogrel phase but not significantly affected by clarithromycin or CYP2B6 genotype. The CYP2B6*6/*6 subjects in the clopidogrel phase showed the highest molar AUC (M1 + M2) among three genotype groups throughout the three phases. The exposure of sibutramine and its metabolites seemed to be associated with the CYP2B6 genotype. The treatment of clopidogrel significantly altered the disposition of active metabolites as well as sibutramine, but clarithromycin only affects the disposition of sibutramine. These results suggest that the perturbation of CYP2B6 activity may contribute to the inter-individual variation of sibutramine drug responses although the clinical relevance is remained to be established.

The role of serum adipocyte fatty acid-binding protein on the development of metabolic syndrome is independent of pro-inflammatory cytokines

BACKGROUND AND AIM

Adipocyte fatty acid-binding protein (FABP4) is abundantly expressed in adipocytes and plays a role in glucose homeostasis. We analysed the relationship between serum FABP4 levels and the progression of metabolic syndrome in healthy adults.

METHODS AND RESULTS

A total of 465 subjects were selected from participants in a medical check-up programme at a Health Promotion Center. Baseline serum FABP4 levels were measured, and the subjects were evaluated for the presence of metabolic syndrome (MetS) according to the recommendations of the American Heart Association/National Heart, Lung, and Blood Institute. The subjects were re-evaluated 4 years later. Baseline FABP4 concentrations were significantly higher in subjects with MetS than in those without MetS (P<0.001). At the 4-year follow-up, subjects in the highest FABP4 tertile at baseline exhibited higher values for body mass index, fat mass and percent body fat, as well as blood pressure, fasting glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, insulin, homeostasis model assessment of insulin resistance, monocyte chemoattractant protein-1 and tumor necrosis factor-α levels (all P<0.05). The subjects with higher FABP4 levels had lower HDL-cholesterol concentrations (P<0.05). After adjustment for age, sex, change in percent body fat and baseline values for other metabolic and inflammatory parameters, FABP4 levels at baseline were shown to be strongly associated with the development of MetS by year 4 (odds ratio (OR), 5.75; 95% confidence interval (CI), 2.71-12.23 for highest tertile vs. lowest tertile, P<0.001)

CONCLUSION

Baseline serum FABP4 levels appear to be a significant predictor for the future development of MetS, independent of pro-inflammatory cytokines.

Kaempferol acts through mitogen-activated protein kinases and protein kinase B/AKT to elicit protection in a model of neuroinflammation in BV2 microglial cells

BACKGROUND AND PURPOSE

Kaempferol, a dietary flavonoid and phyto-oestrogen, is known to have anti-inflammatory properties. Microglial activation has been implicated in various neurodegenerative diseases. Anti-inflammatory effects of kaempferol and the underlying mechanisms were investigated by using LPS-stimulated microglial BV2 cells.

EXPERIMENTAL APPROACH

Cell viability was measured using MTT and neutral red assays. elisa, Western blot, immunocytochemistry and electrophoretic mobility-shift assay were used to analyse NO, PGE(2) , TNF-α and IL-1β production, inducible NOS (iNOS), COX-2 expression and the involvement of signalling pathways such as toll-like receptor-4 (TLR4), MAPK cascades, PKB (AKT) and NF-κB. Accumulation of reaction oxygen species (ROS) was measured by nitroblue tetrazolium and 2'7'-dichlorofluorescein diacetate assay. Matrix metalloproteinase activity was investigated by zymography and immunoblot assay. Phagocytotic activity was assessed by use of latex beads.

KEY RESULTS

Kaempferol significantly attenuated LPS-induced NO, PGE(2) , TNF-α, IL-1β and ROS production and phagocytosis in a concentration-dependent manner. Kaempferol suppressed the expression of iNOS, COX-2, MMP-3 and blocked the TLR4 activation. Moreover, kaempferol inhibited LPS-induced NF-κB activation and p38 MAPK, JNK and AKT phosphorylation.

CONCLUSION AND IMPLICATIONS

Kaempferol was able to reduce LPS-induced inflammatory mediators through the down-regulation of TLR4, NF-κB, p38 MAPK, JNK and AKT suggesting that kaempferol has therapeutic potential for the treatment of neuroinflammatory diseases.

Ancient schwannoma of the thigh mimicking a malignant tumour: a report of two cases, with emphasis on MRI findings

Ancient schwannomas are rare, encapsulated tumours of long duration and are benign in nature. The tumour is solitary and may grow to a large size before detection of notable degenerative changes. The term "ancient schwannoma" is used to describe a tumour that has undergone such changes, typified by relative loss of Antoni type A tissue, perivascular hyalinisation, calcification, cystic necrosis, haemorrhage and the presence of degenerative nuclei that may be misinterpreted as sarcomatous pleomorphism. We report two cases of ancient schwannoma in the thigh mimicking malignancies. Identifying the fibrous capsule of the mass and a split fat sign using MRI is important for differentiating ancient schwannoma from other malignant tumours.

Predicting dental school performance based on prior dental experience and exposure

PURPOSE

The purpose of this study was to evaluate whether the variables of students with prior dental assisting experience and students with a parent who is a dentist can be used as predictors of students' pre-clinical and clinical course performance in dental school.

MATERIALS AND METHODS

The study population consisted of a cohort of 159 students in the Harvard School of Dental Medicine (HSDM) DMD graduation classes of 2001-2005. Data were collected via self-report using students' applications for admission to the HSDM DMD programme on which students provided information regarding whether they had prior dental assisting experience, including the type and duration of the experience and whether one or both of their parents were dentists. Data on the students' undergraduate science grade point average, Dental Admission Test academic average, Perceptual Ability Test (PAT) score, NBDE Part I and HSDM course grades (three pre-clinical and five clinical assessment categories) were collected from the Office of the Registrar. The pre-clinical categories included the first Oral Comprehensive Exam and the first two classes of the pre-clinical portion of the dental school, Treatment of Active Disease (TxAD) and Restorative Treatment (RTx). The clinical categories included the second Oral Comprehensive Exam and the cumulative grades received for the clinical procedures performed during the third and fourth years in the fields of Endodontics, Operative Dentistry, Periodontics and Prosthodontics. Descriptive and bivariate statistical analyses were performed and included in a multiple logistic regression model.

RESULTS

The results revealed that for the variable of prior dental-assisting experience, no statistically significant differences were noted in the pre-clinical and clinical assessment categories. However, students who had any amount of assisting experience were 2.2 times more likely to earn a grade of honours in TxAD compared with students who did not have assisting experience (P = 0.05). Students with a parent who was a dentist performed better only in Operative Dentistry clinical assessment compared with students without a dentist parent (P < 0.05).

CONCLUSIONS

Information on prior dental-assisting experience and having a parent who is a dentist have minimal merits for use as predictive agents based on these findings. Dental school admissions committees should continue to review a full spectrum of variables and ensure an applicant's true interest and motivation to pursue a career in dentistry.

Estimating medical expenditure associated with osteoporotic hip fracture in elderly Korean women based on the National Health Insurance Claims Database 2002-2004

OBJECTIVES

To estimate the medical expenditure associated with osteoporotic hip fracture in elderly Korean women from insurer's perspective.

METHODS

All claim records of women aged > or =50 years and diagnosed with hip fracture from 2002 to 2004 were obtained from the Korean National Health Insurance. The first 6 months were considered a "window period" during which patients with fractures were defined as incident cases if their initial records of visit or admission were observed after June 30, 2002. We included only those with claim records showing diagnosis of osteoporosis or prescription for antiosteoporosis drugs. For each patient, we calculated the cumulative claims amount related to the initial and follow-up treatment for 2 years after fracture.

RESULTS

A total of 22,247 patients were identified during 2.5 years. During the first year of fracture, an average of 3.28 visits and 0.97 admissions were recorded; during the second year, 0.35 visits and 0.02 admissions were recorded. The 2-year cost per patient was KRW3,175,467, 97.4% of which was incurred during first year.

CONCLUSION

Exploring the economic burden of osteoporotic hip fracture in the elderly women is expected to motivate policymakers and clinicians to adopt effective treatment options for the disease prevention and expenditure control.

Innervated myotendinous cylinders alterations in human extraocular muscles in patients with strabismus

Purpose

To analyze innervated myotendinous cylinders (IMCs) in the extraocular muscles (EOMs) of normal subjects and strabismic patients.

Methods

The rectus muscles of 37 subjects were analyzed. Distal myotendinous specimens were obtained from 3 normal subjects, 20 patients with acquired strabismus, 11 with infantile strabismus, and from 3 with congenital nystagmus, and were studied by using light microscopy. Some specimens (6 rectus muscles) were also examined by transmission electron microscopy.

Results

IMCs were found in the distal myotendinous regions of EOMs. The IMCs of patients with acquired strabismus showed no significant morphological alterations. However, significant IMCs alterations were observed at the distal myotendinous junction of patients with congenital strabismus and congenital nystagmus.

Conclusions

This study supports the notion that IMCs in human EOMs function mainly as proprioceptors, along with effector properties, and a disturbance of ocular proprioceptors plays an important role in the pathogenesis of oculomotor disorder. We suggest that a proprioceptive feedback system should be stimulated and calibrated early in life for the development of binocular vision.

Effect of ABCA1 variant on atherogenic dyslipidaemia in patients with Type 2 diabetes treated with rosiglitazone

AIMS

To investigate the effect of two common ATP-binding cassette transporter 1 (ABCA1) polymorphisms (rs4149263 and rs2020927) on atherogenic dyslipidaemia in Korean Type 2 diabetic patients who were treated with rosiglitazone.

PATIENTS AND METHODS

Two hundred and fifty-six patients with Type 2 diabetes who had never previously received peroxisome proliferator-activated receptor gamma (PPAR-gamma) agonists or lipid-lowering treatment were treated with 4 mg of rosiglitazone daily for 12 weeks without any adjustment to their glucose-lowering regimen. The primary outcome was the change in atherogenic index of plasma (AIP), calculated as log [triglyceride (mmol/l)/high-density lipoprotein cholesterol (mmol/l)], before and after rosiglitazone treatment. The effect of rosiglitazone on the change in AIP was compared across the ABCA1 single nucleotide polymorphisms (SNPs) rs41429263 and rs2020927.

RESULTS

Before adjustment, the change in AIP at 12 weeks was significantly different across the rs4149263 genotypes [median (interquartile range): -0.05 (-0.21, 0.09) for TT; 0.02 (-0.09, 0.17) for TC; and 0.11 (0.03, 0.25) for CC; P = 0.003], but not across the rs2020927 [-0.04 (-0.18, 0.10) for TT; 0.03 (-0.17, 0.15) for TC; and -0.03 (-0.13, 0.10) for CC; P = 0.401]. After controlling for age, gender and duration of diabetes, the presence of the C-allele was significantly associated with an increase in AIP by 0.13 [95% confidence interval (CI), 0.04-0.21; P = 0.003]. This association did not change significantly when body mass index and pretreatment metabolic parameters were additionally controlled for (the change in AIP: 0.14; 95% CI, 0.04-0.24; P = 0.007).

CONCLUSIONS

The ABCA1 SNP rs4149263 may be associated with the change in atherogenic lipid profile in Type 2 diabetes treated with rosiglitazone.

[Estimating the economic burden of osteoporotic vertebral fracture among elderly Korean women]

OBJECTIVES

To estimate the economic burden of osteoporotic vertebral fracture (VF) from a societal perspective.

METHODS

From 2002 to 2004, we identified all National Health Insurance claims records for women >or= 50 years old with a diagnosis of VF. The first 6-months was defined as a "clearance period," Ysuch that patients were considered as incident cases if their first claim of fracture was recorded after June 30, 2002. We only included patients with >or= one claim of a diagnosis of, or prescription for, osteoporosis over 3 years. For each patient, we cumulated the claims amount for the first visit and for the follow-up treatments for 1 year. The hospital charge data from 4 hospitals were investigated to measure the proportion of the non-covered services. Face-to-face interviews were conducted with 106 patients from the 4 study sites to measure the out-of-pocket spending outside of hospitals.

RESULTS

During 2.5 years, 131,453 VF patients were identified. The patients had an average of 3.38 visits, 0.40 admissions and 6.36 inpatient days. The per capita cost was 1,909,690 Won: 71.5% for direct medical costs, 20.6% for direct non-medical costs and 7.9% for indirect costs. The per capita cost increased with increasing age: 1,848,078 Won for those aged 50-64, 2,084,846 Won for 65-74, 2,129,530 Won for 75-84 and 2,121,492 Won for those above 84.

CONCLUSIONS

Exploring the economic burden of osteoporotic VF is expected to motivate to adopt effective treatment options for osteoporosis in order to prevent the incidence of fracture and the consequent costs.

Direct comparison of optical frequency combs using a comb-injection-lock technique

This paper demonstrates a direct comparison of optical frequency combs (OFCs) with different repetition rates without a stable intermediate laser using a single-mode comb-injection-lock technique. Two OFCs based on Ti:Sapphire mode-locked lasers were compared utilizing a single-mode diode laser for the selection and the amplification of one mode of an OFC by comb-injection, which makes the direct comb comparison possible. The frequencies of the two combs were found to agree within 0.019 Hz at 352 THz with the uncertainty of 0.25 Hz (7.1 x 10(-16) ). This is one of the best results among the comparisons of combs referenced to a microwave frequency. This technique simplifies the comb comparison utilities and can be applied even when repetition rates differ.

Optical phenomenon of peri-implant soft tissue. Part II. preferred implant neck color to improve soft tissue esthetics

OBJECTIVES

The purpose of this study was to investigate an optical solution to eliminate the undesirable shine-through effect of implants on peri-implant mucosa by selecting an optimized implant neck color based on an objective and quantifiable method.

MATERIAL AND METHODS

The optical effect of color strips on 15 peri-implant mucosal sites of 14 patients with Straumann single-tooth implant replacements in the maxillary anterior region was analyzed. The color differences between the peri-implant mucosa with insertion of each of eight different color strips (white, black, light pink, pink, light orange, orange, gold, violet) and the gingiva of an adjacent or contralateral tooth without any color strips were compared for the selection of optimal color of implant neck. Spectrophotometric color measurements were performed to compare the color difference index (DeltaE) and color coordinates (DeltaL*, Deltaa*, Deltab* and DeltaC*).

RESULTS

The colors of the peri-implant mucosa with color strips and the gingiva of natural tooth demonstrated that the test site soft tissue with color strips of light pink, pink, light orange and orange showed a significantly smaller DeltaE value (P<0.05). Moreover, light pink exhibited the lowest mean DeltaE value of 2.6+/-0.6, indicating a clinically indistinguishable color difference.

CONCLUSIONS

The results suggest that it is possible to improve gingival esthetics by coloring the implant neck, most effectively with light pink, to mask the impact of the underlying titanium implant. The use of implants with optimized neck colors to correct an esthetic deficiency may be a feasible approach to establish improved peri-implant soft tissue esthetics.

Chondrocyte apoptosis in the regenerated articular cartilage after allogenic chondrocyte transplantation in the rabbit knee

We attempted to repair full-thickness defects in the articular cartilage of the trochlear groove of the femur in 30 rabbit knee joints using allogenic cultured chondrocytes embedded in a collagen gel. The repaired tissues were examined at 2, 4, 8, 12 and 24 weeks after operation using histological and histochemical methods. The articular defect filling index measurement was derived from safranin-O stained sections. Apoptotic cellular fractions were derived from analysis of apoptosis in situ using TUNEL staining, and was confirmed using caspase-3 staining along with quantification of the total cellularity. The mean articular defect filling index decreased with time. After 24 weeks it was 0.7 (sd 0.10), which was significantly lower than the measurements obtained earlier (p < 0.01). The highest mean percentage of apoptotic cells were observed at 12 weeks, although the total cellularity decreased with time. Because apoptotic cell death may play a role in delamination after chondrocyte transplantation, anti-apoptotic gene therapy may protect transplanted chondrocytes from apoptosis.

Coherent multi-frequency optical source generation using a femto-second laser and its application for coherent population trapping

We present a coherent multi-frequency source generated from a mode-locked femto-second laser. The key concept for the coherent multi-frequency source generation is using the mode-locked femto-second laser as many continuous wave (CW) optical sources. We simultaneously selected and amplified the desired modes of the optical frequency comb using femto-second laser injection-locking (FSLIL). Using two coherent sources generated by the mode-locked femto-second laser, we have demonstrated a coherent spectroscopy in a Lambda-type system of the Cs D2 line. The proposed coherent multi-frequency source generation technique will be a useful technique for optical frequency standards based on multi-photon schemes.

Sweep optical frequency synthesizer with a distributed-Bragg-reflector laser injection locked by a single component of an optical frequency comb

A sweep optical frequency synthesizer is demonstrated by using a frequency-stabilized optical frequency comb and injection-locked distributed-Bragg-reflector (DBR) laser diode. The injection-locked DBR laser acts as a single-frequency filter and, simultaneously, a high-gain amplifier of the optical frequency comb. The frequency instability of the heterodyne beat signal between two independently injection-locked DBR lasers is measured to be 2.3 x 10(-16) at 1 s averaging time. The output frequency of the sweep optical frequency synthesizer can be precisely tuned over 1 GHz, and a saturated absorption spectrum of the Cs D2 line at 852 nm is recorded by the injected DBR laser.

The effect of tibiofemoral joint kinematics on patellofemoral contact pressures under simulated muscle loads

Altered patellofemoral joint contact pressures are thought to contribute to patellofemoral joint symptoms. However, little is known about the relationship between tibiofemoral joint kinematics and patellofemoral joint contact pressures. The objective of this paper was to investigate the effect of tibiofemoral joint kinematics on patellofemoral joint pressures using an established in vitro robotic testing experimental setup. Eight cadaveric knee specimens were tested at 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 120 degrees of flexion under an isolated quadriceps load of 400 N and a combined quadriceps/hamstrings load of 400 N/200 N. Tibiofemoral joint kinematics were measured by the robot and contact pressures by a TekScan pressure sensor. The isolated quadriceps loading caused anterior translation and internal rotation of the tibia up to 60 degrees of flexion and posterior translation and external rotation of the tibia beyond 60 degrees. The co-contraction of the hamstring muscles caused a posterior translation and external rotation of the tibia relative to the motion of the tibia under the quadriceps load. Correspondingly, the contact pressures were elevated significantly at all flexion angles. For example, at 60 degrees of flexion, the hamstrings co-contraction increased the posterior tibial translation by approximately 2.8 mm and external tibial rotation by approximately 3.6 degrees. The peak contact pressure increased from 1.4+/-0.8 to 1.7+/-1.0 MPa, a 15% increase. The elevated contact pressures after hamstrings co-contraction indicates an intrinsic relation between the tibiofemoral joint kinematics and the patellofemoral joint biomechanics. An increase in posterior tibial translation and external rotation is accompanied by an increase in contact pressure in the patellofemoral joint. These results imply that excessive strength conditioning with the hamstring muscles might not be beneficial to the patellofemoral joint. Knee pathology that causes an increase in tibial posterior translation and external rotation might contribute to degeneration of the patellofemoral joint. These results suggest that conservative treatment of posterior cruciate ligament injury should be reconsidered.