Three-dimensional soft tissue changes after reduction malarplasty in female patients.

The aim of this study was to determine the three-dimensional soft tissue changes after reduction malarplasty. Soft tissue changes relative to the amount of movement of the zygomatic bone were studied. Pre- and postoperative cone beam computed tomography images of 21 female patients were superimposed. The anterior-most point of the body osteotomy (point A), arch osteotomy site (point D), and points dividing line A-D into thirds (points B and C) were marked on lateral view images. The vertical distances from the midsagittal line to the centre of the zygomatic bone and the outer prominence of the soft tissue were measured on the coronal view of each image. The proportion of the change in soft tissue to that of the bone before and after surgery was calculated for each point. The relationship between body mass index and the soft tissue change ratio, and the differences in soft tissue changes at each point were analysed. Mean soft tissue changes for points A, B, C, and D were 53.43%, 66.66%, 63.67%, and 57.23%, respectively. The amount of soft tissue change at point B was greater than that at points A and D, which were osteotomy sites. There was no statistical correlation between body mass index and the soft tissue change ratio at each point.

Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias.

BACKGROUND: Delayed gastric emptying can complicate surgery for hiatus hernia. The aim of this study was to quantify its incidence following laparoscopic repair of very large hiatus hernias, identify key risk factors for its occurrence and determine its impact on clinical outcomes. METHODS: Data collected from a randomized trial of patients who underwent laparoscopic mesh versus sutured repair of very large hiatus hernias (more than 50 per cent of stomach in chest) were analysed retrospectively. Delayed gastric emptying was defined as endoscopic evidence of solid food in the stomach after fasting for 6 h at 6 months after surgery. RESULTS: Delayed gastric emptying occurred in 19 of 102 patients (18·6 per cent). In univariable analysis, type 2 paraoesophageal hernia (relative risk (RR) 3·15, 95 per cent c.i. 1·41 to 7·06), concurrent anterior and posterior hiatal repair (RR 2·66, 1·14 to 6·18), hernia sac excision (RR 4·85, 1·65 to 14·24), 270°/360° fundoplication (RR 3·64, 1·72 to 7·68), division of short gastric vessels (RR 6·82, 2·12 to 21·90) and revisional surgery (RR 3·69, 1·73 to 7·87) correlated with delayed gastric emptying. In multivariable analysis, division of short gastric vessels (RR 6·27, 1·85 to 21·26) and revisional surgery (RR 6·19, 1·32 to 28·96) were independently associated with delayed gastric emptying. Delayed gastric emptying correlated with adverse gastrointestinal symptomatology, including higher rates of bloating, nausea, vomiting and anorexia, as well as reduced patient satisfaction with the operation and recovery. CONCLUSION: Delayed gastric emptying following large hiatus hernia repair is common and associated with adverse symptoms and reduced patient satisfaction. Division of short gastric vessels and revisional surgery were independently associated with its occurrence.

Mandibular stability using sliding or conventional four-hole plates for fixation after bilateral sagittal split ramus osteotomy for mandibular setback.

Our aim was to compare the postoperative stability of the mandible when two different fixation methods had been used after bilateral sagittal split ramus osteotomy (BSSRO) for mandibular setback. The study included 23 patients who had two-jaw BSSRO mandibular setback at the Department of Oromaxillofacial Surgery, Korea University Guro Hospital, between January 2011 and June 2014. The first group (four-hole (control) group, n=13) comprised patients whose bony segments were fixed with conventional four-hole plates, and the second (sliding plate (experimental) group, n=10) included patients whose bone segments were fixed with sliding plates. Lateral cephalograms were taken and analysed at three time points: preoperatively (T1), and one week (T2), and 1year (T3) postoperatively. The Mann-Whitney U test was used to compare the postoperative stability of the mandible in each group. There were no significant differences between the two groups in changes in the horizontal and vertical positions of point B and pogonion postoperatively, nor were there any significant differences between them in ramal inclination and inclination of the SN plane with point B at the given time points (p=>0.05 in surgical changes in the mandible immediately after surgery and 0.397, 0.616, 0.082, 0.951, 0.901, 0.476 in postoperative changes in the mandible 1 week to 1 year after surgery). Like the conventional four-hole plate, the sliding plate can also be used to achieve stability in the fixation of mandibular bone segments after BSSRO.

Feasibility of high-pitch dual-source low-dose chest CT: Reduction of radiation and cardiac artifacts.

PURPOSE: To compare the radiation dose and image quality, focused mainly on cardiac pulsation artifact, between high-pitch low-dose chest computed tomography (HP-LDCT) and standard low-dose chest CT (LDCT). PATIENTS AND METHODS: One hundred patients underwent HP-LDCT (50 patients) or LDCT (50 patients). Scan parameters were the same except for the pitch and gantry rotation time: 3.0 vs. 1.2 and 0.28s vs. 0.5s, respectively. Objective image noise at five regions and subjective image quality, such as noise, artifacts, cardiac pulsation artifacts, and overall diagnostic acceptability, were evaluated using a five-point scale. The significance level for all tests was set at P<0.05. RESULTS: The dose-length products (DLPs) with HP-LDCT and LDCT were 90.2±4.3mGycm and 103.1±6.4mGycm, respectively (P<0.01). DLP of HP-LDCT showed a 13% reduction versus LDCT. Objective image noise was not significantly different. Cardiac pulsation artifacts showed a significant reduction on HP-LDCT (P<0.01). Other subjective image quality parameters of HP-LDCT were similar to those of LDCT. The overall diagnostic acceptability of HP-LDCT was better than that of LDCT (P<0.01). CONCLUSIONS: HP-LDCT showed a 13% mean radiation dose reduction with no deterioration in image quality due to cardiac pulsation artifacts.

Positivity rates of antithyroid antibody, antinuclear antibody and thyroid peroxidase antibody in different types of vitiligo.

BACKGROUND: Vitiligo is associated with various autoimmune disorders, and organ-specific autoantibodies are frequently found in patients with this disorder. Vitiligo is classically divided into segmental vitiligo (SV) and nonsegmental vitiligo (NSV), and it is believed that the pathogenesis differs between these two types. As the NSV type is related to an autoimmune mechanism, autoantibody detection rates are likely to be higher in the NSV type than in the segmental type; however, no comparative studies have been performed. AIM: To analyse the rates of autoantibody positivity according to the clinical features in patients with vitiligo. METHODS: Rates of antithyroid antibody (Tg Ab), antinuclear antibody (ANA) and thyroid peroxidase antibody (TPO Ab) positivity were analysed and compared according to the sex, clinical type and age of onset of 807 patients with vitiligo. RESULTS: There were 106 patients with SV (13.1%) and 701 patients with NSV (86.9%). Tg Ab and ANA positivity did not differ between the SV and NSV types. A positive TPO Ab result was obtained in 16 patients with SV (15.1%) and 173 patients with NSV (24.7%). The TPO Ab positivity rate was significantly higher in NSV (χ² = 4.14, P < 0.05). The positivity rates of the three autoantibodies differed significantly according to age of onset (P = 0.001, P = 0.02 and P < 0.001 for Tg Ab, ANA and TPO Ab positivity, respectively). The TPO Ab positivity rate also showed a sex difference (P < 0.001). CONCLUSIONS: The positivity rates for the three autoantibodies showed differences according to age of onset and sex. The rates of Tg Ab and ANA positivity showed no significant differences according to clinical type, but the TPO Ab positivity rate was significantly different between SV and NSV. It appears likely that an autoimmune mechanism contributes to the pathogenesis of SV.

Surgical management of damaged inferior alveolar nerve caused by endodontic overfilling of calcium hydroxide paste.

AIM: To evaluate the neurosensory outcome of management of damaged inferior alveolar nerves caused by endodontic overfilling and to assess the efficacy of delayed surgical intervention. METHODOLOGY: Nine patients who underwent surgical removal of extruded endodontic material were included. All patients were evaluated for neurosensory function using a set of standardized tests. The outcome of surgical intervention was evaluated through patient interview and quantitative statistical analysis. RESULTS: Surgical procedures included foreign body removal, microsurgical external/internal decompression, excision of neuroma followed by nerve repair, and excision of damaged nerve segment with interpositional nerve graft. Seven of the nine patients had significant improvement according to the follow-up neurosensory assessment. Four patients reported significant improvement, three patients reported mild improvement and two patients reported no appreciable improvement in the Visual Analog Scale (VAS). Two patients who reported no appreciable improvement in VAS also did not achieve FSR. In these patients, calcium hydroxide was spread widely along the IAN and a surgical approach was obtained via sagittal spit osteotomy. The mean time to reach FSR was 222.7 (±41.8) days with a range of 106-397 days. In the early repair group who received surgery within 60 days, three out of five patients achieved FSR in a mean time of 198.0 (±76.2) days. The mean time to FSR in all four subjects who received surgical attention over 60 days after injury was 241.3 (±139.8) days with a range of 106-397 days. As all four cases in the late repair group with limited amount of nerve injury achieved FSR, only 3 of 5 early repair cases with wide-spread injury achieved a similar outcome. CONCLUSION: The results of this case series confirmed the notion that surgical management of the inferior alveolar nerve is effective in the treatment of nerve injuries caused by endodontic extrusion of calcium hydroxide paste. Delayed surgical repair of the inferior alveolar nerve can be indicated and helpful for the neurosensory recovery of damaged IAN, however, the surgical management was less effective in case of widespread nerve injuries.

Estimating retrospective exposure of household humidifier disinfectants.

UNLABELLED: We conducted a comprehensive humidifier disinfectant exposure characterization for 374 subjects with lung disease who presumed their disease was related to humidifier disinfectant use (patient group) and for 303 of their family members (family group) for an ongoing epidemiological study. We visited the homes of the registered patients to investigate disinfectant use characteristics. Probability of exposure to disinfectants was determined from the questionnaire and supporting evidence from photographs demonstrating the use of humidifier disinfectant, disinfectant purchase receipts, any residual disinfectant, and the consistency of their statements. Exposure duration was estimated as cumulative disinfectant use hours from the questionnaire. Airborne disinfectant exposure intensity (µg/m(3)) was estimated based on the disinfectant volume (ml) and frequency added to the humidifier per day, disinfectant bulk level (µg/ml), the volume of the room (m(3)) with humidifier disinfectant, and the degree of ventilation. Overall, the distribution patterns of the intensity, duration, and cumulative exposure to humidifier disinfectants for the patient group were higher than those of the family group, especially for pregnant women and patients ≤6 years old. Further study is underway to evaluate the association between the disinfectant exposures estimated here with clinically diagnosed lung disease. PRACTICAL IMPLICATIONS: Retrospective exposure to household humidifier disinfectant as estimated here can be used to evaluate associations with clinically diagnosed lung disease due to the use of humidifier disinfectant in Korea. The framework, with modifications to account for dispersion and use patterns, can also be potentially adapted to assessment of other household chemical exposures.

Percutaneous ultrasonography-guided radiofrequency ablation of hepatocellular carcinomas: usefulness of image fusion with three-dimensional ultrasonography.

AIM: To evaluate the usefulness of fusion imaging with real-time ultrasonography (US) and three-dimensional (3D) US for the guidance of radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs) 2-5 cm in diameter. MATERIALS AND METHODS: This study was conducted as a retrospective cohort study. It was approved by the institutional review board and informed consent was waived. During percutaneous RFA of HCCs, targeting was performed under conventional fusion imaging guidance, whereas monitoring and controlling were conducted under fusion with 3D US guidance. Technical success, technique effectiveness, incidence of major complications, and local tumour progression rate were evaluated. According to tumour size (small: <3 cm versus medium: 3-5 cm), the roundness indexes of the ablation zones and local tumour progression rates were compared. RESULTS: There were 29 small-sized HCCs (2.5 ± 0.3 cm) and 17 medium-sized HCCs (3.4 ± 0.5 cm). All RFA procedures were performed in a single RFA session. Both the technical success and technique effectiveness rates were 100%. One patient with medium-sized HCC developed a hepatic abscess (n = 1) as a major complication. The local tumour progression rate was 8.7% (4/46) with a mean follow-up period of 18.2 months. The roundness indexes of the ablation zone were not significantly different between small- and medium-sized HCCs, and the local tumour progression rates were also not significantly different between the two groups [3.4% (1/29) versus 17.6% (3/17); p = 0.135]. CONCLUSION: Image fusion with real-time US and 3D US is useful for the guidance of percutaneous RFA for HCCs 2-5 cm in diameter.

Percutaneous radiofrequency ablation of hepatic tumours: factors affecting technical failure of artificial ascites formation using an angiosheath.

AIM: To evaluate the technical feasibility of artificial ascites formation using an angiosheath before percutaneous radiofrequency ablation (RFA) for hepatic tumours and to determine predictive factors affecting the technical failure of artificial ascites formation. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board. One hundred and thirteen patients underwent percutaneous RFA of hepatic tumours after trying to make artificial ascites using an angiosheath to avoid collateral thermal damage. The technical success rate of making artificial ascites using an angiosheath and conversion rate to other techniques after initial failure of making artificial ascites were evaluated. The technical success rate for RFA was assessed. In addition, potential factors associated with technical failure including previous history of transcatheter arterial chemoembolization (TACE) or RFA, type of abdominal surgery, and adjacent perihepatic structures were reviewed. Predictive factors for the technical failure of artificial ascites formation were analysed using multivariate analysis. RESULTS: The technical success rates of artificial ascites formation by angiosheath and that of RFA were 84.1% (95/113) and 97.3% (110/113), respectively. The conversion rate to other techniques after the failure of artificial ascites formation using an angiosheath was 15.9% (18/113). Previous hepatic resection was the sole independent predictive factor affecting the technical failure of artificial ascites formation (p<0.001, odds ratio = 29.03, 95% confidence interval: 4.56-184.69). CONCLUSION: Making artificial ascites for RFA of hepatic tumours using an angiosheath was technically feasible in most cases. However, history of hepatic resection was a significant predictive factor affecting the technical failure of artificial ascites formation.

Comparison of therapeutic efficacy and safety of radiofrequency ablation of hepatocellular carcinomas between internally cooled 15-G and 17-G single electrodes.

OBJECTIVE: To compare the ablation volume, local tumour progression rate and complication rate of radiofrequency ablation (RFA) for small hepatocellular carcinomas (HCCs) using 15-G and 17-G single electrodes. METHODS: This retrospective study was approved by the institutional review board and informed consent was waived. We reviewed percutaneous RFA cases for HCCs using 15-G or 17-G electrodes without multiple overlapping ablations. A total of 36 pairs of HCCs matched according to tumour size and active tip length were included. We compared ablation volume and complication rate between the two electrode groups. Cumulative local tumour progression rates were estimated using the Kaplan­Meier method and compared using the log-rank test. RESULTS: Tumour size and ablation time were not significantly different between the 15-G and 17-G groups (p50.661 and p50.793, respectively). However, ablation volume in the 15-G electrode group was larger than that in the 17-G group (14.465.4cm3 vs 8.762.5cm3; p,0.001). No statistical difference in complication rates between the two electrode groups was found. The 10- and 20-month local tumour progression rates were not significantly different between the two groups (2.8% and 5.6% vs 11.1% and 19.3%; p50.166). CONCLUSION: Ablation volume by the 15-G electrode was larger than that by the 17-G electrode. However, local tumour progression rate and complication rate were not significantly different between the two electrode groups. ADVANCES IN KNOWLEDGE: RFA of HCC using a 15-G electrode is useful to create larger ablation volumes than a 17-G electrode.

Nonablative fractional laser as a tool to facilitate skin penetration of 5-aminolaevulinic acid with minimal skin disruption: a preliminary study.

BACKGROUND: Effective penetration of a photosensitizer is an essential step in photodynamic therapy (PDT). There have been trials of several methods, including laser treatment, to facilitate prompt and sufficiently deep transdermal drug delivery. OBJECTIVE: To evaluate the effects of nonablative fractional laser pretreatment on 5-aminolaevulinic acid (ALA) penetration of the skin. METHODS: Twelve treatment areas (1 × 1 cm(2)) on the backs of 10 healthy male subjects were mapped. Test areas received laser treatment followed by incubation with ALA. Laser treatment was performed with a 1550 nm fractional erbium glass laser, and the laser energy was set to 20 or 50 mJ with a spot density of 50 cm(-2). ALA incubation time was 30, 60 or 180 min. Porphyrin fluorescence was measured. RESULTS: Sites pretreated with nonablative fractional laser showed significantly increased porphyrin fluorescence compared with nonpretreated areas. Laser energy strength and ALA incubation time were positively correlated with ALA absorption. CONCLUSIONS: Nonablative fractional laser treatment effectively enhanced ALA skin penetration. Pretreatment with a nonablative fractional laser can be used for ALA-PDT to achieve higher ALA uptake and shortened ALA incubation times with minimal skin barrier disruption compared with ablative laser.

Local tumour progression after loco-regional therapy of hepatocellular carcinomas: value of fusion imaging-guided radiofrequency ablation.

AIM: To assess the value of fusion imaging of real-time ultrasonography (US) with liver computed tomography (CT)/magnetic resonance imaging (MRI) images for planning US of radiofrequency ablation (RFA) in improving conspicuity of the lesions and reducing false-positive detection of local tumour progression (LTP) found after transcatheter arterial chemoembolization (TACE) or RFA of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This study was approved by the institutional review board and informed consent was waived. Fifty patients with LTP (mean ± SD, 1.5 ± 0.6 cm; range 0.5-3 cm) detected at follow-up CT or MRI were included. Planning US was performed by two radiologists using conventional US first and fusion imaging later in the same session. False-positive detection rates were assessed using conventional US based on the results of fusion imaging. The number cases of initially invisible tumours on conventional US that became visible after image fusion were also evaluated. The true-positive detection rate and conspicuity scores of the index tumours were compared between conventional US and fusion imaging. RESULTS: On conventional US, 40 (80%) out of 50 HCCs with LTP were identified. However, the false-positive detection rate of conventional US was 12.5% (5/40). Out of 10 initially invisible HCCs with LTP on conventional US, six (60%) became visible after image fusion. The true-positive detection rate on conventional US was 70% (35/50), whereas it was increased to 92% (46/50) after image fusion (p = 0.0026). CONCLUSION: Fusion imaging can improve the conspicuity of lesions and reduce the false-positive detection of LTP after TACE or RFA.

First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: local control rate and risk of peritoneal seeding at long-term follow-up.

AIM: To compare the long-term local control of hepatocellular carcinoma (HCC) and risk of peritoneal seeding via percutaneous radiofrequency ablation (RFA) using artificial ascites with those of RFA without artificial ascites. MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study. From April 2005 to February 2008, 160 patients (121 men, 39 women; age range 36-79 years) with a single subcapsular HCC (mean size 2.19 cm) were treated with ultrasonography-guided percutaneous RFA as a first-line therapy. Forty-four patients were treated with RFA using artificial ascites, whereas the other 116 patients were treated without artificial ascites. The cumulative local tumour progression (LTP) and peritoneal seeding were compared in both groups using follow-up computed tomography (CT). Cumulative LTP rates were analysed using the Kaplan-Meier method and the log-rank test. Risk of peritoneal seeding was investigated by means of multivariate analysis. RESULTS: The overall median follow-up period was 52.5 months (range 13-76 months). The 1, 2, 4, and 6 year cumulative LTP rates were 17.1, 27.6, 35.2, and 35.2%, respectively, in the group with artificial ascites, and 8, 15.2, 26.6, and 34.4% in the group without artificial ascites, without significant difference (p = 0.332). The rates of peritoneal seeding were 6.8% (3/44) in the group with artificial ascites and 2.6% (3/116) in the group without artificial ascites, a non-significant difference (p = 0.347). The biopsy prior to RFA was the independent risk factor of peritoneal seeding regardless of the use of artificial ascites. CONCLUSION: Long-term local tumour control and risk of peritoneal seeding were comparable for RFA with or without artificial ascites when used as a first-line therapy for subcapsular HCC.

Automated segmentation of hippocampal subfields in drug-naïve patients with Alzheimer disease.

BACKGROUND AND PURPOSE: Although a few automated hippocampal subfield segmentation methods have been developed, there is no study on the effects of the diagnosis of Alzheimer disease on the hippocampal subfield volume with in vivo MR imaging. The aim of this study was to investigate hippocampal subfield volume differences between drug-naïve subjects with AD and healthy elderly controls by using an automated hippocampal subfield segmentation technique. MATERIALS AND METHODS: Thirty-one drug-naïve subjects with AD and 33 group-matched healthy control subjects underwent 3T MR imaging, and hippocampal subfield volume was measured and compared between the groups. RESULTS: Subjects with AD had significantly smaller volumes of the presubiculum, subiculum, CA2-3, and CA4 DG compared with healthy subjects (uncorrected, P<.001). In addition, we found significant positive correlations between the presubiculum and the subicular volumes and the MMSE-K and the CERAD-K verbal delayed recall scores in the AD group. CONCLUSIONS: We are unaware of previous imaging studies of automated hippocampal subfield segmentation in AD. These structural changes in the hippocampal presubiculum, subiculum, and CA2-3 might be at the core of underlying neurobiologic mechanisms of hippocampal dysfunction and their relevance to verbal delayed recall impairments in AD.

Detection of residual brain arteriovenous malformations after radiosurgery: diagnostic accuracy of contrast-enhanced four-dimensional MR angiography at 3.0 T.

OBJECTIVE: To evaluate the diagnostic accuracy of four-dimensional MR angiography (4D-MRA) at 3.0 T for detecting residual arteriovenous malformations (AVMs) after Gamma Knife (Elekta Instrument AB, Stockholm, Sweden) radiosurgery (GKRS). METHODS: We assessed 36 angiographically confirmed AVMs in 36 patients who had been treated with GKRS. 4D-MRA was performed after GKRS and the time intervals were 39.4 ± 26.0 months [mean ± standard deviation (SD)]. 4D-MRA was obtained at 3.0 T after contrast injection, with a measured voxel size of 1 × 1 × 1 mm and a temporal resolution of 1.1 s (13 patients) or a voxel size of 1 × 1 × 2 mm and a temporal resolution of 0.98 s (23 patients). X-ray angiography was performed as the standard reference within 53 ± 47 days (mean ± SD) after MRA. To determine a residual AVM, the 4D-MRA results were independently reviewed by two readers blinded to the X-ray angiography results. We evaluated diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 4D-MRA for detection of a residual AVM. RESULTS: A residual AVM was identified in 13 patients (13/36, 36%) on X-ray angiography. According to Readers 1 and 2, 4D-MRA had a sensitivity of 79.6% and 64.3%, a specificity of 90.9% and 100%, a PPV of 84.6% and 100% and an NPV of 90% and 81.5%, respectively, and a diagnostic accuracy of 86.1% for Readers 1 and 2, for detecting residual AVMs after GKRS. CONCLUSION: The diagnostic accuracy of 4D-MRA at 3.0 T seems high, but there is still the possibility of further improving the spatiotemporal resolution of this technique.

Dual-energy CT in the evaluation of intracerebral hemorrhage of unknown origin: differentiation between tumor bleeding and pure hemorrhage.

BACKGROUND AND PURPOSE: Detection of underlying tumor in patients with unknown-origin acute ICH may be difficult because acute hematoma may mask enhancement of tumor on postcontrast CT. We intended to investigate the clinical utility of DECT in differentiating tumor bleeding from pure ICH. MATERIALS AND METHODS: Using a dual-source CT scanner, we obtained TNC single-energy and postcontrast DECT scans for 56 patients with unknown-origin spontaneous ICH. From the 2 sets of postcontrast DECT images obtained with different tube energy, EA (equivalent to conventional postcontrast CT), VNC, color-coded iodine overlay, fusion images of iodine overlay and VNC images were produced. The diagnostic performances of fusion, EA, and combined EA and TNC images for detecting underlying tumors were compared. RESULTS: Of the 56 patients, 17 had primary or metastatic tumors (18 lesions) and 39 had nontumorous ICH. The sensitivities of fusion, EA, and combined EA and TNC images for detecting brain tumors were 94.4%, 61.1%, and 66.7%, respectively, and their specificities were 97.4%, 92.3%, and 89.7%, respectively. The areas under the ROC curves were 0.964, 0.786, and 0.842, respectively. Overall, the diagnostic performance of fusion images was significantly superior to EA (P = .006) and combined EA and TNC (P = .011) images. CONCLUSIONS: DECT may be useful in detecting underlying tumors in patients with unknown-origin ICH.

Reduction of molybdate to molybdenum blue by Klebsiella sp. strain hkeem.

A novel molybdate-reducing bacterium, tentatively identified as Klebsiella sp. strain hkeem and based on partial 16s rDNA gene sequencing and phylogenetic analysis, has been isolated. Strain hkeem produced 3 times more molybdenum blue than Serratia sp. strain Dr.Y8; the most potent Mo-reducing bacterium isolated to date. Molybdate was optimally reduced to molybdenum blue using 4.5 mM phosphate, 80 mM molybdate and using 1% (w/v) fructose as a carbon source. Molybdate reduction was optimum at 30 °C and at pH 7.3. The molybdenum blue produced from cellular reduction exhibited absorption spectrum with a maximum peak at 865 nm and a shoulder at 700 nm. Inhibitors of electron transport system such as antimycin A, rotenone, sodium azide, and potassium cyanide did not inhibit the molybdenum-reducing enzyme. Mercury, silver, and copper at 1 ppm inhibited molybdenum blue formation in whole cells of strain hkeem.

MR diagnosis of facial neuritis: diagnostic performance of contrast-enhanced 3D-FLAIR technique compared with contrast-enhanced 3D-T1-fast-field echo with fat suppression.

BACKGROUND AND PURPOSE: Current MRI with the CE T1-weighted sequence plays a limited role in the evaluation of facial neuritis due to prominent normal facial nerve enhancement. Our purpose was to retrospectively investigate the usefulness of the CE 3D-FLAIR sequence compared with the CE 3D-T1-FFE sequence in facial neuritis patients. MATERIALS AND METHODS: We assessed 36 consecutive patients who underwent temporal bone MR imaging at 3T for idiopathic facial palsy. Two readers independently reviewed CE 3D-T1-FFE and CE 3D-FLAIR images to determine the degree of enhancement in each of 5 segments of the facial nerve. We compared AUCs using the Z-test, compared diagnostic performance of 2 MR techniques with the McNemar test, and evaluated interobserver agreement. The Pearson χ(2) test was used for each segment of the facial nerve. RESULTS: The AUC of CE 3D-FLAIR (reader 1, 0.754; reader 2, 0.746) was greater than that of CE 3D-T1-FFE (reader 1, 0.624; reader 2, 0.640; P < .001). The diagnostic sensitivities, specificities, and accuracies were 97.2%, 86.1%, and 91.7%, respectively, for CE 3D-FLAIR, and 100%, 56.9%, and 78.5%, respectively, for CE 3D-T1-FFE. The specificity and accuracy of CE 3D-FLAIR were greater than those of CE 3D-T1-FFE (specificity, P = .029; accuracy, P = .008). The interobserver agreements for CE 3D-FLAIR (κ-value, 0.831) and CE 3D-T1-FFE (κ-value, 0.694) were excellent. Enhancement of the canalicular and anterior genu segments on CE 3D-FLAIR were significantly correlated with the occurrence of facial neuritis (P < .001 for canalicular; P = .032 and 0.020 for anterior genu by reader 1 and reader 2, respectively). CONCLUSIONS: CE 3D-FLAIR can improve the specificity and overall accuracy of MR imaging in patients with idiopathic facial palsy.