Pregnancy and symptomatic relief following ultrasound-guided transvaginal radiofrequency ablation in patients with adenomyosis.

AIM: To report the reproductive results and symptomatic relief of patients with adenomyosis who attempted to conceive after ultrasound-guided radiofrequency ablation (RFA). METHODS: Of 182 consecutive patients with adenomyosis who had undergone RFA, only 81 patients were eligible for this study. Pregnancy outcomes, postoperative complications, preoperative and postoperative pictorial blood loss assessment chart scores, and pain scores were evaluated. RESULTS: Of these 81 patients, 74 were infertile and seven were single at the time of RFA. The mean age at the time of operation was 35.8 years. The mean duration from the time of RFA to conception was 18.9 months (range, 2-72 months). Fifty-nine patients tried natural conception, while 22 patients attempted conception with assisted reproductive techniques. Twenty-nine (35.8%) patients achieved 39 pregnancies. Except for the 23 patients who did not actively try to conceive and who inevitably or arbitrarily discontinued pregnancy attempts, the pregnancy success rate reached 50%. Twenty-two (84.6%) of the 29 patients delivered 24 (66.7%) live babies (nine vaginal deliveries and 15 cesarean sections). Twelve (33.3%) pregnancies ended in spontaneous abortions. No uterine ruptures occurred. Paired sample t-tests revealed that preoperative pictorial blood loss assessment chart and pain scores were significantly (P < 0.05) different from the postoperative scores at 1-, 3- and 6-months. CONCLUSION: RFA could be considered a minimally-invasive treatment option for patients with adenomyosis who desire to maintain fertility and alleviate symptoms.

Abdominal ultrasound-guided transvaginal myometrial core needle biopsy for the definitive diagnosis of suspected adenomyosis in 1032 patients: a retrospective study.

STUDY OBJECTIVE: To assess the results of abdominal ultrasound-guided transvaginal myometrial core needle biopsy (CNB) for the definitive diagnosis of adenomyosis. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Private practice. PATIENTS: A total of 1032 consecutive premenopausal women aged 22 to 53 years who had undergone myometrial CNB and uterine-preserving surgery to treat adenomyosis, which was preliminarily diagnosed on the basis of symptoms and ultrasonographic findings. INTERVENTION: Transvaginal myometrial CNB under abdominal ultrasound guidance. MEASUREMENTS AND MAIN RESULTS: The mean age of the 1032 patients was 41.4 years (range, 22-53 years); 61% were aged 40 to 49 years, and 33% were aged 30 to 39 years. The mean Pictorial Blood Loss Assessment Chart (PBAC) score was 271.1, and total pain score was 11.79. The mean anterior myometrial thickness was 2.79 cm (range, 0.7-8.7 cm), and the posterior myometrial thickness was 3.72 cm (range, 1.1-9.4 cm). A total of 2596 myometrial tissue cores were obtained from thickened myometrium via abdominal ultrasound-guided transvaginal myometrial CNB. At histopathologic examination the tissue cores demonstrated adenomyosis in 2167, myometrial hypertrophy in 343, and leiomyoma in 86. Patients were classified into a concordant group (adenomyosis only, adenomyosis plus hypertrophy, and adenomyosis plus leiomyoma; n = 951) and a discordant group (hypertrophy and leiomyoma; n = 81), depending on conformance between the pathologic result and the preliminary ultrasonographic diagnosis. The study showed a 92.26% concordance rate of adenomyosis between the transvaginal myometrial CNB and ultrasonographic diagnoses. The mean number of tissue cores in the discordant (n = 2.12) and concordant (n = 2.55) groups differed significantly (p < .05). CONCLUSION: Abdominal ultrasound-guided transvaginal myometrial CNB can be used in the definitive diagnosis of clinically and/or sonographically suspected adenomyosis in patients undergoing uterine-preserving surgery. Future research should focus on improving the definitive diagnostic rate of adenomyosis by using transvaginal myometrial CNB.

Unlocking synergies: Harnessing the potential of biological methane sequestration through metabolic coupling between Methylomicrobium alcaliphilum 20Z and Chlorella sp. HS2.

A halotolerant consortium between microalgae and methanotrophic bacteria could effectively remediate in situ CH4 and CO2, particularly using saline wastewater sources. Herein, Methylomicrobium alcaliphilum 20Z was demonstrated to form a mutualistic association with Chlorella sp. HS2 at a salinity level above 3.0%. Co-culture significantly enhanced the growth of both microbes, independent of initial inoculum ratios. Additionally, increased methane provision in enclosed serum bottles led to saturated methane removal. Subsequent analyses suggested nearly an order of magnitude increase in the amount of carbon sequestered in biomass in methane-fed co-cultures, conditions that also maintained a suitable cultural pH suitable for methanotrophic growth. Collectively, these results suggest a robust metabolic coupling between the two microbes and the influence of the factors other than gaseous exchange on the assembled consortium. Therefore, multi-faceted investigations are needed to harness the significant methane removal potential of the identified halotolerant consortium under conditions relevant to real-world operation scenarios.

The Influence of Working Environment on Person-centere / 한국직업건강간호학회지

Purpose@#The purpose of this study was to examine the impact of the working environment on person-centered care for home visiting dementia caregivers. @*Methods@#Participants in this study were 146 caregivers, with the least 6 months of experience working at visiting care centers in Busan, and used a total of 133 questionnaires suitable for analysis. Data were collected from June 9 to July 20, 2023, and were analyzed using descriptive statistics, t-test, ANOVA, pearson’s correlation coefficients, and multiple linear regression using IBM/SPSS 27.0. @*Results@#As a result of multiple linear regression analysis, organizational factors (β=-.37, p<.001), job-related factors (β=-.27, p=.001), and religion (β=.18, p<.013) were factors affecting person-centered care of home visiting dementia caregivers, and working environment explained 37% (F=10.63, p<.001) of person-centered care. @*Conclusion@#Based on the results of this study, the exploration of strategies to improve the working environment will be necessary in order to increase person-centered care for home visiting dementia caregivers.

Long V-Y advancement technique for large nipple reconstruction in Asian women

Previously reported nipple-areolar complex reconstruction (NAR) methods involve multiple incisions and wide skin redraping, which increase retraction forces and heighten the risk of nipple-areolar complex (NAC) flattening. We introduce a NAR method using the long V-Y advancement technique that can overcome these disadvantages. A V-shaped flap is designed with the width of the flap base 4–5 mm larger than the diameter of the normal nipple. The flap length is designed to be at least 2.5 times its width. Dissection is performed to the top of the artificial dermal matrix or muscle layer. The nipple is constructed with the same projection as the contralateral side by folding the elevated flap. The tip of the elevated flap is apposed in the middle of the donor defect to minimize the deformity during donor site closure. A 3-point skin suture is applied to the upper third of the folded flap to mold its shape. Using this long V-Y advancement technique, we successfully decreased skin tension in NAC flaps and improved the maintenance of reconstructed nipple projection. The long V-Y advancement technique provides an easy, simple NAR method, effectively maintaining longer nipple projections and reducing breast deformities, especially in Asian women with relatively large nipples.

Metabolic Syndrome Severity Score for Predicting Cardiovascular Events: A Nationwide Population-Based Study from Korea

Background@#Recently, a metabolic syndrome severity score (MS score) using a dataset of the Korea National Health and Nutrition Examination Surveys has been developed. We aimed to determine whether the newly developed score is a significant predictor of cardiovascular (CV) events among the Korean population. @*Methods@#From the Korean National Health Insurance System, 2,541,364 (aged 40 to 59 years) subjects with no history of CV events (ischemic stroke or myocardial infarction [MI]), who underwent health examinations from 2009 to 2011 and were followed up until 2014 to 2017, were identified. Cox proportional hazard model was employed to investigate the association between MS score and CV events. Model performance of MS score for predicting CV events was compared to that of conventional metabolic syndrome diagnostic criteria (Adult Treatment Program III [ATP-III]) using the Akaike information criterion and the area under the receiver operating characteristic curve. @*Results@#Over a median follow-up of 6 years, 15,762 cases of CV events were reported. MS score at baseline showed a linear association with incident CV events. In the multivariable-adjusted model, the hazard ratios (95% confidence intervals) comparing the highest versus lowest quartiles of MS score were 1.48 (1.36 to 1.60) for MI and 1.89 (1.74 to 2.05) for stroke. Model fitness and performance of the MS score in predicting CV events were superior to those of ATP-III. @*Conclusion@#The newly developed age- and sex-specific continuous MS score for the Korean population is an independent predictor of ischemic stroke and MI in Korean middle-aged adults even after adjusting for confounding factors.

Metabolic Syndrome Severity Score for Predicting Cardiovascular Events: A Nationwide Population-Based Study from Korea

Background@#Recently, a metabolic syndrome severity score (MS score) using a dataset of the Korea National Health and Nutrition Examination Surveys has been developed. We aimed to determine whether the newly developed score is a significant predictor of cardiovascular (CV) events among the Korean population. @*Methods@#From the Korean National Health Insurance System, 2,541,364 (aged 40 to 59 years) subjects with no history of CV events (ischemic stroke or myocardial infarction [MI]), who underwent health examinations from 2009 to 2011 and were followed up until 2014 to 2017, were identified. Cox proportional hazard model was employed to investigate the association between MS score and CV events. Model performance of MS score for predicting CV events was compared to that of conventional metabolic syndrome diagnostic criteria (Adult Treatment Program III [ATP-III]) using the Akaike information criterion and the area under the receiver operating characteristic curve. @*Results@#Over a median follow-up of 6 years, 15,762 cases of CV events were reported. MS score at baseline showed a linear association with incident CV events. In the multivariable-adjusted model, the hazard ratios (95% confidence intervals) comparing the highest versus lowest quartiles of MS score were 1.48 (1.36 to 1.60) for MI and 1.89 (1.74 to 2.05) for stroke. Model fitness and performance of the MS score in predicting CV events were superior to those of ATP-III. @*Conclusion@#The newly developed age- and sex-specific continuous MS score for the Korean population is an independent predictor of ischemic stroke and MI in Korean middle-aged adults even after adjusting for confounding factors.

Quantifying gas emissions from the "Millennium Eruption" of Paektu volcano, Democratic People's Republic of Korea/China.

Paektu volcano (Changbaishan) is a rhyolitic caldera that straddles the border between the Democratic People's Republic of Korea and China. Its most recent large eruption was the Millennium Eruption (ME; 23 km3 dense rock equivalent) circa 946 CE, which resulted in the release of copious magmatic volatiles (H2O, CO2, sulfur, and halogens). Accurate quantification of volatile yield and composition is critical in assessing volcanogenic climate impacts but is challenging, particularly for events before the satellite era. We use a geochemical technique to quantify volatile composition and upper bounds to yields for the ME by examining trends in incompatible trace and volatile element concentrations in crystal-hosted melt inclusions. We estimate that the ME could have emitted as much as 45 Tg of S to the atmosphere. This is greater than the quantity of S released by the 1815 eruption of Tambora, which contributed to the "year without a summer." Our maximum gas yield estimates place the ME among the strongest emitters of climate-forcing gases in the Common Era. However, ice cores from Greenland record only a relatively weak sulfate signal attributed to the ME. We suggest that other factors came into play in minimizing the glaciochemical signature. This paradoxical case in which high S emissions do not result in a strong glacial sulfate signal may present a way forward in building more generalized models for interpreting which volcanic eruptions have produced large climate impacts.

A case report of Madelung’s disease

Madelung’s disease (MD) otherwise known as Launois-Bensaude syndrome, multiple symmetrical lipomatosis, or benign symmetric lipomatosis, is a rare disease characterized by abnormal diffuse lipomatosis in proximal upper limbs and neck. Here, we report a rare case of MD. A 66-year-old man presented with massive growth of soft tissues in the cervico-occipital region of more than 2 years duration. Physical examination showed diffuse enlargement of the anterior neck (Madelung’s collar) and three huge humps at the posterior neck. Under a diagnosis of MD, lipectomy via a single anterior transverse incision and liposuction were performed. This rare case report may be helpful for assessing patients with abnormal diffuse lipomatosis in the neck and proximal upper limbs.

Are postoperative prophylactic antibiotics in closed reduction of nasal bone fracture valuable?: prospective study of 30 cases

BACKGROUND: Prophylactic antibiotic administration after surgery for a nasal bone fracture is performed due to concerns about infection-related complications, such as, toxic shock syndrome. To evaluate the validity and efficacy of antibiotic use, we compared the results obtained and the bacterial profiles of nasal packing materials in patients that underwent closed reduction for a nasal bone fracture with or without prophylactic antibiotic administration. METHODS: Thirty consecutive patients with a nasal bone fracture, but without an open wound, that underwent closed reduction during March to August 2017 were included in the present study. Fifteen of these 30 patients were randomly assigned to a control group, members of were administered postoperative intravenous antibiotics once at the day of surgery and then oral antibiotics for 4 days. The other 15 patients were assigned to an experimental group and not administered any antibiotic postoperatively. Antibiotic ointment was not applied to nasal packing in either group. Nasal packing was removed on postoperative day 4 in all cases. Removed nasal gauze packings were culture tested and strains identified in the two groups were compared. RESULTS: Bacterial strain types cultured from packings were similar in the experimental and control groups and no patient showed signs of clinically significant infection. CONCLUSION: The findings of this study suggest postoperative prophylactic antibiotic use is not clinically required after closed reduction of a nasal bone fracture. Furthermore, the non-use of postoperative antibiotics is biologically beneficial, as it reduces the occurrence of resistant strains and medical costs, and is more convenient for patients.

A case report of pleomorphic adenoma in the parapharyngeal space

Determination of pretreatment serum CEA and SCCA in patients with oral squamous cell carcinoma