Patterns, predictive factors and prognostic impact of multilevel metastasis in N1b papillary thyroid carcinoma.

BACKGROUND: The patterns, predictive factors and prognostic impact of multilevel metastasis in patients with N1b papillary thyroid carcinoma (PTC) were investigated. METHODS: A retrospective review of patients with N1b PTC from a tertiary referral centre in Korea who underwent unilateral modified radical neck dissection was undertaken. RESULTS: Of 658 patients, multilevel metastasis was found in 73·9 per cent; the most common type was metastasis in two levels. Tumour size per 0·1-cm increment (adjusted odds ratio (OR) 1·33, 95 per cent c.i. 1·08 to 1·64), microscopic extrathyroidal extension (adjusted OR 1·72, 1·10 to 2·71), gross extrathyroidal extension (adjusted OR 2·35, 1·24 to 4·46), unilateral central lymph node metastasis (adjusted OR 2·45, 1·53 to 3·92) and bilateral central lymph node metastasis (adjusted OR 4·06, 2·29 to 7·18) were independent predictors of multilevel metastasis. Only four-level metastasis significantly increased the risk of overall locoregional recurrence (LRR) (adjusted hazard ratio (HR) 7·41, 95 per cent c.i. 2·20 to 24·53) and lateral neck LRR (adjusted HR 7·22, 1·82 to 28·65), compared with one-level metastasis. Two subgroup analyses were conducted, showing that only three-level metastasis including metastasis in level V significantly increased the risk of overall LRR (adjusted HR 5·66, 1·20 to 26·75). In addition, having level V metastasis was an independent predictor of both overall (adjusted HR 3·26, 1·72 to 6·18; P < 0·001) and lateral neck (adjusted HR 3·28, 1·50 to 7·16; P = 0·003) LRR. CONCLUSION: Level V metastasis rather than multilevel metastasis itself is associated with an increased risk of LRR. Patients with N1b PTC and level V metastasis require risk restratification and meticulous follow-up.

Correlation between intravesical pressure and prostatic obstruction grade using computational fluid dynamics in benign prostatic hyperplasia.

An urodynamic test which measures various physiologic variables during voiding is generally used for accurate diagnosis of a bladder outlet obstruction (BOO) resulting from benign prostatic hyperplasia (BHP). However, this method is difficult to directly apply to all patients because it is an invasive test and many patients suffer from anxiety and embarrassment during the test. Thus, other diagnosis methods such as uroflowmetry and prostatic symptom score are performed to measure the degree of BOO prior to the urodynamic test, and it is necessary to construct a quantitative relationship among the obstruction level, the intravesical pressure, and the uroflow rate. The aim of this paper is to analyse the variation of intravesical pressure as a function of the extent of the obstruction and the uroflow rate from given information on the size of the bladder and the urodynamic test using a computational fluid dynamics approach. In order to analyse the intravesical pressure, a two-dimensional axisymmetric model of the bladder including a narrowed region, i.e. the prostatic obstruction, is created. Then the variation of the intravesical pressure is quantitatively obtained as a function of the magnitude of the uroflow rate and the extent of the obstruction. It is shown that the intravesical pressure significantly increases even for small obstructions and that at large obstructions it can reach values higher than 100 cm H2O, which is a dangerous value. It is shown that the intravesical pressure decreases as the uroflow rate decreases. This study can form the basis of a non-invasive test for the diagnosis of BHP.

Electric polarization reversal and memory in a multiferroic material induced by magnetic fields.

Ferroelectric and magnetic materials are a time-honoured subject of study and have led to some of the most important technological advances to date. Magnetism and ferroelectricity are involved with local spins and off-centre structural distortions, respectively. These two seemingly unrelated phenomena can coexist in certain unusual materials, termed multiferroics. Despite the possible coexistence of ferroelectricity and magnetism, a pronounced interplay between these properties has rarely been observed. This has prevented the realization of multiferroic devices offering such functionality. Here, we report a striking interplay between ferroelectricity and magnetism in the multiferroic TbMn2O5, demonstrated by a highly reproducible electric polarization reversal and permanent polarization imprint that are both actuated by an applied magnetic field. Our results point to new device applications such as magnetically recorded ferroelectric memory.

Associations of DNase IV polymorphisms with autoantibodies in patients with systemic lupus erythematosus.

OBJECTIVES: The aim of this study was to investigate genetic polymorphisms of DNase IV and their relationship with SLE and various autoantibodies present in SLE patients. METHODS: A total of 532 SLE patients and 521 healthy controls belonging to the Korean population were enrolled into this study. Sequencing of the entire coding region of the DNase IV gene (including the promoter region) was carried out using a DNA analyser. Autoantibodies including anti-Sm, anti-Ro, anti-La, anti-RNP and anti-dsDNA were determined either by indirect immunofluorescence or double immunodiffusion methods. Multiple logistic regression analysis was performed to examine the genetic association with SLE and autoantibodies. RESULTS: We found three single-nucleotide polymorphisms (SNPs): -2753G-->A, +147T-->G (Gly49Gly) and +1466G-->T. The -2753G-->A and +147T-->G (Gly49Gly) SNPs were selected for larger scale genotyping based on linkage disequilibria and haplotype-tagging status. Although the -2753G-->A SNP was more common than the +147T-->G (Gly49Gly) SNP (frequencies: 0.330 and 0.002, respectively), its association with the risk of SLE was not statistically significant. However, -2753G-->A SNP was significantly associated with the production of anti-Sm antibody [odds ratio (95% CI): co-dominant model, 1.89 (1.28-2.79); dominant model, 2.17 (1.20-3.90) and recessive model, 2.62 (1.33-5.17)]. CONCLUSIONS: We did not find significant relationships between DNase IV polymorphisms and the risk of SLE, but the association of the common -2753G-->A allele in the promoter region with the production of anti-Sm antibody implicates DNase IV as a putative candidate gene of SLE.

Elemental Profiling of Rice FOX Lines Leads to Characterization of a New Zn Plasma Membrane Transporter, OsZIP7.

Iron (Fe) and zinc (Zn) are essential micronutrients required for proper development in both humans and plants. Rice (Oryza sativa L.) grains are the staple food for nearly half of the world's population, but a poor source of metals such as Fe and Zn. Populations that rely on milled cereals are especially prone to Fe and Zn deficiencies, the most prevalent nutritional deficiencies in humans. Biofortification is a cost-effective solution for improvement of the nutritional quality of crops. However, a better understanding of the mechanisms underlying grain accumulation of mineral nutrients is required before this approach can achieve its full potential. Characterization of gene function is more time-consuming in crops than in model species such as Arabidopsis thaliana. Aiming to more quickly characterize rice genes related to metal homeostasis, we applied the concept of high throughput elemental profiling (ionomics) to Arabidopsis lines heterologously expressing rice cDNAs driven by the 35S promoter, named FOX (Full Length Over-eXpressor) lines. We screened lines expressing candidate genes that could be used in the development of biofortified grain. Among the most promising candidates, we identified two lines ovexpressing the metal cation transporter OsZIP7. OsZIP7 expression in Arabidopsis resulted in a 25% increase in shoot Zn concentrations compared to non-transformed plants. We further characterized OsZIP7 and showed that it is localized to the plasma membrane and is able to complement Zn transport defective (but not Fe defective) yeast mutants. Interestingly, we showed that OsZIP7 does not transport Cd, which is commonly transported by ZIP proteins. Importantly, OsZIP7-expressing lines have increased Zn concentrations in their seeds. Our results indicate that OsZIP7 is a good candidate for developing Zn biofortified rice. Moreover, we showed the use of heterologous expression of genes from crops in A. thaliana as a fast method for characterization of crop genes related to the ionome and potentially useful in biofortification strategies.

Stabilization of ferromagnetic ordering in cobaltite double perovskites of La2CoIrO6 and La2CoPtO6.

We investigated the local electronic structure and magnetic properties of the cobaltite double perovskites La2CoIrO6 and La2CoPtO6 using Co L2,3-edge x-ray absorption spectroscopy and x-ray magnetic circular dichroism. Despite similarity in the local electronic structure (Co(2+) high-spin states) as well as in the crystal structure (P2(1)/n), only La2CoIrO6 exhibits substantial orbital and spin magnetic moments of Co(2+), whereas they are much weaker in the case of La2CoPtO6. This composition dependence is consistent with the results of magnetization measurements. The details of the mechanism of ferromagnetic ordering in the Co(2+) sublattice in La2CoIrO6 and the lack thereof in La2CoPtO6 are explained in terms of the orbital hybridization of the Co minority-spin t(2g) state and the Ir/Pt j(eff) = 1/2 state.

A new functional approach to the surgical management of Pierre Robin syndrome: experimental and clinical report.

A functional and simple surgical method for treating the respiratory distress of the neonate affected by Pierre Robin syndrome is described. The base of the tongue is placed in an anterior position via a buried wire suture tied around the body of the hyoid. The method proposed in this paper fulfills the following: 1. It is physiologic since the infant is able to suckle and maintain its nutrition by preserving the function of the mobile portion of the tongue for deglutition. 2. Maintenance of the "pushing" action of the tongue stimulates growth of the mandible. 3. The anchoring wire is not exposed in the oral cavity and the risk of tissue breakdown and infection is eliminated. 4. This technique utilizes the stronger fibrous portion of the mid-tongue rather than muscle which "gives" more readily under pressure. 5. The shortest distance from the base of the tongue to the mid-hyoid provides the best mechanical advantage. 6. The suture, if need be, may be tightened at subsequent periods of time. Under Ketamin (Ketalan) anesthesia the tip of the tongue was held in the forward position. An 18 gauge stainless steel wire was inserted via a large curved needle through the midline of the posterior-most portion at the base of the tongue. The needle was directed anteriorly and inferiorly to emerge below the mid point of the inferior border of the hyoid bone. The opposite end of the wire was then tunneled submucosally to the anterior portion of the base of the tongue at foramen caecum, and directed inferiorly to emerge above the superior border of the mid-portion of the hyoid bone. Through a small skin incision opposite the body of the hyoid bone, both free ends of the wire were tied under tension around the body of the hyoid while pulling the base of the tongue forward. The skin incision was closed with a single nylon suture. A prosthetic obturator was used to close the cleft palate. The outcome was satisfactory with no morbidity.

Electrical burn injury of the scalp--bone regrowth following application of latissimus dorsi free flap to the area.

A large defect of the scalp was observed soon after debridement of a high-tension electrical burn of the scalp. Bone scan revealed no uptake of radioactive material to the parietal bone below the necrotic tissue of the scalp. Consecutive bone scans after latissimus dorsi free flap transfer revealed progressive regrowth of the bone.

The state of leucocyte adhesiveness/aggregation (LAA) in the peripheral blood of burned mice: an early and sensitive inflammatory indicator and a marker of pulmonary leukostasis.

The inflammatory response during thermal injury increases the adhesiveness of white blood cells. A direct slide test was used to compare the state of leucocyte adhesiveness/aggregation (LAA) in the peripheral blood of mice subjected to a thermal injury with the findings in control animals. The state of LAA in the peripheral blood increased from baseline values of 1.1 +/- 1.1 per cent to 6.5 +/- 1.3 per cent within 1 h and to 11.0 +/- 1.2 per cent and 14.8 +/- 4 per cent after 3 and 6 h respectively following thermal injury. The respective leucocyte counts were 3075 +/- 277/mm3 (baseline), 3871 +/- 359, 3840 +/- 687 and 6395 +/- 1152 cells/mm3. The LAA values had subsided by 5 days following burning and correlated with the degree of pulmonary leukostasis. Our study suggests that the LAA is an early and sensitive marker of inflammation and that it can be used as a marker for the presence of pulmonary leukostasis during thermal injury.

Reconstruction of the floor of the mouth with a free Dorsalis pedis flap.

The dorsalis pedis flap used for immediate reconstruction in two patients after resection of cancers of the floor of the mouth. The procedure has much to recommend it in the immediate repair of such defects.

Extensive sebaceous nevus.

An unusual patient with extensive sebaceous nevus lesions is presented. The lesions were found on the scalp and face and extended into the mouth and anal region. They were associated with premature eruption of three teeth, a cleft in the secondary palate, and a deformation of the upper third of the right auricle. Skeletal deformities were not found. Neurologic defects were not present during first months. The definitive treatment was postponed because of the patient's young age and the magnitude of the lesions.

A new technique for treating the exposed cardiac pacemaker wires in the supraclavicular region.

Exposure of pacemaker wires has become a common challenge in plastic surgery. Suggested techinques for dealing with this problem include removal and reintroduction of the entire pacemaker system or coverage with local flaps. We propose a new technique, which in addition to local flap coverage, eliminates the problem future pressure necrosis by placing the wires in the clavicle rather than about it.

Congenital fusion of the gums with bilateral fusion of the temporomandibular joints.

A newborn baby with congenital bilateral complete fusion of the gums and the temporomandibular joints is presented. It seems to be the second case reported in the literature. The embryology, clinical features, and treatment of this rare disorder are described.

Lymphedema of the hand following a fracture of the distal radius.

A case of chronic lymphedema of the hand and forearm following a fracture of the distal radius is reported. None of the classic causes of secondary lymphedema appeared to be the cause. A strong psychogenic component appeared to be the underlying mechanism. This rare phenomenon was thought to be self-induced and not genetic in nature.

Cerium oxide-deposited mesoporous silica nanoparticles for the determination of carcinoembryonic antigen in serum using inductively coupled plasma-mass spectrometry.

CeO2-deposited mesoporous silica nanoparticles were synthesized as a probe to determine carcinoembryonic antigen (CEA) in serum by inductively coupled plasma-mass spectrometry (ICP-MS). The prepared mesoporous nanoparticles were modified and tagged to the target for sandwich-type immunoassay. Fe3O4 magnetic nanoparticles (MNPs) were also synthesized and immobilized with antibody to extract the target biomarker. The calibration curve of the synthesized CeO2-deposited silica nanoparticles, which was plotted by the signal ratio of (140)Ce/(57)Fe measured by ICP-MS vs. the concentration of CEA, showed excellent linearity and sensitivity owing to the signal amplification and low spectral interference. Under optimal conditions, the sandwich-type analytical method was applied to determine CEA in serum spiked in the range of 0.001-5 ng mL(-1) and showed a limit of detection of 0.36 ng mL(-1). Since the deposited CeO2 in the mesoporous silica layer can be substituted by other metal compounds, various kinds of metal-deposited nanoparticles can be prepared as probe materials for multiplex detection in bioanalysis.

Factors associated with participation in providing buccal cell DNA for a genetic epidemiologic study.

AIMS: Our aim was to investigate factors associated with participation in buccal cell DNA collection using a large-scale prospective cohort study. METHODS: Of the 183,634 Korea Medical Insurance Corporation (KMIC) prospective cohort study enrollees, 44,773 (36,794 men) were randomly selected. Buccal cell collection kits were mailed and collected from March to September 2004. Epidemiologic characteristics measured at baseline (1990 or 1992) and during follow-up (1998) were compared between respondents and nonrespondents. RESULTS: Among the 13,084 (29.2%) respondents, 78.7% submitted usable samples (DNA concentration ≥3 µg). After adjustments for either or both age and family history of chronic disease, participation in men was positively associated with old age, a family history of chronic disease, low subjective health status, and regular exercise, and negatively associated with current smoking status. In women, only old age was associated with participation. Low body mass index (BMI) (<18.5 kg/m(2)), blood pressure, total cholesterol, and fasting blood glucose level were negatively associated with participation in men after adjustments for age and family history of chronic disease, but not in women, except for low BMI. CONCLUSIONS: In this study, collecting buccal cell DNA by mailed survey has a low success rate (29%), and there appear to be a nonresponse bias and gender differences in the collection process.

Electronic structure of double perovskite A2FeReO6 (A = Ba and Ca): interplay between spin-orbit interaction, electron correlation, and lattice distortion.

We have investigated the electronic structure of double perovskites, Ba(2)FeReO(6) (metallic) and Ca(2)FeReO(6) (insulating) using optical and x-ray absorption spectroscopy. By comparing the experimental results with the density functional theory calculations, we found that the electronic structure of Ba(2)FeReO(6) could be determined from the interaction of the electron correlation and spin-orbit coupling. On the other hand, for Ca(2)FeReO(6), the lattice distortion and electron correlation are important in determining the electronic structure. Additionally, the insulating gap in Ca(2)FeReO(6) is realized by the spin-orbit coupling. Our work shows that the subtle interplay of the spin-orbit interaction, electron correlation, and lattice distortion should be taken into account to understand the electronic structure of the 5d transition metal oxides.