Prognostic Indicators for Anterior Mandibular Repositioning in Adolescents with Class II Malocclusion: A Cross-Sectional Cephalometric Study.

OBJECTIVE: To investigate the cephalometric changes following anterior repositioning of the mandible for predicting the treatment effects in Class II adolescent patients. STUDY DESIGN: Lateral cephalograms of 28 patients (ANB > 4°) were taken in centric occlusion (CO) and edge-to-edge bite (EtoE) before orthodontic treatment. The patients were classified into two groups according to their mandibular plane angle [MPA; low MPA (LMPA) ≤ 28° and high MPA (HMPA) > 28°]. Cephalometric changes of hard and soft tissues were measured and analyzed with an x-y cranial base coordinate system. RESULTS: For CO to EtoE, there were no significant cephalometric changes between HMPA and LMPA, but the horizontal ratio of soft to hard tissue pogonion (H-Pog'/H-Pog) change was significantly greater with LMPA than with HMPA while the vertical ratio (V-Pog'/V-Pog) showed vice versa. For CO to EtoE, MPA showed significant correlations with H-Pog'/H-Pog and V-Pog'/V-Pog. Y-axis angle, V-Pog'/V-Pog and H-Pog'/H-Pog can be used as good tools to discriminate between HMPA and LMPA. CONCLUSION: Cephalometric findings for CO to EtoE may be useful in predicting the vertical and horizontal changes of hard and soft tissues with the treatment of growing adolescents having various vertical skeletal patterns of Class II malocclusion.

Perinatal outcomes: intravenous patient-controlled fentanyl versus no analgesia in labor.

AIM: To investigate perinatal outcomes, the analgesic efficacy and maternal satisfaction in nulliparous women receiving fentanyl intravenous patient-controlled analgesia (i.v.-PCA). MATERIAL AND METHODS: A total of 1401 nulliparous women with a singleton pregnancy who received fentanyl i.v.-PCA (i.v.-PCA group, n = 290) or no analgesia (control group, n = 1111) in labor between 2005 and 2010 were reviewed. Fentanyl i.v.-PCA was implemented on maternal request during the first stage of labor over 35 weeks of gestation, and discontinued at full cervical dilatation. Perinatal outcomes were compared between the i.v.-PCA and the control groups. The numerical rating scale (NRS) levels during labor were also examined in the i.v.-PCA group. Additionally, parturients received fentanyl i.v.-PCA in 2010 (n = 73) were asked about overall satisfaction using a scale poor, moderate, good and excellent on postpartum day 0-3. RESULTS: Women receiving i.v.-PCA showed significantly longer labor and more need of oxytocin augmentation, compared with the control. Cesarean section was significantly less frequent in the i.v.-PCA group compared with the control (11.0% v.s. 24.1%, respectively), with the vacuum-assisted delivery rate comparable between groups. Neonatal outcomes (i.e. Apgar score <7 at 1 min or 5 min, umbilical artery pH <7.20) were comparable between groups, irrespective of mode of delivery. Significant reduction of NRS levels was noted until 3 h after induction of i.v.-PCA, compared to the baseline. Of the women who expressed their satisfaction, 72% (48/67) exhibited 'excellent' or 'good' for pain relief by i.v.-PCA. CONCLUSION: Fentanyl i.v.-PCA could be a useful approach for labor pain relief in nulliparas when regional blocks are unavailable.

Congenitally corrected transposition of the great arteries.

Congenitally corrected transposition of the great arteries (cTGA) is an uncommon cardiac malformation characterized by discordant atrioventricular and ventriculoarterial connections. Most cases of cTGA are associated with cardiac anomalies. As the ventricular outflow tract may appear to arise correctly from the right and left ventricles, cases of cTGA with a mild associated anomaly are rarely detected prenatally. Parallel vessels are evident in cTGA, but this sign is also present in complete TGA. We report a case of cTGA diagnosed in utero at 29 weeks' gestation. The fetus was diagnosed as TGA and referred to our hospital at 28 weeks' gestation. cTGA was found at 29 weeks' gestation in our hospital, and no additional cardiac anomalies were seen prenatally. After birth, patent ductus arteriosus with bidirectional flow was present. Careful examination of the four-chamber view suggested atrioventricular discordance. Identification of a parallel course of the great vessels, with the aorta anterior and to the left of the pulmonary trunk (l-transposition), may help accurate prenatal diagnosis of cTGA.

Abnormal first-trimester fetal nuchal translucency and amniotic band syndrome.

We report a case of amniotic band syndrome diagnosed prenatally by serial sonographic examinations. Our initial sonographic image showed a large fetal nuchal translucency (NT) at 12 weeks' gestation. Repeated fetal ultrasound images revealed an amniotic band and right upper limb anomaly. Fetal MRI at 19 weeks' gestation revealed right forearm hypoplasia and pseudosyndactyly. The fetus was prenatally diagnosed with amniotic band syndrome and was suspected of having severe functional impairment of the deformed limb. The parents decided to terminate the pregnancy at 21 weeks' gestation. In fetuses with aneuploidy and various structural and genetic abnormalities, the NT thickness is increased in the first trimester. As far as we are aware, this is the first case report of increased NT and limb anomaly associated with amniotic band syndrome. In chromosomally normal fetuses with increased NT, intensive sonographic follow-up should provide grounds for a precise antenatal diagnosis.

Transcriptome analysis of an antibiotic downregulator mutant and synergistic Actinorhodin stimulation via disruption of a precursor flux regulator in Streptomyces coelicolor.

Through microarray analysis of an antibiotic-downregulator-deleted Streptomyces coelicolor ΔwblA ΔSCO1712 mutant, 28 wblA- and SCO1712-dependent genes were identified and characterized. Among 14 wblA- and SCO1712-independent genes, a carbon flux regulating 6-phosphofructokinase SCO5426 was additionally disrupted in the ΔwblA ΔSCO1712 mutant and further stimulated actinorhodin production in S. coelicolor, implying that both regulatory and precursor flux pathways could be synergistically optimized for antibiotic production.

Putative TetR family transcriptional regulator SCO1712 encodes an antibiotic downregulator in Streptomyces coelicolor.

A tetR family transcriptional regulatory gene (SCO1712) was identified as a global antibiotic regulatory gene from a Streptomyces interspecies DNA microarray analysis. SCO1712 disruption in Streptomyces coelicolor not only upregulated antibiotic biosynthesis through pathway-specific regulators when a previously identified pleiotropic downregulatory wblA was expressed but also further stimulated antibiotic production in a wblA deletion mutant, implying that SCO1712 might encode a novel antibiotic downregulator.

Biotechnological doxorubicin production: pathway and regulation engineering of strains for enhanced production.

Doxorubicin (DXR) is an anthracycline-type polyketide, typically produced by Streptomyces peucetius ATCC 27952. Like the biosynthesis of other secondary metabolites in Streptomyces species, DXR biosynthesis is tightly regulated, and a very low level of DXR production is maintained in the wild-type strain. Despite that DXR is one of the most broadly used and clinically important anticancer drugs, a traditional strain improvement strategy has long been practiced via recursive random mutagenesis, with little understanding of the molecular genetic basis underlying such enhanced DXR production. Since DXR titer enhancement is imperative in the fermentation industry, attaining a comprehensive understanding and its application of the specific regulatory systems that govern secondary metabolite production is an important aspect of metabolic engineering that can efficiently improve fermentation titers. In this mini-review, various efforts to improve the titers of DXR have been summarized based on biosynthetic and regulatory studies including transcriptional and product analyses.

Isolation and genetic manipulation of the antibiotic down-regulatory gene, wblA ortholog for doxorubicin-producing Streptomyces strain improvement.

Cross-genome comparative transcriptome analyses were previously conducted using the sequenced Streptomyces coelicolor genome microarrays to understand the genetic nature of doxorubicin (DXR) and daunorubicin (DNR) overproducing industrial mutant (OIM) of Streptomyces peucetius. In this previous work, a whiB-like putative transcription factor (wblA ( sco )) was identified as a global antibiotic down-regulator in S. coelicolor (Kang et al., J Bacteriol 189:4315-4319, 2007). In this study, a total genomic DNA library of a DXR/DNR-overproducing S. peucetius OIM was constructed and screened using wblA ( sco ) as a probe, resulting in the isolation of a wblA ortholog (wblA ( spe )) that had 95% amino acid identity to wblA ( sco ). Gene disruption of wblA ( spe ) from the S. peucetius OIM resulted in an approximately 70% increase in DXR/DNR productivity, implying that the DXR/DNR production in the S. peucetius OIM could be further improved via comparative transcriptomics-guided target gene manipulation. Furthermore, several putative wblA ( spe ) -dependent genes were also identified using S. coelicolor interspecies DNA microarray analysis between the S. peucetius OIM and wblA ( spe )-disrupted S. peucetius OIM. Among the genes whose expressions were significantly stimulated in the absence of wblA ( spe ), the overexpression of a conserved hypothetical protein (SCO4967) further stimulated the total production of DXR/DNR/akavinone by 1.3-fold in the wblA ( spe )-disrupted S. peucetius OIM, implying that the sequential genetic manipulation of target genes identified from interspecies comparative microarray analysis could provide an efficient and rational strategy for Streptomyces strain improvement.

Pancreatic beta-cell function and fetal growth in gestational impaired glucose tolerance.

OBJECTIVE: To investigate the metabolic phenotype and pregnancy outcomes of gestational impaired glucose tolerance (IGT) defined by isolated hyperglycemia during an oral glucose tolerance test (OGTT). DESIGN: Retrospective cohort study. SETTING: University referral hospital. POPULATION: A total of 4,789 women were screened for gestational diabetes mellitus (GDM) between 1996 and 2008 with a glucose challenge test (GCT), followed by a 2-hour 75-g OGTT if the GCT result was abnormal; in addition, measurement of plasma insulin concentration during the OGTT was implemented from 2004. METHODS: The insulin sensitivity (IS(OGTT)) and beta-cell function (insulinogenic index/homeostasis model assessment for insulin resistance) were calculated for 283 women who underwent a diagnostic OGTT between 2004 and 2008. Perinatal complications were examined in 4,789 women who were screened for GDM between 1996 and 2008. MAIN OUTCOME MEASURES: Comparison of outcomes among women stratified by glucose tolerance status using the GCT and OGTT profiles. RESULTS: Insulin sensitivity and beta-cell function significantly decreased from normal OGTT to 2-hour IGT (single hyperglycemia at 2 hours) to 1-hour IGT (single hyperglycemia at 1 hour) to GDM, with significant differences between normal OGTT and 1-hour IGT or GDM. The occurrence of large-for-gestational age (LGA) neonates was significantly increased in women with GDM or 1-hour IGT (adjusted odds ratio: 2.15, 2.22; 95% confidence interval 1.23-3.75 and 1.04-4.35, respectively) compared to those with normal GCT or normal diagnostic OGTT results. CONCLUSIONS: Like GDM, isolated 1-hour hyperglycemia on the OGTT is associated with beta-cell dysfunction and an increased risk for LGA neonates.

Proteomics-driven identification of SCO4677-dependent proteins in Streptomyces lividans and Streptomyces coelicolor.

AfsR2 is a global regulatory protein which stimulates antibiotic biosynthesis in both Streptomyces lividans and S. coelicolor. Previously, various afsR2-dependent genes including a putative abaA-like regulatory gene, SCO4677, were identified through comparative DNA microarray analysis. To further identify the putative SCO4677-dependent proteins, the comparative proteomics-driven approach was applied to the SCO4677-overexpressing strains of S. lividans and S. coelicolor along with the wild-type strains. The 2D gel-electrophoresis gave approximately 277 protein spots for S. lividans and 207 protein spots for S. coelicolor, showing different protein expression patterns between the SCO4677-overexpressing strains and the wild-type strains. Further MALDI-TOF analysis revealed that only 18 proteins exhibited similar expression patterns in both S. lividans and S. coelicolor, suggesting that the SCO4677 could encode an abaA-like regulator which controls a few cross-species proteins as well as many species-specific proteins in Streptomyces species.

Changes in the hyoid bone, tongue, and oropharyngeal airway space after mandibular setback surgery evaluated by cone-beam computed tomography.

BACKGROUND: Mandibular setback surgery can change the position of the mandible which improves occlusion and facial profile. Surgical movement of the mandible affects the base of the tongue, hyoid bone, and associated tissues, resulting in changes in the pharyngeal airway space. The aim of this study was to analyze the 3-dimensional (3D) changes in the hyoid bone and tongue positions and oropharyngeal airway space after mandibular setback surgery. METHODS: A total of 30 pairs of cone-beam computed tomography (CBCT) images taken before and 1 month after surgery were analyzed by measuring changes in the hyoid bone and tongue positions and oropharyngeal airway space. The CBCT images were reoriented using InVivo 5.3 software (Anatomage, San Jose, USA) and landmarks were assigned to establish coordinates in a three-dimensional plane. The mean age of the patients was 21.7 years and the mean amount of mandibular setback was 5.94 mm measured from the B-point. RESULTS: The hyoid bone showed significant posterior and inferior displacement (P < 0.001, P < 0.001, respectively). Significant superior and posterior movements of the tongue were observed (P < 0.05, P < 0.05, respectively). Regarding the velopharyngeal and glossopharyngeal spaces, there were significant reductions in the volume and minimal cross-sectional area (P < 0.001). The anteroposterior and transverse widths of the minimal cross-sectional area were decreased (P < 0.001, P < 0.001, respectively). In addition, the amount of mandibular setback positively correlated with the amount of posterior and inferior movement of the hyoid bone (P < 0.05, P < 0.05, respectively). CONCLUSION: There were significant changes in the hyoid bone, tongue, and airway space after mandibular setback surgery.

The Association between Placenta Implantation at Prior Myomectomy Locations and Perinatal Outcomes in Pregnant Women Who Previously Underwent One-Step Hysteroscopic Myomectomy.

OBJECTIVES: There are no data describing the correlation between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women after transcervical resection myomectomy (TCR-M). The aim of the study is to investigate the correlations between placenta implantation at prior myomectomy locations and perinatal outcomes in pregnant women who had previously undergone TCR-M. MATERIALS AND METHODS: This was a retrospective, single-center study. We reviewed the records of 34 pregnant women who had previously undergone TCR-M for submucosal myoma and perinatal care in our hospital between January 2012 and January 2019. We examined surgical and pregnancy outcomes and evaluated correlations between placenta implantation at prior myomectomy locations and perinatal outcomes in women who delivered after 22 gestational weeks (n = 24). RESULTS: Median maternal age at conception was 38 years (range, 28-44) and median duration between TCR-M and conception was 1.4 years (range, 0.3-5.8). There were 24 deliveries after 22 gestational weeks and 10 pregnancy losses. Among these 24 deliveries, the median gestational age at delivery was 39 weeks (range, 34-41); median birthweight, 3025 g (range, 2092-4012); and median blood loss at delivery, 573 g (range, 100-3000). There were no cases of placenta accreta and uterine rupture. Placenta implantation at a prior myomectomy location was detected in 14/24 women using transabdominal ultrasonography. Median blood loss was significantly higher in the implantation than in the nonimplantation group (P < 0.01). CONCLUSION: Our one-step TCR-M is useful for women with submucosal myoma. However, we suggest that clinicians should review and check the association between prior myomectomy locations and placenta implantation.

Is the risk of small for gestational age influenced by maternal body composition in young Japanese women?

Background: We aimed to investigate whether there was a high incidence of young Japanese mothers being underweight (pregravid body mass index [BMI] < 18.5 kg/m2) and if they delivered infants who were small for gestational age (SGA).Materials and methods: Our study was carried out from 2013 to 2017 and included adolescent women (maternal age at delivery: <20 years old; n = 94), women in their early twenties (maternal age at delivery: 20-24 years; n = 479), and controls (maternal age at delivery: 25-34 years; n = 2061).Results: In both the adolescent and early twenties groups, the incidence of being underweight, based on prepregnancy BMI, was significantly higher than controls (p < .0001 and p < .05, respectively). In both groups, gestational weight gain (GWG) was significantly higher than controls (p < .0001). There were no notable group differences in the incidences of SGA.Conclusion: The incidence of being underweight was higher in younger mothers than in controls. However, the risk of SGA did not increase in younger mothers, possibly because their GWG overcame the influence of their pre-pregnancy body composition.

Effectiveness and safety of electrical moxibustion for knee osteoarthritis: A multicenter, randomized, assessor-blinded, parallel-group clinical trial.

BACKGROUND: The prevalence of knee osteoarthritis (KOA) is increasing, and it has emerged as a major health issue. Studies have been reported that moxibustion is effective for treating KOA, but conventional moxibustion is difficult to control the intensity of stimulation and causes smoke, harmful gases, or odors. An electrical moxibustion (EM) device was developed to solve these problems, so we conducted this study to evaluate the effectiveness and safety of EM as a treatment for KOA. METHODS: This is a multicenter, randomized, assessor-blinded, parallel-group clinical trial. Participants with KOA were randomly allocated into EM, traditional indirect moxibustion (TIM), or usual care groups. The moxibustion groups were received 12 sessions of moxibustion treatment at six acupuncture points (ST36, ST35, ST34, SP9, EX-LE4, SP10) over a period of 6 weeks. The usual care group was received usual treatment and self-care. The primary outcome was the degree of pain measured by numerical rating scale (NRS). The second outcomes were measured using visual analog scale, Korean version of the Western Ontario and McMaster Universities osteoarthritis index, patient global assessment, European quality of life five dimension five level scale, and warm sense threshold and heat pain threshold. For safety assessment, laboratory test and adverse events (AEs) were recorded. RESULTS: A total of 138 participants were assigned. While there was no significant NRS change in the usual care, EM and TIM showed significant decrease after treatment. Compared to the usual care, the mean change of NRS in the EM and TIM was significantly different, but there was no significance between two groups. Regarding secondary outcomes, EM and TIM also showed significant difference compared to the usual care, but there was no significance between two groups. Regarding safety assessment, while usual care showed significant safety among three groups, EM showed seven treatment-related AEs by four participants compared TIM's 10 events by 10 participants. In addition, there was no blister caused by burns in the EM, which occurred four cases in the TIM. CONCLUSION: This study shows that EM is effective to improve the pain and function by KOA with a certain level of safety.

Prenatal diagnosis of retroperitoneal teratoma: a case report and review of the literature.

We report a case of retroperitoneal teratoma diagnosed prenatally by serial sonographic examinations in the third trimester. A 29-year-old woman was referred for sonographic evaluation at 33 weeks' gestation because of a fetal intra-abdominal mass. Our initial sonographic image suggested a neuroblastoma. Repeat ultrasound images demonstrated an increase in size of the tumor, while the content of the tumor became predominantly solid with areas of calcification. Teratoma should be considered on detection of any cystic or mixed semisolid mass, especially when calcification is present. The fetus was prenatally diagnosed with retroperitoneal teratoma. After birth at 39 weeks, the tumor was removed and histological analysis revealed an immature retroperitoneal teratoma. Intensive monitoring of the changes in ultrasound images of the tumor should provide ground for a precise antenatal diagnosis.

The periphery of the human fetal adrenal gland is a site of angiogenesis: zonal differential expression and regulation of angiogenic factors.

CONTEXT: Although the inner fetal zone (FZ) of the mid-gestation human fetal adrenal (HFA) produces dehydroepiandrosterone sulfate, the function of the outer definitive zone (DZ) remains less clear. We have proposed that the DZ phenotype is that of a pool of progenitor cells, many of which are mitotically active. Recently, we studied HFA expression of a family of vascular endothelial cell-specific angiogenic factors, the angiopoietins (Angs), and demonstrated that Ang2 was localized predominantly in the periphery of the gland. Ang1 stabilizes, whereas Ang2 destabilizes, vessels, increasing responsiveness to angiogenic stimuli such as vascular endothelial growth factor (VEGF)-A and fibroblast growth factor (FGF)-2. OBJECTIVE: Our objective was to test the hypothesis that the periphery of the HFA is a site of angiogenesis. DESIGN: Studies were conducted involving RNA, frozen sections, and primary cell cultures from midgestation HFAs. MAIN OUTCOME MEASURES: Immunofluorescence, laser capture microdissection, and real-time quantitative RT-PCR were used. RESULTS: Double immunostaining demonstrated that proliferating endothelial cells were limited to the DZ and DZ/FZ border. Ang2 mRNA was primarily expressed in the DZ, whereas Ang1 mRNA was primarily in the FZ. VEGF-A and FGF-2 mRNA levels were higher in the DZ. FGF-2 (10 ng/ml) induced Ang2 mRNA by 4-fold in both zones of cells (P < 0.01, at 24 h), but not Ang1 or VEGF-A mRNA. CONCLUSION: Data suggest that angiogenesis occurs at the periphery of the HFA. The DZ-predominant expression of Ang2 may be explained, in part, by the parallel pattern of FGF-2 expression.

Development of pseudoaneurysm in cesarean section scar pregnancy: a case report and literature review.

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. It is becoming more common, but it can lead to uterine rupture and severe hemorrhage. Here, we report a case of a 37-year-old woman with CSP complicated with pseudoaneurysm. The pseudoaneurysm emerged following focal injection of methotrexate (MTX) and potassium chloride with systemic MTX treatment. Due to a risk of sudden bleeding, uterine artery embolization (UAE) was recommended, but the patient hoped to avoid this if possible. Because the serum human chorionic gonadotropin level and the gestational sac were still persistent, dilation and curettage were performed with interventional radiologists on standby. Severe hemorrhage occurred and continued during the procedure, which necessitated emergent UAE. We reviewed six CSP case reports with vascular abnormalities, and all of them necessitated UAE, surgical excision, or hysterectomy. In the case of CSP combined with pseudoaneurysm, treatment should be planned carefully considering the risk of massive hemorrhage.

Chronic obstructive pulmonary disease is independently associated with hypertension in men: A survey design analysis using nationwide survey data.

Although studies have shown that chronic obstructive pulmonary disease (COPD) and hypertension are linked as comorbidities, it remains unclear whether COPD is independently associated with the risk of hypertension or is caused by common risk factors such as age and smoking. The objective of this study was to investigate the relationship between COPD and hypertension by using nationally representative data.This cross-sectional study analyzed data from the Korea National Health and Nutrition Examination Survey V conducted during 2010 to 2012. Hypertension was defined as a mean systolic blood pressure ≥ 140 mm Hg and/or a diastolic blood pressure ≥ 90 mm Hg, or current consumption of antihypertensive medications. A diagnosis of COPD was defined as a smoking history of at least 10 pack-years with airflow limitation on spirometry. Multivariate logistic regression was performed to investigate the independent association between COPD and hypertension after adjusting for covariates. Survey design analyses were conducted for all analyses.Among 4043 men (aged ≥ 40 years) who underwent spirometry, 2190 (54.2%) had hypertension. Even after adjusting for age, body mass index, smoking status, diabetes, metabolic syndrome, and stroke, COPD was independently associated with hypertension (adjusted odds ratio, 1.71; 95% confidence interval, 1.37-2.13; P < .001). Adjusted pulse pressure significantly increased as the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity and FEV1 decreased.COPD is independently associated with hypertension, and this could explain the link between the risk of cardiovascular diseases and COPD.

Celiac Disease in a Predisposed Subject (HLA-DQ2.5) with Coexisting Graves' Disease.

Celiac disease is an intestinal autoimmune disorder, triggered by ingestion of a gluten-containing diet in genetically susceptible individuals. The genetic predisposition is related to human leukocyte antigen (HLA) class II genes, especially HLA-DQ2-positive patients. The prevalence of celiac disease has been estimated to be ~1% in Europe and the USA, but it is rarer and/or underdiagnosed in Asia. We report a case of celiac disease in a predisposed patient, with a HLA-DQ2 heterodimer, and Graves' disease that was treated successfully with a gluten-free diet. A 47-year-old woman complained of persistent chronic diarrhea and weight loss over a 9 month period. Results of all serological tests and stool exams were negative. However, the patient was found to carry the HLA DQ2 heterodimer. Symptoms improved after a gluten-free diet was initiated. The patient has been followed and has suffered no recurrence of symptoms while on the gluten-free diet. An overall diagnosis of celiac disease was made in a genetically predisposed patient (HLA-DQ2 heterodimer) with Graves' disease.