Monoradiculopathy-induced abdominal pseudohernia caused by T11-12 soft disc herniation: a case report and literature review.

BACKGROUND: An abdominal pseudohernia is a rare clinical entity that consists of an abnormal bulging of the abdominal wall that can resemble a true hernia but does not have an associated underlying fascial or muscle defect. Abdominal pseudohernia is believed to result from denervation of the abdominal muscles in cases of herpes zoster infection, diabetes mellitus, lower thoracic or upper lumbar disc herniation, surgical injuries, and rib fracture. To date, nine cases of abdominal pseudohernia caused by disc herniation at the lower thoracic or upper lumbar levels have been reported. CASE PRESENTATION: A 35-year-old man with no underlying disease or traumatic event presented with chief complaints of left flank pain and a protruding left lower abdominal mass that had formed one day earlier. There was no true abdominal hernia on abdominal computed tomography (CT), although CT and magnetic resonance imaging (MRI) showed a herniated soft (non-calcified) disc into the left neural foramen at the T11-12 level. A nonsteroidal anti-inflammatory drug was prescribed for the flank pain, and the patient was followed on a regular basis for six months. Follow-up MRI taken at the last visit showed complete resorption of the herniated disc. Abdominal pseudohernia and flank pain were also completely resolved. CONCLUSION: We report a rare case of monoradiculopathy-induced abdominal pseudohernia caused by foraminal soft disc herniation at the T11-12 level. In patients who have an abdominal pseudohernia without herpes zoster infection, diabetes mellitus, or traumatic events, lower thoracic disc herniations should be included in differential diagnosis.

Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review.

BACKGROUND: Vertebroplasty (VP) is considered an alternative therapy in an osteoporotic compression fracture that failed conservative treatment. However, cement leakage into the intradural space can cause catastrophic complications. To the best of our knowledge, intradural cement leakage following VP has been reported only in 7 cases. We report here a case of intradural cement leakage following VP with a literature review. CASE PRESENTATION: An 84-year-old female with an L1 osteoporotic fracture underwent percutaneous VP at a local hospital. Immediately after the procedure, she complained of weakness, numbness, and pain in both legs, and her back pain aggravated. She was transferred to our hospital. The initial muscle power was grade 2 for the right leg and grade 4 for the left leg. Computed tomography (CT) scan showed intradural cement leakage from T10 to L2. Magnetic resonance imaging showed an intradural mass lesion. Although we performed total laminectomy with durotomy and removed intradural cement completely, the neurological deficit did not completely recover. The muscle power was grade 3 for the right leg and grade 4 for the left leg at the last follow-up. CONLCUSIONS: If a neurological deficit is found after VP, a CT scan should be taken to confirm the pattern of cement leakage. In case of intradural cement leakage, surgical decompression should be recommended to improve neurological deficit. To prevent intradural cement leakage during the VP, the needle tip should not perforate the medial wall of the pedicle with appropriate viscosity of cement.

Effect of lumbar spinal stenosis on bone mineral density in osteoporosis patients treated with ibandronate.

BACKGROUND: Lumbar spinal stenosis (LSS) can cause various neurological symptoms and reduce the daily activity of patients. Many studies have shown that free physical activities and exercise can improve bone mineral density (BMD) in patients with osteoporosis. However, the effect of LSS on BMD has not been reported. The purpose of this study was to investigate the effects of LSS on BMD in patients treated with ibandronate for newly diagnosed osteoporosis. METHODS: Group 1 included 83 patients treated for osteoporosis alone, and group 2 included 76 patients treated for both osteoporosis and symptomatic LSS. We confirmed four BMD values presented as T-score at initial, and 1-, 2-, and 3-year follow-ups. Mean BMD and annual changes of BMD for three years were compared between the two groups. Correlations between initial BMD and total change of BMD, and related factors for continuous BMD improvement for three years were also evaluated. RESULTS: Mean annual BMDs were significantly higher in group 1 compared than in group 2 (-3.39 vs. -3.58 at 1-year; -3.27 vs. -3.49 at 2-year; -3.13 vs. -3.45 at 3-year; all p < 0.05). Annual change of BMD at 1-year follow-up (0.32 vs. 0.21, p = 0.036) and total change of BMD for three years (0.57 vs. 0.35, p = 0.002) were significantly higher in group 1. Group 1 had a strong negative correlation (r = -0.511, P = 0.000) between initial BMD and total change of BMD, whereas group 2 showed a weak negative correlation (r = -0.247, p = 0.032). In multivariate analysis, symptomatic LSS was the only independent risk factor for continuous BMD improvement (Odds ratio = 0.316, p = 0.001). CONCLUSIONS: Symptomatic LSS may interfere with BMD improvement in the treatment of osteoporosis with ibandronate. Active treatment for LSS with more potent treatment for osteoporosis should be taken to increase BMD for patients with osteoporosis and LSS.

Cerebrospinal fluid-cutaneous fistula associated with post-traumatic Charcot spinal arthropathy: a case report and review of literature.

BACKGROUND: Charcot spinal arthropathy, also known as Charcot spine and neuropathic spinal arthropathy, is a progressive and destructive condition that affects an intervertebral disc and the adjacent vertebral bodies following loss of spinal joint innervation. We report the first case of Charcot spinal arthropathy (CSA) associated with cerebrospinal fluid (CSF)-cutaneous fistula. CASE PRESENTATION: A 54-year-old male who underwent T10-L2 posterior instrumented spinal fusion seven years prior for treatment of T11 burst fracture and accompanying T11 complete paraplegia visited our department complaining of leakage of clear fluid at his lower back. The patient had also undergone various types of skin graft and myocutaneous flap surgeries for treatment of repetitive pressure sores around his lumbosacral area. The patient presented with persistent CSF leakage from a cutaneous fistula (CSF-cutaneous fistula) formed in a lumbosacral pressure sore. The CSF-cutaneous fistula arose from the L5 post-traumatic CSA. Surgery was planned for management of CSF-cutaneous fistula and post-traumatic L5 CSA. We successfully treated the CSF-cutaneous fistula with ligation and transection of the dural sac and cauda equina at the L2-L3 level. In addition, the post-traumatic L5 CSA was successfully treated with a posterior four-rod spinopelvic fixation from T9 to ilium and S2 foramina. After surgery, the CSF leakage stopped and no other adverse neurological changes were found. The four-rod spinopelvic construct was well maintained five years later. CONCLUSIONS: CSA associated with CSF-cutaneous fistula is a very rare disorder. Only surgical treatment for both CSA and CSF-cutaneous fistula with ligation and transection of the dural sac and posterior four-rod spinopelvic fixation can bring satisfactory results.

Does arthroscopic preemptive extensive rotator interval release reduce postoperative stiffness after arthroscopic rotator cuff repair?: a prospective randomized clinical trial.

BACKGROUND: To investigate whether preemptive extensive rotator interval (RI) release during arthroscopic rotator cuff repair (ARCR) would reduce postoperative stiffness. METHODS: From July 2015 to September 2016, a total of 80 patients who were scheduled for ARCR were enrolled and randomly allocated into 2 groups: the preemptive extensive RI release group (group 1, n=40) and the RI nonrelease group (group 2, n=40). The American Shoulder and Elbow Surgeons scale, Constant score, Korean Shoulder Scale (KSS), visual analog scale (VAS) pain score, and range of motion (ROM) were evaluated before surgery; 3, 6, and 12 months after surgery; and at last follow-up. Magnetic resonance imaging was performed at postoperative 12 months. RESULTS: The mean follow-up period was 26.5 months. The functional and pain scores in both groups were significantly improved at the last follow-up (P < .05). Group 1 showed a significantly higher sum of ROM with a difference of 27° and 1.6 vertebral level of internal rotation compared to group 2 at postoperative 3 months (P < .05). Constant score and KSS were significantly higher in group 1 than in group 2 at this time point (P < .05). Functional scores and ROM were not significantly different between 2 groups at postoperative 6 or 12 months or at the last follow-up (P > .05). The retear rate and pathologic change of the long head of the biceps tendon during follow-up were not significantly different between the 2 groups (P > .05). CONCLUSION: Arthroscopic preemptive extensive RI release can reduce early postoperative shoulder stiffness after ARCR but does not significantly change the overall clinical outcome after surgery.

Comparison of the regeneration induced by acellular nerve allografts processed with or without chondroitinase in a rat model.

There have been various studies about the acellular nerve allograft (ANA) as the alternative of autologous nerve graft in the treatment of peripheral nerve defects. As well as the decellularization process methods of ANA, the various enhancement methods of regeneration of the grafted ANA were investigated. The chondroitin sulfate proteoglycans (CSPGs) inhibit the action of laminin which is important for nerve regeneration in the extracellular matrix of nerve. Chondroitinase ABC (ChABC) has been reported that it enhances the nerve regeneration by degradation of CSPGs. The present study compared the regeneration of ANA between the processed without ChABC group and the processed with ChABC group in a rat sciatic nerve 15 mm gap model. At 12 weeks postoperatively, there was not a significant difference in the histomorphometric analysis. In the functional analysis, there were no significant differences in maximum isometric tetanic force, wet muscle weight of tibialis anterior. The processed without ChABC group had better result in ankle contracture angle significantly. In conclusion, there were no significant differences in the regeneration of ANA between the processed without ChABC group and the processed with ChABC group.

Initial Discharge Behavior of an Ultra High Loading 3D Sulfur Cathode for a Room-Temperature Na/S Battery.

A 3D sulfur cathode for a large-scale room-temperature (RT) Na/S battery with a high sulfur loading of 14.63 mg cm-2 was fabricated. The first discharge was tested in order to understand the macroscopic changes. A first discharge capacity of 865 mAh g-1 was obtained at 1/1000 C-rate along with a discharge curve with two clear plateaus at 2.29 V and 1.78 V, respectively. A visual change occurs in the 3D sulfur cathode. A thick layer of discharge products at the solid electrolyte separator face of the 3D sulfur cathode was observed and analyzed using a scanning electron microscope (SEM) coupled with energy dispersive X-ray spectroscopy (EDS).

Electrochemical Properties of Micron-Sized SnO Anode Using a Glyme-Based Electrolyte for Sodium-Ion Battery.

Tin monoxide (SnO) anodes are promising candidates for use in sodium-ion batteries because of their high theoretical capacities and stable cycle performance. In previous reports, electrodes with excellent performance have been prepared by using nano-sized SnO particles. However, the synthesis of nano-sized SnO particles is complex, time-consuming, and expensive. In this paper, an anode of micron-sized SnO is prepared by using commercial micron-sized SnO particles. The electrode exhibits a reversible capacity of 450 mAh g-1 in the 1st cycle at a current rate of 100 mA g-1. We used a tetraethylene glycol dimethyl ether (TEGDME)-based electrolyte, which is well known for its superior electrochemical performance in sodium-ion batteries. The mechanism of operation of the anode containing micron-sized SnO particles has been confirmed by a detailed study using X-ray diffraction (XRD), scanning electron microscopy (SEM), and electrochemical impedance spectroscopy (EIS). During initial discharge, the SnO changed to Sn and sodium oxide, and the surface of the electrode became covered with a film. The electrode composed of micron-sized SnO is a potential candidate for use in sodium-ion batteries.

Effect of Ball Milling on Electrochemical Properties of Sulfur/Polyacrylonitrile (SPAN) Cathode in Li/S Battery.

Ball-milling process was applied to increase sulfur content in sulfur/polyacrylonitrile (SPAN) composites and improve electrochemical properties of Li/S batteries. In contrast to as-received PAN, pre-heated PAN was pulverized by the ball-milling, resulting in the continuous size reduction with increasing the milling time. Sulfur contents in SPAN composites synthesized with a pre-heated and milled PAN were increased with prolonging the milling time and the maximum content reached 44.5% for the milling time of 10 h. Li/S cells with SPAN electrodes delivered the first discharge capacities of 1356, 1409, 1512, and 1610 mAh/g-sulfur for milling times of 0, 1, 5, and 10 h. The 10 h-milled SPAN electrode with the highest sulfur content exhibited poor initial efficiency and low capacity retention at 100 cycles, whereas from a comprehensive viewpoint of the specific capacity and capacity retention, the 6 h-milled SPAN electrode exhibited the best electrochemical performance due to the suitable size and sulfur content.

Analysis of a systematic error appearing as a periodic fluctuation in the frequency-domain absorption spectra of metamaterial absorbers.

A metamaterial is a periodic structure which can be considered as an effective medium that exhibits an atypical response for a corresponding range of electromagnetic (EM) waves. For metamaterial absorbers (MMA) working in the GHz regime, the frequency-domain-measurement setup consisting of two horn antennas connected to a network analyzer is widely used. The absorption spectra obtained with this setup usually exhibits some periodic fluctuation (PF) across the entire range of measurement. Typically, this PF in the frequency-domain spectrum is ignored because it is distinct from major features and has a small amplitude. We have examined the PF through a finite-difference time-domain (FDTD) simulation in order to verify the validity of such assumption. We concluded that the PF is caused by a part of EM wave radiated by an antenna (source), and directly propagating to another (detector), resulting in an interference between this leaked EM wave and the one reflected from the sample. We have successfully reproduced the periodic fluctuation of the experimental spectra by FDTD simulation. We examined the angle of incidence dependence. The amplitude increases because the amount of leaked EM waves increases, while the periodicity increases because the distance between the two antennas increases, resulting in a shortened path difference. We conclude that the PF is a systematic error which can be safely ignored.

Quadriplegia caused by an epidural abscess occurring at the same level of cervical destructive spondyloarthropathy: a case report.

BACKGROUND: Destructive spondyloarthropathy (DSA) is one of the major complications in patients undergoing long-term hemodialysis. To the best of our knowledge, an epidural abscess occurring at the level of preexisting cervical DSA has not been well described in the literature. We report a unique case of quadriplegia caused by an epidural abscess occurring at the same level of preexisting cervical DSA. CASE PRESENTATION: A 49-year-old woman was transferred to our emergency department with 5 days of sepsis, drowsy mental status, and quadriplegia below the C5 level. The patient had a medical history of hemodialysis for 10 years. Magnetic resonance imaging showed spinal cord compression by an epidural abscess at the level of preexisting cervical DSA. Blood culture revealed methicillin-sensitive Staphylococcus aureus. Infection of the arteriovenous (AV) shunt was considered as the primary focus of sepsis and pyogenic spondylitis. We performed an emergent open door laminoplasty and the vascular team debrided the infected AV shunt site. Approximately 8 months after surgery, the patient was able to perform activities of daily living somewhat independently. CONCLUSIONS: Emergent surgical decompression and intensive medical care led to successful recovery from a septic and quadriplegic state in this patient. When diagnosing a patient who has undergone long-term hemodialysis presenting with neurologic deficits, the possibility of infectious spondylitis at the same level as DSA should be considered.

Autologous Tumor Cell Lysate-Loaded Dendritic Cell Vaccine Inhibited Tumor Progression in an Orthotopic Murine Model for Hepatocellular Carcinoma.

The immune status of the tumor microenvironment influences tumor progression, and hepatocellular carcinoma (HCC) with an immunosuppressive signature often is associated with a poor prognosis. This study examined the impact of a bone marrow-derived dendritic cell (DC) vaccine loaded with autologous tumor cell lysate on tumor progression and the tumor microenvironment using an orthotopic murine HCC model. An orthotopic murine HCC was established by implantation of Hepa1-6 cells in the liver. The impact of DC vaccine loaded with Hepa1-6 cell lysate on tumor progression, survival, and tumor-infiltrating lymphocytes and cytokines was examined. Treating mice with DC vaccine loaded with Hepa1-6 cell lysate inhibited the progression of murine HCC generated through orthotopic implantation of Hepa1-6 cells and resulted in a 90 % survival rate by day 60 compared with a survival rate lower than 5 % for untreated mice. This anti-tumor response was associated with inhibition of STAT3 phosphorylation within the tumor. The DC vaccine reduced accumulation of Foxp3+CD4+ regulatory T cells within the tumor microenvironment and prevented TGF-ß production from the tumor tissue. Tumor cell lysate-loaded DC vaccine prevented HCC progression in a clinically relevant orthotopic murine HCC model. The effect of DC vaccine on the accumulation of Foxp3+CD4+ regulatory T cells within the tumor microenvironment and on the production of TGF-ß suggests that tumor regression by DC vaccination may be associated with an altered immunosuppressive tumor microenvironment.

Effects of stimulating interleukin -2/anti- interleukin -2 antibody complexes on renal cell carcinoma.

BACKGROUND: Current therapies for advanced renal cell carcinoma (RCC) have low cure rates or significant side effects. It has been reported that complexes composed of interleukin (IL)-2 and stimulating anti-IL-2 antibody (IL-2C) suppress malignant melanoma growth. We investigated whether it could have similar effects on RCC. METHODS: A syngeneic RCC model was established by subcutaneously injecting RENCA cells into BALB/c mice, which were administered IL-2C or phosphate-buffered saline every other day for 4 weeks. RCC size was measured serially, and its weight was assessed 4 weeks after RENCA injection. Immune cell infiltration into RCC lesions and spleen was assessed by flow cytometry and immunohistochemistry. RESULTS: IL-2C treatment increased the numbers of CD8(+) memory T and natural killer (NK) cells in healthy BALB/c mice (P < 0.01). In the spleen of RCC mice, IL-2C treatment also increased the number of CD8(+) memory T, NK cells, and macrophages as compared to PBS-treated controls (P < 0.01). The number of interferon-γ- and IL-10-producing splenocytes increased and decreased, respectively after 4 weeks in the IL-2C-treated mice (P < 0.01). Tumor-infiltrating immune cells including CD4(+) T, CD8(+) T, NK cells as well as macrophages were increased in IL-2C-treated mice than controls (P < 0.05). Pulmonary edema, the most serious side effect of IL-2 therapy, was not exacerbated by IL-2C treatment. However, IL-2C had insignificant inhibitory effect on RCC growth (P = 0.1756). CONCLUSIONS: IL-2C enhanced immune response without significant side effects; however, this activity was not sufficient to inhibit RCC growth in a syngeneic, murine model.

Preoperative anxiety about spinal surgery under general anesthesia.

PURPOSE: No study has investigated preoperative anxiety about spinal surgery under general anesthesia. The purposes of this study were (1) to determine how many patients have preoperative anxiety about spinal surgery and general anesthesia, (2) to evaluate the level of anxiety, (3) to identify patient factors potentially associated with the level of anxiety, and (4) to describe the characteristics of the anxiety that patients experience during the perioperative period. METHODS: This study was performed in 175 consecutive patients undergoing laminectomy for lumbar stenosis or discectomy for herniated nucleus pulposus under general anesthesia. Demographic data, information related to surgery, and characteristics of anxiety were obtained using a questionnaire. The level of anxiety was assessed using a visual analog scale of anxiety (VAS-anxiety). Patient factors potentially associated with the level of anxiety were investigated using multiple stepwise regression analysis. RESULTS: Of 157 patients finally included in this study, 137 (87%) had preoperative anxiety (VAS-anxiety > 0). The mean VAS-anxiety score for spinal surgery was significantly higher than that for general anesthesia (4.6 ± 3.0 vs. 3.2 ± 2.7; P < 0.001). Sex and age were significant patient factors related to the level of anxiety about spinal surgery (P = 0.009) and general anesthesia (P = 0.018); female patients had a higher level of anxiety about spinal surgery, and elderly patients had a higher level of anxiety about general anesthesia. The most helpful factors in overcoming anxiety before surgery and in reducing anxiety after surgery were faith in the medical staff (48.9 %) and surgeon's explanation of the surgery performed (72.3%), respectively. CONCLUSIONS: Patients awaiting laminectomy or discectomy feared spinal surgery more than general anesthesia. This study also found that medical staff and surgeons play important roles in overcoming and reducing patient anxiety during the perioperative period.

Dual broadband metamaterial absorber.

We propose polarization-independent and dual-broadband metamaterial absorbers at microwave frequencies. This is a periodic meta-atom array consisting of metal-dielectric-multilayer truncated cones. We demonstrate not only one broadband absorption from the fundamental magnetic resonances but additional broadband absorption in high-frequency range using the third-harmonic resonance, by both simulation and experiment. In simulation, the absorption was over 90% in 3.93-6.05 GHz, and 11.64-14.55 GHz. The corresponding experimental absorption bands over 90% were 3.88-6.08 GHz, 9.95-10.46 GHz and 11.86-13.84 GHz, respectively. The origin of absorption bands was elucidated. Furthermore, it is independent of polarization angle owing to the multilayered circular structures. The design is scalable to smaller size for the infrared and the visible ranges.

Motor unit number index (MUNIX) in the orbicularis oculi muscle of healthy subjects.

INTRODUCTION: The motor unit number index (MUNIX) refers to an electrophysiological method that measures the number of motor units in the surface electromyographic interference pattern (SIP) recorded during graded muscle contractions. MUNIX studies of limb muscles have been conducted, but MUNIX studies of bulbo-facial muscles have not been reported. METHODS: We assessed bilateral orbicularis oculi muscles using MUNIX, and the reference values and reproducibility of MUNIX and motor unit size index (MUSIX) were investigated in healthy subjects. RESULTS: In this study, MUNIX was applied successfully to the orbicularis oculi muscles and showed good reproducibility. The correlation coefficients for MUNIX and MUSIX were 0.803 and 0.592, respectively, and the coefficients of variation were 20.9% and 8.5%, respectively. CONCLUSIONS: The MUNIX procedure for the orbicularis oculi muscle would be a useful tool for evaluating bulbar symptoms, especially in amyotrophic lateral sclerosis.

Assessing prognostic significance of preoperative alpha-fetoprotein in hepatitis B-associated hepatocellular carcinoma: normal is not the new normal.

BACKGROUND: Hepatitis B (HBV)-associated hepatocellular carcinoma (HCC) is often associated with alpha-fetoprotein (AFP) production. Although serum AFP has been demonstrated to be a prognostic factor for patient survival, optimal cutoff levels remain unclear. METHODS: Patients with HBV-associated HCC treated by primary liver resection were prospectively followed at a single institution between 1995 and 2008. AFP level was categorized into quintiles for Kaplan­Meier analysis and multivariable Cox proportional hazards regression models. RESULTS: Best 5-year survival after surgery was observed for patients with AFP in the first quintile (1.4-4.1 ng/mL), with progressively worse outcomes for patients in each increasing quintile. AFP was associated with overall survival (HR = 1.61; 95 % CI 1.30-1.98), disease-free survival (HR = 1.26; 95 % CI 1.10-1.44), and 2-year recurrence (HR = 1.30; 95 % CI 1.07-1.57) in multivariate analysis. Noncirrhotic patients (Ishak 1-5) with AFP in quintile 1 had 94 % 5-year survival, compared with 0 % survival for patients with AFP in quintile 5 (2,332.7-327,560.0 ng/mL) and Ishak stage 6 cirrhosis. CONCLUSIONS: Preoperative serum AFP is an independent predictor of prognosis among HBV-HCC patients following surgical resection. Categorizing AFP into quintiles creates the opportunity to observe differences in outcomes even at low serum levels within the normal range. Additionally, combining AFP quintiles and fibrosis staging provides a predictive model of prognosis for HCC. Thus, even small differences in AFP within the normal range may impact prognosis and disease progression for HBV-HCC.

A mutation in Ampd2 is associated with nephrotic syndrome and hypercholesterolemia in mice.

BACKGROUND: Previously, we identified three loci affecting HDL-cholesterol levels in a screen for ENU-induced mutations in mice and discovered two mutated genes. We sought to identify the third mutated gene and further characterize the mouse phenotype. METHODS: We engaged, DNA sequencing, gene expression profiling, western blotting, lipoprotein characterization, metabolomics assessment, histology and electron microscopy in mouse tissues. RESULTS: We identify the third gene as Ampd2, a liver isoform of AMP Deaminase (Ampd), a central component of energy and purine metabolism pathways. The causative mutation was a guanine-to-thymine transversion resulting in an A341S conversion in Ampd2. Ampd2 homozygous mutant mice exhibit a labile hypercholesterolemia phenotype, peaking around 9 weeks of age (251 mg/dL vs. wildtype control at 138 mg/dL), and was evidenced by marked increases in HDL, VLDL and LDL. In an attempt to determine the molecular connection between Ampd2 dysfunction and hypercholesterolemia, we analyzed hepatic gene expression and found the downregulation of Ldlr, Hmgcs and Insig1 and upregulation of Cyp7A1 genes. Metabolomic analysis confirmed an increase in hepatic AMP levels and a decrease in allantoin levels consistent with Ampd2 deficiency, and increases in campesterol and ß-sitosterol. Additionally, nephrotic syndrome was observed in the mutant mice, through proteinuria, kidney histology and effacement and blebbing of podocyte foot processes by electron microscopy. CONCLUSION: In summary we describe the discovery of a novel genetic mouse model of combined transient nephrotic syndrome and hypercholesterolemia, resembling the human disorder.

Symmetry-breaking motility of penetrable objects in active fluids.

We investigate how a symmetric penetrable object immersed in an active fluid becomes motile due to a negative drag acting in the direction of its velocity. While similar phenomena have been reported only for active fluids that possess polar or nematic order, we demonstrate that such motility can occur even in active fluids without any preexisting order. The emergence of object motility is characterized by both continuous and discontinuous transitions associated with the symmetry-breaking bifurcation of the object's steady-state velocity. Furthermore, we also discuss the relevance of the transitions to the nonmonotonic particle-size dependence of the object's diffusion coefficient.

Impact of intrahepatic hepatitis B DNA and covalently closed circular DNA on survival after hepatectomy in HBV-associated hepatocellular carcinoma patients.

BACKGROUND: Chronic hepatitis B virus (HBV) infection induces persistent but ineffective immune activation that contributes to necroinflammation, fibrosis, and risk of hepatocellular carcinoma (HCC). This study aims to determine the relationship of intrahepatic total HBV (ih HBV) DNA and covalently closed circular DNA (cccDNA) with necroinflammation and fibrosis, and their impact on prognosis after resection in HBV HCC patients. METHODS: Data are from 111 patients treated with primary liver resection for HBV HCC at Mount Sinai, New York (1991-2008). ih HBV DNA and cccDNA were quantitated by real-time PCR. Necroinflammation was graded according to histologic activity index (HAI), and liver fibrosis was staged by the modified Ishak method. RESULTS: A total of 106 (95%) and 89 patients (80%) had detectable ih HBV DNA and cccDNA, respectively, while 43% had detectable serum HBV DNA. cccDNA made up a small proportion of ih HBV DNA (median cccDNA/ih HBV DNA ratio = 0.022). Higher levels of ih HBV DNA were associated with higher HAI and serum alanine aminotransferase (ALT), while a lower ratio of cccDNA/ih HBV DNA was associated with higher HAI, ALT, and Ishak fibrosis stage. ih HBV and cccDNA were not associated with survival, but the lowest quintile of cccDNA/ih HBV DNA ratio (<0.0024) was independently associated with poor overall survival. CONCLUSIONS: A lower cccDNA/ih HBV DNA ratio was associated with greater necroinflammation and liver fibrosis, and was independently associated with poor overall survival. Thus, intracellular virus loads and relative proportions of virus DNA reflect histologic damage in the liver and influence the clinical outcome of HBV HCC patients.