Solution immersed silicon (SIS)-based biosensors: a new approach in biosensing.

A novel, solution immersed silicon (SIS)-based sensor has been developed which employs the non-reflecting condition (NRC) for a p-polarized wave. The SIS sensor's response is almost independent of change in the refractive index (RI) of a buffer solution (BS) which makes it capable of measuring low-concentration and/or low-molecular-weight compounds.

Decision support for ecological river rehabilitation using fish habitat database.

After the recent success of several river rehabilitation projects including the Cheong-gye river case, a large number of local governments have been promoting their own projects in Korea. Most of the projects are aimed at securing the soundness of aquatic ecosystems according to the guidelines presented by the Korea Ministry of Environment. However, there is no clear guidance for the management goals of water quality and quantity. In this study, we have made an attempt to construct a habitat database (DB) for each domestic freshwater fish species. The fish population, and physical and physicochemical properties of the habitat of 70 domestic freshwater fish species were investigated using field monitoring data. After the statistical processing, the inhabitable range and optimal range of each species were suggested. Furthermore, based on the DB, a decision support system for ecological river restoration and rehabilitation has been developed, and applied for field tests. It became clear that the decision support procedure based on the fish habitat DB is useful in the planning stage of river rehabilitation projects to select the flagship fish, to decide the restoration goals considering their appropriate habitat and to suggest the optimum quantitative combination of each available water resource.

Development of Automated Delivery Quality Assurance Analysis Software for Helical Tomotherapy.

BACKGROUND: To develop a fully automated in-house gamma analysis software for the "Cheese" phantom-based delivery quality assurance (QA) of helical tomotherapy plans. METHODS: The developed in-house software was designed to automate several procedures, which need to be manually performed using commercial software packages. The region of interest for the analysis was automatically selected by cropping out film edges and thresholding dose values (>10% of the maximum dose). The film-measured dose was automatically aligned to the computed dose using an image registration algorithm. An optimal film scaling factor was determined to maximize the percentage of pixels passing gamma (gamma passing rate) between the measured and computed doses (3%/3 mm criteria). This gamma analysis was repeated by introducing setup uncertainties in the anterior-posterior direction. For 73 tomotherapy plans, the gamma analysis results using the developed software were compared to those analyzed by medical physicists using a commercial software package. RESULTS: The developed software successfully automated the gamma analysis for the tomotherapy delivery quality assurance. The gamma passing rate (GPR) calculated by the developed software was higher than that by the clinically used software by 3.0%, on average. While, for 1 of the 73 plans, the GPR by the manual gamma analysis was higher than 90% (pass/fail criteria), the gamma analysis using the developed software resulted in fail (GPR < 90%). CONCLUSIONS: The use of automated and standardized gamma analysis software can improve both the clinical efficiency and veracity of the analysis results. Furthermore, the gamma analyses with various film scaling factors and setup uncertainties will provide clinically useful information for further investigations.

Submitral left ventricular aneurysm of ischemic origin: report of two surgical cases.

Submitral left ventricular aneurysm has been exclusively recognized in the young African population and its occurrence in other than black Africans is rarely reported. Here we describe two surgical cases of submitral left ventricular aneurysm in Asian elderly persons. Although the aneurysms were typically located beneath the posterior mitral valve leaflet, we could identify diseased coronary arteries as well, unlike the reports in the literature asserting that this type of aneurysm occurs in the absence of coronary disease. The possible racial difference with regard to the etiology is addressed.

Central lymph node metastases in unilateral papillary thyroid microcarcinoma.

BACKGROUND: The indications for and appropriate extent of prophylactic central lymph node (CLN) dissection for clinically node-negative patients with unilateral papillary thyroid microcarcinoma (PTMC) are unknown. METHODS: The frequency, patterns and predictive factors for CLN metastases in 86 patients with unilateral PTMC and a clinically node-negative neck were analysed with respect to age and sex; metastasis, age, completeness, invasiveness, size (MACIS) score; tumour size; number and location of tumours; presence of ipsilateral CLN metastases; and presence of lymphovascular or capsular invasion. All patients underwent total thyroidectomy and CLN dissection. RESULTS: Twenty-seven (31 per cent) of 86 patients had metastatic CLNs: 18 ipsilateral and nine bilateral. Univariable analysis suggested male sex and tumour size greater than 0.5 cm to be significant factors in predicting ipsilateral CLN metastases. Only ipsilateral nodal positivity was a significant predictor of contralateral CLN metastases in multivariable analysis (P = 0.007). CONCLUSION: CLN metastases are relatively common in PTMC.

Risk factors for sepsis in Korean trauma patients.

PURPOSE: Sepsis in severely injured patients is one of the leading causes of death in hospitals. The incidence of and risk factors for sepsis after trauma have been studied outside, but not within Korea. Therefore, this study investigated the incidence of sepsis and the independent risk factors for sepsis in moderately to severely injured patients in Korea. METHODS: The electronic medical records of patients who visited the emergency department from January 2010 to December 2012 were reviewed retrospectively. Patients older than 18 years of age with an Injury Severity Score (ISS) greater than or equal to nine points were included. RESULTS: A total of 183 patients met the study inclusion criteria. The median ISS was 14 (range 9-17) points and 15 (8 %) patients developed sepsis. The patients' age [adjusted OR, 1.053; 95 % confidence intervals (CI), 1.015-1.094], ISS (adjusted OR, 1.114; 95 % CI, 1.046-1.187), and emergency surgery (adjusted OR, 3.727; 95 % CI, 1.051-13.221) were independent risk factors for post-traumatic sepsis. CONCLUSIONS: Among the risk factors identified in the literature, our research confirmed only the patients' age and ISS as risk factors for sepsis after trauma, and, additionally, identified emergency surgery as a risk factor in Korean patients. Therefore, trauma patients who have any of the risk factors mentioned above have a high risk of post-traumatic sepsis, which requires certain precautionary clinical measures.

Comparison of diameter and perimeter methods for tumor volume calculation.

PURPOSE: Lesion volume is often used as an end point in clinical trials of oncology therapy. We sought to compare the common method of using orthogonal diameters to estimate lesion volume (the diameter method) with a computer-assisted planimetric technique (the perimeter method). METHODS: Radiologists reviewed 825 magnetic resonance imaging studies from 219 patients with glioblastoma multiforme. Each study had lesion volume independently estimated via the diameter and perimeter methods. Cystic areas were subtracted out or excluded from the outlined lesion. Inter- and intrareader variability was measured by using multiple readings on 48 cases. Where serial studies were available in noncystic cases, a mock response analysis was used. RESULTS: The perimeter method had a reduced interreader and intrareader variability compared with the diameter method (using SD of differences): intrareader, 1.76 mL v 7.38 mL (P < .001); interreader, 2.51 mL v 9.07 mL (P < .001) for perimeter and diameter results, respectively. Of the 121 noncystic cases, 23 had serial data. In six (26.1%) of those 23, a classification difference occurred when the perimeter method was used versus the diameter method. CONCLUSION: Variability of measurements was reduced with the computer-assisted perimeter method compared with the diameter method, which suggests that changes in volume can be detected more accurately with the perimeter method. The differences between these techniques seem large enough to have an impact on grading the response to therapy.

High serum lipoprotein(a) levels in Korean type 2 diabetic patients with proliferative diabetic retinopathy.

OBJECTIVE: To examine the possible association between serum lipoprotein(a) [Lp(a)] concentration and proliferative diabetic retinopathy (PDR) in Korean patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 412 Korean outpatients with type 2 diabetes were examined. Diabetic retinopathy was determined by an ophthalmologist using fundoscopic examination. Serum Lp(a) levels were measured by two-site sandwich enzyme-linked immunosorbent assay. RESULTS: The patients with PDR had higher serum Lp(a) levels than those with no diabetic retinopathy or with nonproliferative diabetic retinopathy (NPDR). Multiple logistic regression analysis showed that high serum Lp(a) levels and the presence of diabetic nephropathy were independent variables having a statistically significant association with PDR. CONCLUSIONS: Korean type 2 diabetic patients with PDR had higher serum Lp(a) levels versus those with no diabetic retinopathy or with NPDR. Although these results suggest that Lp(a) might play a role in the occlusion of retinal capillaries leading to PDR, further prospective studies are required to prove the causal relationship.

Development and progression of diabetic retinopathy in Koreans with NIDDM.

OBJECTIVE: To determine the incidence and risk factors for the development and progression of diabetic retinopathy in Korean patients with NIDDM. RESEARCH DESIGN AND METHODS: A total of 186 patients with NIDDM who did not have proliferative diabetic retinopathy (PDR) at baseline were prospectively studied for 5.3 +/- 1.0 years in an outpatient clinic of a university hospital. The incidence and progression of diabetic retinopathy was determined by annual funduscopic examination by an ophthalmologist. RESULTS: Of the 130 patients who were free of diabetic retinopathy at baseline, 30 developed it, giving an incidence of 44.4/1,000 person-years. Age and known duration of diabetes, mean fasting plasma glucose, and HbA1 levels during the follow-up period were higher in the patients who developed diabetic retinopathy. Of the 56 patients who had nonproliferative diabetic retinopathy at baseline, 11 developed PDR, giving an incidence of 37.5/1,000 person-years. The patients who progressed to PDR during follow-up (progressors) had a higher change of BMI and urinary albumin excretion rate at baseline and a higher mean HbA1 during the follow-up period than the nonprogressors. Cox proportional hazards analysis revealed that mean HbA1 was the only independent risk factor for both the development and progression of diabetic retinopathy. CONCLUSIONS: The incidence of PDR in Korean NIDDM patients is comparable to that reported in other populations. Poor glycemic control is the most important risk factor for both the development and progression of diabetic retinopathy in NIDDM patients.

Effects of retinal adhesion of temperature, cyclic AMP, cytochalasin, and enzymes.

We have studied factors that contribute to retinal adhesion, by measuring directly the force required to peel rabbit retina from the retinal pigment epithelium (RPE). Exposing the tissue to either testicular hyaluronidase or neuraminidase, or acidifying the medium to pH 6.0, reduced the peeling force within 2 min. Cooling the tissue to 25 degrees C or 4 degrees C increased the peeling force to such a degree that retinal separation occurred by rupture of the RPE cells rather than widening of the subretinal space. Inhibition of the cytoplasmic contractile system with cytochalasin had no significant effect on peeling force, but dibutyryl cAMP (which decreases fluid absorption by the RPE) weakened adhesion. These results suggest that retinal adhesion involves a number of interrelated physical and metabolic factors.

Depletion of intracellular zinc and copper with TPEN results in apoptosis of cultured human retinal pigment epithelial cells.

PURPOSE: Although zinc deficiency may contribute to the pathogenesis of age-related macular degeneration, how it leads to retinal pigment epithelium (RPE) degeneration is unknown. To investigate this, cultured human RPE cells were rendered zinc depleted with a membrane-permeant metal chelator, N,N,N',N-tetrakis(2-pyridylmethyl) ethylenediamine (TPEN), and the resultant cytopathic changes were examined. METHODS: RPE cell degeneration was examined with light microscopy, TdT-mediated dUTP nick end labeling (TUNEL) staining, Hoechst dye staining, and electron microscopy and quantified with cell counting or lactate dehydrogenase release assay. The effect of sublethal zinc depletion on the vulnerability of RPE cells to UV irradiation or hydrogen peroxide (H(2)O(2)) exposure, was studied in cultures without or with pretreatment with low-concentration TPEN. RESULTS: Exposure to 1 to 4 microM TPEN for 48 hours induced RPE cell death in a concentration-dependent manner. Features of apoptosis such as membrane blebbing, chromatin condensation, nuclear fragmentation, and caspase-3 activation, accompanied the TPEN-induced cell death. Addition of equimolar zinc or copper completely reversed TPEN-induced apoptosis, whereas addition of iron had no effect. As in apoptosis of several other cell types including neurons, a protein synthesis inhibitor as well as caspase inhibitors blocked TPEN-induced apoptosis. On the contrary, at sublethal concentrations, TPEN increased the vulnerability of RPE cells to subsequent UV irradiation but not to H(2)O(2) exposure. CONCLUSIONS: The present results suggest that depletion of intracellular zinc and copper, but not copper alone, may be harmful to RPE cells, directly inducing apoptosis or indirectly increasing vulnerability of RPE cells to UV injury. The present culture model may be useful for gaining insights into the mechanisms of zinc depletion-associated RPE cell degeneration.

Dextromethorphan protects retina against ischemic injury in vivo.

Retinal ischemia was induced in rabbits by increasing intraocular pressure above systolic blood pressure for 60 or 75 minutes, and retinal function was monitored by electroretinography. Pretreatment with intravenous dextromethorphan, a nonprescription antitussive and selective antagonist of N-methyl-D-aspartate receptors, enhanced greatly the post-ischemic recovery of b-wave amplitude. Dextromethorphan may prove to be useful clinically in the management of retinal ischemic disease.

Needle thoracic sympathectomy for essential hyperhidrosis: intermediate-term follow-up.

BACKGROUND: Essential hyperhidrosis is a condition with excessive sweating localized to certain part of the body. A definitive cure can be obtained by upper thoracic sympathectomy. METHOD: Between June and October 1997, 117 patients with essential hyperhidrosis underwent needle thoracoscopic sympathectomy. Of the 94 patients, 42 were men and 52 women. Their ages ranged from 14 to 63 years, with a mean age of 23 years. RESULTS: There were no mortality or life-threatening complications. Symptomatic improvement was found in 95.7%. Compensatory hyperhidrosis was found in 71.2% of the patients, but in these compensatory hyperhidrosis were mostly tolerable. CONCLUSIONS: This therapeutic procedure is minimally invasive and very effective. Further development of the new device and surgical technique are expected to follow.

Myositis ossificans of the chest wall simulating malignant neoplasm.

Myositis ossificans originating from the chest wall is extremely rare. We report a case of myositis ossificans occurring in a young woman with progressive painful swelling in the chest wall. Preoperative examination suggested a malignant neoplasm originating from soft tissue. Although rare, myositis ossificans is one of the potential causes of painful swelling in the chest wall, and can be mistaken for a malignant neoplasm.

High vulnerability of GABA-immunoreactive neurons to kainate in rat retinal cultures: correlation with the kainate-stimulated cobalt uptake.

Like other areas of the central nervous system, the retina is highly vulnerable to ischemia. In particular, neurons in the inner nuclear layer, including gamma-amino butyric acid (GABA)-ergic amacrine neurons, are highly vulnerable. Since excitotoxicity is likely a major mechanism of ischemic retinal injury, using rat retinal cell culture, we examined whether GABAergic retinal neurons are differentially vulnerable to particular excitotoxins. The neuronal population as a whole, identified by anti-microtubule associated protein-2 (MAP-2) immunocytochemistry, was equally vulnerable to kainate, but more resistant to N-methyl-d-aspartate (NMDA) than cultured cortical neurons. Compared to Thy-1 immunoreactive neurons, GABA immunoreactive neurons were more vulnerable to kainate, but more resistant to NMDA neurotoxicity. Double staining of cultures with anti-GABA immunocytochemistry and the kainate-stimulated cobalt uptake method, revealed a close correlation between the two. However, unlike in other neuronal cells, there was no clear correlation between GluR2 immunoreactivity and the cobalt staining. The heightened vulnerability of GABAergic neurons to kainate, as compared to the general neuronal population, may be due to the calcium-permeable AMPA/kainate receptors they have, as identified functionally by the kainate-stimulated cobalt uptake staining. Since these neurons are preferentially injured in ischemia, AMPA/kainate receptor-mediated neurotoxicity may contribute significantly to ischemic retinal injury.

Depletion of intracellular zinc induces macromolecule synthesis- and caspase-dependent apoptosis of cultured retinal cells.

Although zinc deficiency may contribute to age-related macular degeneration (ARMD), the pathogenic mechanism is as yet uncertain. In light of evidence that cellular zinc depletion induces apoptosis in cortical neurons and thymocytes, in the present study, we examined the possibility that the same phenomenon occurs also in retinal cells. Exposure of primary retinal cell cultures to 1-3 microM of a cell membrane-permeant zinc chelator TPEN for 24 h induced concentration-dependent death of neurons, photoreceptor cells, and astrocytes. Addition of zinc or copper reversed TPEN toxicity to all cell components, indicating the particular involvement of zinc chelation in cell death. Consistent with apoptosis, oligonucleosomal DNA fragmentation and chromatin condensation accompanied, and the protein synthesis inhibitor cycloheximide blocked the TPEN-induced retinal cell death. During TPEN-induced retinal cell apoptosis, cleavage/activation of procaspase-1, but little of procaspase-3, was observed. Consistent with this finding, a broad-spectrum caspase inhibitor (zVAD-fmk) was significantly more protective than a caspase-3-selective inhibitor (DEVD-fmk). The present study has demonstrated that depletion of intracellular zinc is sufficient to induce macromolecule synthesis- and caspase-dependent apoptosis of cultured retinal cells. In light of the possibility that zinc depletion may contribute to the pathogenesis of ARMD, the current culture model may be a useful tool for the investigation of the mechanism of zinc depletion-induced retinal cell death.

Reconstruction of basement membrane in skin equivalent; role of laminin-1.

To reconstruct the basement membrane in a skin equivalent, the epidermodermal interface was coated with porcine type IV collagen and mouse laminin-1 at various ratios before keratinocyte seeding. Laminin-1, a component of the basement membrane, induced massive infiltration of keratinocytes into the dermal equivalent, while type IV collagen induced discrete demarcation between dermal and epidermal compartments without any infiltrating cells. Immunohistochemical staining indicated that the laminin-induced infiltrating cells expressed endogenous type IV collagens at the cell periphery, which were not incorporated into the basement membrane structure. The infiltrating cells did not express fibronectin receptor alpha5beta1 integrin but showed MMP-9 secretion and cell surface associated MMP-2. However, when laminin-1 was preincubated with type IV collagen, laminin-1-induced keratinocyte infiltration as well as MMP-9 induction were almost completely suppressed to basal levels. Therefore, replenishment of the type IV collagen lattice seemed to cause laminin-stimulated cells to anchor to the lattice, in a similar manner to the basal cells on the basement membrane of normal skin. Our study suggests that the molar ratio of basement membrane components may determine the behavior of basal cells within the wound healing microenvironment, which is probably regulated either by extracellular matrix deposition or degradation.

Increases in intraocular pressure during hemodialysis in eyes during early postvitrectomy period.

BACKGROUND AND OBJECTIVES: To identify risk factors for intraocular pressure (IOP) increases during hemodialysis (HD) in the early postoperative period following pars plana vitrectomy (PPV). PATIENTS AND METHODS: Comparisons of 36 vitrectomized eyes of 22 diabetics undergoing maintenance HD with those of 138 eyes of 69 nonoperated patients. Serial IOPs were measured before PPV, after PPV/before dialysis, and during dialysis. Serum osmolarity and blood pressure were also recorded. RESULTS: In 20 of 36 operated eyes (55.6%) and 18 of 138 nonoperated eyes (13.0%) IOP was increased (> or =4 mm Hg) during HD. In the operated group, marked increases (> or =7 mm Hg) were noted in 9 eyes and ocular pain in 5 eyes. Eyes with pre-existing outflow obstruction and/or acute postoperative outflow compromise carried high risks. No correlation with changes in serum osmolarity or blood pressure was found. CONCLUSION: Monitoring of IOP during HD seems warranted when diabetics with pre-existing outflow obstruction and/or postoperative outflow compromise, undergo HD following PPV.

Iron-induced cytotoxicity in cultured rat retinal neurons.

Oxidative stress has been proposed as a major injury mechanism in the central nervous system including the retina. In this study, as an initial attempt to study the mechanism of oxidative injury in the retina, we developed a cell culture model by utilizing the iron exposure paradigm. Exposure of rat retinal cultures for 24 hours to 10-40 MicroM ferrous or ferric chloride induced a concentration-dependent death of retinal neurons but not of photoreceptors or astrocytes. An antioxidant, trolox effectively attenuated the iron-induced death of neurons and photoreceptors in a dose-dependent manner whereas neither glutamate receptor antagonists nor cycloheximide were protective. Of retinal interneurons, GABAergic neurons were more vulnerable to the iron toxicity than calbindin (+) horizontal neurons. These findings show that iron exposure induces anti-oxidant-sensitive neuronal injury in retinal culture, independent of the excitotoxic or the apoptotic mechanisms. Of retinal neurons, different cell types exhibit differential vulnerabilities to the iron-induced oxidative injury. This simplified culture model system may be useful in elucidating mechanisms of oxidative injury in the retina.

Preservation of retinal sensitivity in central visual field after panretinal photocoagulation in diabetics.

Changes in retinal sensitivity within central 30 degrees following panretinal photocoagulation (PRP) for more severe diabetic retinopathy were investigated. Twenty-five eyes with visual acuity of 0.4 or better and minimal maculopathy were studied prospectively. All underwent PRP in two sittings, and Humphrey field analyzer 30-2 threshold test was done before and 1 week, 1 and 3 months after the treatment. The mean retinal sensitivity threshold was obtained from each hemifield between 15 and 30 degrees and from the central 15 degree area, and the changes in the values were analyzed. Mean sensitivity threshold in the upper visual field at pre-PRP, post-PRP 1 week, 1, 3 months were 15.62, 13.81, 14.31, 14.85, respectively. Values in the lower field were 18.71, 17.25, 17.10, 18.17. Difference between pre-PRP and post-PRP was statistically significant at 1 week but no longer thereafter. Retinal sensitivity within the central 15 degrees remained stable. The data show that retinal sensitivity decreases significantly 1 week after PRP but recovers upto 95% of pre-PRP level over the following 3 months.