The risk factors of miscarriage and obstetrical outcomes of intrauterine normal pregnancy following heterotopic pregnancy management.

To investigate the clinical characteristics and risk factors for miscarriage of intrauterine normal pregnancy of patients with a heterotopic pregnancy (HP) after treatment.This was a retrospective study of medical records from CHA Bundang Medical Center. Sixty-four patients who were diagnosed with a HP between February 2006 and July 2017 were included in this study. All analyses were performed using SAS software, version 9.4 (SAS Institute, Inc., Cary, NC). P values < .05 were considered statistically significant.Forty-eight patients had tubal ectopic pregnancies (EP), 10 patients had cornual EPs, 1 patient had a cesarean section scar EP, 4 patients had an ovarian EP, and 1 patient had bilateral tubal EP. Among the 64 patients, 14.1% (9/64) miscarried before 10 weeks of gestation after management. Mean gestational age (GA) at treatment was 5.97 ±â€Š0.50 weeks and 6.80 ±â€Š1.04 weeks for miscarriage and nonmiscarriage group, respectively (P = .008). Significant differences were observed between 2 groups in terms of ultrasonographic features at the time HP was diagnosed (P = .040) Logistic regression models indicated that gestational age at treatment showed significant differences between 2 groups (OR: 0.003, 95% CI: 0.001-0.604).Immediate management after diagnosis could expect favorable prognosis of HP. GA at treatment was the only independent risk factor for miscarriage in patients with HP regardless of treatment methods.

The combination of mannitol and temozolomide increases the effectiveness of stem cell treatment in a chronic stroke model.

BACKGROUND: The blood-brain barrier (BBB) presents a significant challenge to the therapeutic efficacy of stem cells in chronic stroke. Various methods have been developed to increase BBB permeability, but these are associated with adverse effects and are, therefore, not clinically applicable. We recently identified that combination drug treatment of mannitol and temozolomide improved BBB permeability in vitro. Here, we investigated whether this combination could increase the effectiveness of stem cell treatment in an animal model of chronic ischemic stroke. METHODS: Chronic stroke was induced in rats by middle cerebral artery occlusion (MCAo). After then, rats were administered human umbilical cord-derived mesenchymal stromal cells (hUC-MSCs) by intravenous injection with or without combination drug treatment of mannitol and temozolomide. To evaluate the therapeutic efficacy, behavioral and immunohistochemical tests were performed, and the differences among control, stem cell only, combination drug only and stem cell with combination drug treatment were analyzed. RESULTS: Although no hUC-MSCs were detected in any group, treatment with stem cells and combination drug of mannitol and temozolomide increased the intracerebral delivery of hCD63-positive microvesicles compared with stem cell only treatment. Furthermore, treatment with stem cells and drug combination ameliorated behavioral deficits and increased bromodeoxyuridine-, doublecortin- and Reca-1-positive cells in the perilesional area as compared with other groups. DISCUSSION: The combination drug treatment of mannitol and temozolomide allowed for the efficient delivery of hUC-MSC-derived microvesicles into the brain in a chronic stroke rat model. This attenuated behavioral deficits, likely by improving neural regeneration and angiogenesis. Thus, combination drug treatment of mannitol and temozolomide could be a novel therapeutic option for patients with chronic ischemic stroke.

Embolization of the inferior mesenteric artery for post-partum hemorrhage with a vaginal laceration: A case with unusual collateral supply.

A 36-year-old primipara woman was referred to the interventional department for management of severe primary post-partum hemorrhage with a vaginal laceration after a normal vaginal delivery. Angiography revealed that the superior rectal branch of the inferior mesenteric artery was one of the origins of persistent vaginal bleeding following embolization of both uterine arteries. The patient was successfully treated by selective embolization without other complications. Our case report highlights that the inferior mesenteric artery should be considered as an unusual extrauterine source for post-partum hemorrhage.

Embolization of Inferior Mesenteric Artery for Intractable Intrapelvic and Vaginal Bleeding After Hysterectomy.

Branches of the internal iliac artery or ovarian artery are the typical sources of pelvic hemorrhage. The inferior mesenteric artery has been rarely reported as the origin of pelvic bleeding. We present 2 cases of intractable intrapelvic and vaginal bleeding after hysterectomy. One patient underwent a hysterectomy because of uncontrolled postpartum hemorrhage and another underwent a vaginal hysterectomy to treat vaginal prolapse. Both patients were subjected to angiography to control continuous vaginal bleeding after hysterectomy. The angiography revealed that the bleeding originated from the inferior mesenteric artery. Selective embolization of the inferior mesenteric artery successfully controlled the intractable intrapelvic and vaginal bleeding without complications. The inferior mesenteric artery is a potential source of intractable intrapelvic and vaginal bleeding for patients with a lower genital tract injury.

Distribution of Toxin Genes and Enterotoxins in Bacillus thuringiensis Isolated from Microbial Insecticide Products.

Bacillus thuringiensis microbial insecticide products have been applied worldwide. Although a few cases of B. thuringiensis foodborne illness have been reported, little is known about the toxigenic properties of B. thuringiensis isolates. The aims of this study were to estimate the pathogenic potential of B. thuringiensis selected from microbial insecticide products, based on its possession of toxin genes and production of enterotoxins. Fifty-two B. thuringiensis strains selected from four kinds of microbial insecticide products were analyzed. PCR assay for detection of toxin genes and immunoassay for detection of enterotoxins were performed. The hemolysin BL complex as a major enterotoxin was produced by 17 (32.7%), whereas the nonhemolytic enterotoxin complex was detected in 1 (1.9%) of 52 B. thuringiensis strains. However, cytK, entFM, and ces genes were not detected in any of the tested B. thuringiensis strains. The potential risk of food poisoning by B. thuringiensis along with concerns over B. thuringiensis microbial insecticide products has gained attention recently. Thus, microbial insecticide products based on B. thuringiensis should be carefully controlled.

Prevalence, genetic diversity, and antibiotic resistance of Bacillus cereus isolated from Korean fermented soybean products.

Bacillus cereus contamination is a major food safety problem for Korean fermented soybean products, but few studies have assessed its potential to cause foodborne illness. The objectives of this study were to investigate the prevalence and characteristics of B. cereus isolated from Korean fermented soybean products. B. cereus was detected in 110 of 162 (67.9%) samples. The highest B. cereus frequency was observed in deonjang (68 of 93 samples, 73.1%) and cheonggukjang (18 of 25, 72.0%); however, nonhemolytic enterotoxin was detected only in 22 of 162 samples (13.6%). Although the tested B. cereus isolates showed diverse pulsotypes according to repetitive sequence-PCR banding patterns, they displayed similar antibiotic sensitivity spectra. The low frequency of enterotoxin detection suggests that the potential risk of B. cereus foodborne illness associated with Korean fermented soybean products is lower than generally presumed. However, considering the prevalence of B. cereus and the high content of fermented soybean products in the Korean diet, it is necessary to constantly monitor the level of contamination with B. cereus and its toxins in such Korean food products.

Flexural strength and microstructure of two lithium disilicate glass ceramics for CAD/CAM restoration in the dental clinic.

OBJECTIVES: There has been a growing interest in glass ceramic systems with good esthetics, high fracture resistance and bonding durability, and simplified fabrication techniques using CAD/CAM. The aim of this study is to compare flexural strength before and after heat treatment of two lithium disilicate CAD/CAM blocks, IPS e.max CAD (Ivoclar Vivadent) and Rosetta SM (Hass), and to observe their crystalline structures. MATERIALS AND METHODS: Biaxial flexural strength was tested according to ISO 6872 with 20 disc form specimens sliced from each block before and after heat treatment. Also, the crystalline structures were observed using field-emission scanning microscopy (FE-SEM, Hitachi) and x-ray diffraction (XRD, Rigaku) analysis. The mean values of the biaxial flexural strength were analyzed by the Mann-Whitney U test at a significance level of p = 0.05. RESULTS: There were no statistically significant differences in flexural strength between IPS e.max CAD and Rosetta SM either before heat treatment or after heat treatment. For both ceramics, the initial flexural strength greatly increased after heat treatment, with significant differences (p < 0.05). The FE-SEM images presented similar patterns of crystalline structure in the two ceramics. In the XRD analysis, they also had similar patterns, presenting high peak positions corresponding to the standard lithium metasilicate and lithium disilicate at each stage of heat treatment. CONCLUSIONS: IPS e.max CAD and Rosetta SM showed no significant differences in flexural strength. They had a similar crystalline pattern and molecular composition.

The phenotypic and genotypic characterization of Korean isolates of Cronobacter spp. (Enterobacter sakazakii).

This study was conducted to investigate the phenotypic and genotypic characteristics of Korean isolates of Cronobacter spp. (Enterobacter sakazakii). A total of 43 Cronobacter spp., including 5 clinical isolates, 34 food isolates, 2 environmental isolates, and 2 reference strains (C. sakazakii ATCC 29004 and C. muytjensii ATCC51329) were used in this study. Korean isolates of Cronobacter spp. were divided into 11 biogroups according to their biochemical profiles and 3 genomic groups based on the analysis of their 16S rRNA gene sequences. Biogroups 1 and 2 contained the majority of isolates (n=26), most of which were contained in 16S rRNA cluster 1 (n=34). Korean isolates of Cronobacter spp. showed diverse biochemical profiles. Biogroup 1 contained C. sakazakii GIHE (Gyeonggido Research Institute of Health and Environment) 1 and 2, which were isolated from babies that exhibited symptoms of Cronobacter spp. infection such as gastroenteritis, sepsis, and meningitis. Our finding revealed that Biogroup 1, C. sakazakii, is more prevalent and may be a more pathogenic biogroup than other biogroups, but the pathogenic biogroup was not represented clearly among the 11 biogroups tested in this study. Thus, all biogroups of Cronobacter spp. were recognized as pathogenic bacteria, and the absence of Cronobacter spp. in infant foods should be constantly regulated to prevent food poisoning and infection caused by Cronobacter spp.

Regional context-sensitive support vector machine classifier to improve automated identification of regional patterns of diffuse interstitial lung disease.

We propose the use of a context-sensitive support vector machine (csSVM) to enhance the performance of a conventional support vector machine (SVM) for identifying diffuse interstitial lung disease (DILD) in high-resolution computerized tomography (HRCT) images. Nine hundred rectangular regions of interest (ROIs), each 20 × 20 pixels in size and consisting of 150 ROIs representing six regional disease patterns (normal, ground-glass opacity, reticular opacity, honeycombing, emphysema, and consolidation), were marked by two experienced radiologists using consensus HRCT images of various DILD. Twenty-one textual and shape features were evaluated to characterize the ROIs. The csSVM classified an ROI by simultaneously using the decision value of each class and information from the neighboring ROIs, such as neighboring region feature distances and class differences. Sequential forward-selection was used to select the relevant features. To validate our results, we used 900 ROIs with fivefold cross-validation and 84 whole lung images categorized by a radiologist. The accuracy of the proposed method for ROI and whole lung classification (89.88 ± 0.02%, and 60.30 ± 13.95%, respectively) was significantly higher than that provided by the conventional SVM classifier (87.39 ± 0.02%, and 57.69 ± 13.31%, respectively; paired t test, p < 0.01, and p < 0.01, respectively). We conclude that our csSVM provides better overall quantification of DILD.

Feasibility of automated quantification of regional disease patterns depicted on high-resolution computed tomography in patients with various diffuse lung diseases.

OBJECTIVE: This study was designed to develop an automated system for quantification of various regional disease patterns of diffuse lung diseases as depicted on high-resolution computed tomography (HRCT) and to compare the performance of the automated system with human readers. MATERIALS AND METHODS: A total of 600 circular regions-of-interest (ROIs), 10 pixels in diameter, were utilized. The 600 ROIs comprised 100 ROIs that represented six typical regional patterns (normal, ground-glass opacity, reticular opacity, honeycombing, emphysema, and consolidation). The ROIs were used to train the automated classification system based on the use of a Support Vector Machine classifier and 37 features of texture and shape. The performance of the classification system was tested with a 5-fold cross-validation method. An automated quantification system was developed with a moving ROI in the lung area, which helped classify each pixel into six categories. A total of 92 HRCT images obtained from patients with different diseases were used to validate the quantification system. Two radiologists independently classified lung areas of the same CT images into six patterns using the manual drawing function of dedicated software. Agreement between the automated system and the readers and between the two individual readers was assessed. RESULTS: The overall accuracy of the system to classify each disease pattern based on the typical ROIs was 89%. When the quantification results were examined, the average agreement between the system and each radiologist was 52% and 49%, respectively. The agreement between the two radiologists was 67%. CONCLUSION: An automated quantification system for various regional patterns of diffuse interstitial lung diseases can be used for objective and reproducible assessment of disease severity.

Bayesian classifier for predicting malignant renal cysts on MDCT: early clinical experience.

OBJECTIVE: The objective of our study was to evaluate the feasibility and usefulness of the Bayesian classifier for predicting malignant renal cysts on MDCT. MATERIALS AND METHODS: Ninety-three complicated cysts with pathologic confirmation were enrolled. Patient age and sex and seven morphologic features of the cysts including the maximum diameter, wall features, wall thickness, septa features, measurable enhancement of the wall and septa, presence of calcification, and presence of an enhancing soft-tissue component were used to train the Bayesian classifier. Four radiologists independently reviewed the MDCT images, and the probability of malignancy in each cyst was rated by the radiologists and the Bayesian classifier. The diagnostic performances of the radiologists' visual decisions and the Bayesian classifier were then compared using receiver operating characteristic (ROC) curve analysis. The sensitivity and specificity were also compared between the visual decisions and the Bayesian classifier. RESULTS: The area under the ROC curve for predicting malignant renal cysts by the Bayesian classifier was greater than the visual decisions of three readers (reader 1, p = 0.02; reader 2, p < 0.01; reader 4, p = 0.02) and was similar to the visual decision of one reader (reader 3, p = 0.51). The specificity for predicting malignant renal cysts was greater by the Bayesian classifier than by the visual decisions in readers 2 (p = 0.04) and 4 (p = 0.02) and was similar in readers 1 (p = 0.68) and 3 (p = 1.00). In terms of sensitivity, there was no significant difference between the Bayesian classifier and the visual decisions in all four readers (p > 0.05). CONCLUSION: For predicting malignant renal cysts on MDCT, the Bayesian classifier is feasible and may improve diagnostic performance.

Development of an automatic classification system for differentiation of obstructive lung disease using HRCT.

The motivation is to introduce new shape features and optimize the classifier to improve performance of differentiating obstructive lung diseases, based on high-resolution computerized tomography (HRCT) images. Two hundred sixty-five HRCT images from 82 subjects were selected. On each image, two experienced radiologists selected regions of interest (ROIs) representing area of severe centrilobular emphysema, mild centrilobular emphysema, bronchiolitis obliterans, or normal lung. Besides 13 textural features, additional 11 shape features were employed to evaluate the contribution of shape features. To optimize the system, various ROI size (16 x 16, 32 x 32, and 64 x 64 pixels) and other classifier parameters were tested. For automated classification, the Bayesian classifier and support vector machine (SVM) were implemented. To assess cross-validation of the system, a five-folding method was used. In the comparison of methods employing only the textural features, adding shape features yielded the significant improvement of overall sensitivity (7.3%, 6.1%, and 4.1% in the Bayesian and 9.1%, 7.5%, and 6.4% in the SVM, in the ROI size 16 x 16, 32 x 32, 64 x 64 pixels, respectively; t test, P < 0.01). After feature selection, most of cluster shape features were survived ,and the feature selected set shows better performance of the overall sensitivity (93.5 +/- 1.0% in the SVM in the ROI size 64 x 64 pixels; t test, P < 0.01). Adding shape features to conventional texture features is much useful to improve classification performance of obstructive lung diseases in both Bayesian and SVM classifiers. In addition, the shape features contribute more to overall sensitivity in smaller ROI.

Performance testing of several classifiers for differentiating obstructive lung diseases based on texture analysis at high-resolution computerized tomography (HRCT).

Machine classifiers have been used to automate quantitative analysis and avoid intra-inter-reader variability in previous studies. The selection of an appropriate classification scheme is important for improving performance based on the characteristics of the data set. This paper investigated the performance of several machine classifiers for differentiating obstructive lung diseases using texture analysis on various ROI (region of interest) sizes. 265 high-resolution computerized tomography (HRCT) images were taken from 92 subjects. On each image, two experienced radiologists selected ROIs with various sizes representing area of severe centrilobular emphysema (PLE, n=63), mild centrilobular emphysema (CLE, n=65), bronchiolitis obliterans (BO, n=70) or normal lung (NL, n=67). Four machine classifiers were implemented: naïve Bayesian classifier, Bayesian classifier, ANN (artificial neural net) and SVM (support vector machine). For a testing method, 5-fold cross-validation methods were used and each validation was repeated 20 times. The SVM had the best performance in overall accuracy (in ROI size of 32x32 and 64x64) (t-test, p<0.05). There was no significant overall accuracy difference between Bayesian and ANN (t-test, p<0.05). The naïve Bayesian method performed significantly worse than the other classifiers (t-test, p<0.05). SVM showed the best performance for classification of the obstructive lung diseases in this study.

Semi-automatic measurement of the airway dimension by computed tomography using the full-width-half-maximum method: a study on the measurement accuracy according to the CT parameters and size of the airway.

OBJECTIVE: To assess the influence of variable factors such as the size of the airway and the CT imaging parameters such as the reconstruction kernel, field-of-view (FOV), and slice thickness on the automatic measurement of airway dimension. MATERIALS AND METHODS: An airway phantom was fabricated that contained eleven poly-acryl tubes of various lumen diameters and wall thicknesses. The measured density of the poly-acryl wall was 150 HU, and the measured density of the airspace filled with polyurethane foam was -900 HU. CT images were obtained using a 16-MDCT (multidetector CT) scanner and were reconstructed with various reconstruction kernels, thicknesses and FOV. The luminal radius and wall thickness were measured using in-house software based on the full-width-half-maximum method. The measured values as determined by CT and the actual dimensions of the tubes were compared. RESULTS: Measurements were most accurate on images reconstructed with use of a standard kernel (mean error: -0.03 +/- 0.21 mm for wall thickness and -0.12 +/- 0.11 mm for the luminal radius). There was no significant difference in accuracy among images with the use of variable slice thicknesses or a variable FOV. Below a 1-mm threshold, the measurement failed to represent the change of the real dimensions. CONCLUSION: Measurement accuracy was strongly influenced by the specific reconstruction kernel utilized. For accurate measurement, standardization of the imaging protocol and selection of the appropriate anatomic level are essential.

Semi-automatic measurement of the airway dimension by computed tomography using the full-with-half-maximum method: a study of the measurement accuracy according to the orientation of an artificial airway.

OBJECTIVE: To develop an algorithm to measure the dimensions of an airway oriented obliquely on a volumetric CT, as well as assess the effect of the imaging parameters on the correct measurement of the airway dimension. MATERIALS AND METHODS: An airway phantom with 11 poly-acryl tubes of various lumen diameters and wall thicknesses was scanned using a 16-MDCT (multidetector CT) at various tilt angles (0, 30, 45, and 60 degrees ). The CT images were reconstructed at various reconstruction kernels and thicknesses. The axis of each airway was determined using the 3D thinning algorithm, with images perpendicular to the axis being reconstructed. The luminal radius and wall thickness was measured by the full-width-half-maximum method. The influence of the CT parameters (the size of the airways, obliquity on the radius and wall thickness) was assessed by comparing the actual dimension of each tube with the estimated values. RESULTS: The 3D thinning algorithm correctly determined the axis of the oblique airway in all tubes (mean error: 0.91 +/- 0.82 degrees ). A sharper reconstruction kernel, thicker image thickness and larger tilt angle of the airway axis resulted in a significant decrease of the measured wall thickness and an increase of the measured luminal radius. Use of a standard kernel and a 0.75-mm slice thickness resulted in the most accurate measurement of airway dimension, which was independent of obliquity. CONCLUSION: The airway obliquity and imaging parameters have a strong influence on the accuracy of the airway wall measurement. For the accurate measurement of airway thickness, the CT images should be reconstructed with a standard kernel and a 0.75 mm slice thickness.

Gene inactivation study of gntE reveals its role in the first step of pseudotrisaccharide modifications in gentamicin biosynthesis.

A gene inactivation study was performed on gntE, a member of the gentamicin biosynthetic gene cluster in Micromonospora echinospora. Computer-aided homology analysis predicts a methyltransferase-related cobalamin-binding domain and a radical S-adenosylmethionine domain in GntE. It is also found that there is no gntE homolog within other aminoglycoside biosynthetic gene clusters. Inactivation of gntE was achieved in both M. echinospora ATCC 15835 and a gentamicin high-producer GMC106. High-performance liquid chromatographic analysis, coupled with mass spectrometry, revealed that gntE mutants accumulated gentamicin A2 and its derivative with a methyl group installed on the glucoamine moiety. This result substantiated that GntE participates in the first step of pseudotrisaccharide modifications in gentamicin biosynthesis, though the catalytic nature of this unusual oxidoreductase/methyltransferase candidate is not resolved. The present gene inactivation study also demonstrates that targeted genetic engineering can be applied to produce specific gentamicin structures and potentially new gentamicin derivatives in M. echinospora.

Texture-based quantification of pulmonary emphysema on high-resolution computed tomography: comparison with density-based quantification and correlation with pulmonary function test.

PURPOSE: To develop a system for texture-based quantification of emphysema on high-resolution computed tomography (HRCT) and to compare it with density-based quantification in correlation with pulmonary function test (PFT). MATERIALS AND METHODS: Two hundred sixty-one circular regions of interest (ROI) with 16-pixel diameter [66 ROIs representing typical area of normal lung; 69 representing bronchiolitis obliterans (BO); 64, mild emphysema (ME); and 62, severe emphysema (SE)] were used to train the automated classification system based on the Support Vector Machine classifier and on variable texture and shape features. An automated quantification system was developed with a moving ROI in the lung area, which classified each pixel into 4 categories. To validate the system, the HRCT and standard-kernel-reconstructed volumetric CT data of 39 consecutive patients with emphysema were included. Using this system, the whole lung area was evaluated, and the area fractions of each class were calculated (normal lung%, BO%, ME%, SE%, respectively). The emphysema index (EI) of texture-based quantification was defined as follows: (0.3 x ME% + SE%) (TEI). EIs from density-based quantification with a threshold of -950 Hounsfield Units, were measured on both HRCT (DEI_HR_2D) and on volumetric CT (DEI_standard_3D). The agreement between TEI, DEI_HR_2D, and DEI_standard_3D was assessed using interclass correlation coefficients (ICC). Correlation of the results on the TEI with the PFT results was compared with the results of the DEI_standard_3D and the DEI_HR_2D with Spearman's correlation test. To evaluate the contribution of each texture-based quantification lesion (BO%, ME%, SE%) on PFT, multiple linear regression analysis was performed. RESULTS: The calculated TEI (19.71% +/- 17.98%) was well correlated with the DEI_standard_3D (19.42% +/- 14.30%) (ICC = 0.95), whereas the ICC with DEI_HR_2D (37.22% +/- 9.42%) was 0.43. TEI showed better correlation with PFT than DEI_standard_3D or DEI_HR_2D did [R = 0.71 vs. 0.67 vs. 0.61 for forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC); 0.54 vs. 0.50 vs. 0.43 for diffusing capacity (DLco), respectively]. Multiple linear regression analysis revealed that the BO% and SE% areas were independent determinants of FEV(1)/FVC, whereas the ME% and the SE% were determinants of DLco. CONCLUSION: Texture-based quantification of emphysema using an automated system showed better correlation with the PFT results than density-based quantification. Separate quantification of the BO, ME, and SE areas showed a different contribution of each component to the FEV(1)/FVC and the DLco. The proposed system can be successfully used for detailed regional and global evaluation of lung lesions on HRCT scanning for emphysema.

A three-dimensional analysis of soft and hard tissue changes after a mandibular setback surgery.

This paper is concerned with a three-dimensional (3D) analysis on soft and hard tissue changes after mandibular setback surgery. For comparing with previous two-dimensional (2D) cephalometric data, we proposed a three-dimensional registration and analysis method based on the cephalometric knowledge. The 3D changes of bone, soft tissue and the ratio of soft tissue to bony movement were investigated in eight skeletal class III mandibular prognathism patients. CT scans of each patient were taken at pre- and post-operative states. Each scan was registered to a universal 3D coordinate system defined by cephalometric landmarks. A grid, parallel to the coronal plane, was also designed for the comparison of the changes. The bone and soft tissue was intersected by the projected line from each point on the grid. The coordinate values of intersected point were measured and compared between the pre- and post-operative models. In addition, the reproducibility of the universal coordinate system and the grid was evaluated. The facial surface changes after setback surgery occurred not only in the mandible but also in the mouth corner region. The soft tissue changes of the mandible were measured relatively by the proportional ratios to the bone changes. The ratios at the mid-sagittal plane were 77-102% (p<0.05). The ratios at all other sagittal planes had similar patterns to the mid-sagittal plane with decreased values. All the results conformed to the previous 2D based clinical knowledge and instinct of orthodontists. It is expected that the proposed approach would be applicable to other oral and maxillofacial surgeries as well as plastic surgeries.

The effect of pelvic organ prolapse on lower urinary tract function.

Pelvic organ prolapse (POP) is a process in which the pelvic contents, including the reproductive organ, bladder, rectum, and/or small intestines become herniated through defects in the vaginal wall. The pelvic organs are closely related to the urinary tract and thus various urinary functions can be affected. The purpose of this study was to evaluate the relationship between pelvic organ prolapse and lower urinary tract function by urodynamic studies. From March 1999 to May 2000, 40 patients with pelvic organ prolapse who underwent urodynamic studies (uroflowmetry, filling cystometry, urethral pressure profile) without barrier reduction of prolapse were analyzed. The majority of the cases of low grade POP involvedpatients with anterior wall prolapse, whereas the higher POP stages were more frequent in women with cervical cuff prolapse. Symptoms of stress urinary incontinence and hesitancy were more frequent in the patients with anterior wall prolapse. The urodynamic study showed a statistically significant increase in MUCP in patients with POP stage IV and the leading point of POP was cervical cuff. The subjective urinary symptoms of patients with POP appear to be less reliable as a diagnostic tool. POP had no adverse effect on the bladder storage function. However, POP affected the voiding function through an increase in MUCP, especially in patients with stage IV prolapse and when the leading point of POP was cervical cuff. Following the surgical correction of POP, an evaluation of the preoperative changes in the urodynamic study parameters should be performed.

Isolation and characterization of bluensomycin biosynthetic genes from Streptomyces bluensis.

The biosynthetic gene cluster for bluensomycin, a member of the aminoglycoside family of antibiotics, was isolated and characterized from the bluensomycin producing strain, Streptomyces bluensis ATCC27420. PCR primers were designed specifically to amplify a segment of the dTDP-glucose synthase gene based on its conserved sequences among several actinomycete strains. By screening a cosmid library using amplified PCR fragments, a 30-kb DNA fragment was isolated. Sequence analysis identified 15 open reading frames (ORFs), eight of which had previously been identified by Piepersberg et al. But seven are novel to this study. We demonstrated that one of these ORFs, blmA, confers resistance against the antibiotic dihydrostreptomycin, and another, blmD, encodes a dTDP-glucose synthase. These findings suggest that the isolated gene cluster is very likely to be responsible for the biosynthesis of bluensomycin.