Hemorrhagic morbidity in nulliparous patients with placenta previa without placenta accrete spectrum disorders.

Background: Placental adhesion spectrum (PAS) is a disease in which the trophoblast invades the myometrium, and is a well-known high-risk condition associated with placental previa. Aim: The morbidity of nulliparous women with placenta previa without PAS disorders is unknown. Patients and Methods: The data from nulliparous women who underwent cesarean delivery were collected retrospectively. The women were dichotomized into malpresentation (MP) and placenta previa groups. The placenta previa group was categorized into previa (PS) and low-lying (LL) groups. When the placenta covers the internal cervical os, it is called placenta previa, when the placenta is near the cervical os, it is called the low-lying placenta. Their maternal hemorrhagic morbidity and neonatal outcomes were analyzed and adjusted using multivariate analysis based on univariate analysis. Results: A total of 1269 women were enrolled: 781 women in the MP group and 488 women in the PP-LL group. Regarding packed red blood cell transfusion, PP and LL had adjusted odds ratio (aOR) of 14.7 (95% confidence interval (CI): 6.6 - 32.5), and 11.3 (95% CI: 4.9 - 26) during admission, and 51.2 (95% CI: 22.1 - 122.7) and 10.3 (95% CI: 3.9 - 26.6) during operation, respectively. For intensive care unit admission, PS and LL had aOR of 15.9 (95% CI: 6.5 - 39.1) and 3.5 (95% CI: 1.1 - 10.9), respectively. No women had cesarean hysterectomy, major surgical complications, or maternal death. Conclusion: Despite placenta previa without PAS disorders, maternal hemorrhagic morbidity was significantly increased. Thus, our results highlight the need for resources for those women with evidence of placenta previa including a low-lying placenta, even if those women do not meet PAS disorder criteria. In addition, placenta previa without PAS disorder was not associated with critical maternal complications.

Determining the gluonic gravitational form factors of the proton.

The proton is one of the main building blocks of all visible matter in the Universe1. Among its intrinsic properties are its electric charge, mass and spin2. These properties emerge from the complex dynamics of its fundamental constituents-quarks and gluons-described by the theory of quantum chromodynamics3-5. The electric charge and spin of protons, which are shared among the quarks, have been investigated previously using electron scattering2. An example is the highly precise measurement of the electric charge radius of the proton6. By contrast, little is known about the inner mass density of the proton, which is dominated by the energy carried by gluons. Gluons are hard to access using electron scattering because they do not carry an electromagnetic charge. Here we investigated the gravitational density of gluons using a small colour dipole, through the threshold photoproduction of the J/ψ particle. We determined the gluonic gravitational form factors of the proton7,8 from our measurement. We used a variety of models9-11 and determined, in all cases, a mass radius that is notably smaller than the electric charge radius. In some, but not all cases, depending on the model, the determined radius agrees well with first-principle predictions from lattice quantum chromodynamics12. This work paves the way for a deeper understanding of the salient role of gluons in providing gravitational mass to visible matter.

Deeply Virtual Compton Scattering Cross Section at High Bjorken x_{B}.

We report high-precision measurements of the deeply virtual Compton scattering (DVCS) cross section at high values of the Bjorken variable x_{B}. DVCS is sensitive to the generalized parton distributions of the nucleon, which provide a three-dimensional description of its internal constituents. Using the exact analytic expression of the DVCS cross section for all possible polarization states of the initial and final electron and nucleon, and final state photon, we present the first experimental extraction of all four helicity-conserving Compton form factors (CFFs) of the nucleon as a function of x_{B}, while systematically including helicity flip amplitudes. In particular, the high accuracy of the present data demonstrates sensitivity to some very poorly known CFFs.

Deep Exclusive Electroproduction of π

We report measurements of the exclusive neutral pion electroproduction cross section off protons at large values of x_{B} (0.36, 0.48, and 0.60) and Q^{2} (3.1 to 8.4 GeV^{2}) obtained from Jefferson Lab Hall A experiment E12-06-014. The corresponding structure functions dσ_{T}/dt+εdσ_{L}/dt, dσ_{TT}/dt, dσ_{LT}/dt, and dσ_{LT^{'}}/dt are extracted as a function of the proton momentum transfer t-t_{min}. The results suggest the amplitude for transversely polarized virtual photons continues to dominate the cross section throughout this kinematic range. The data are well described by calculations based on transversity generalized parton distributions coupled to a helicity flip distribution amplitude of the pion, thus providing a unique way to probe the structure of the nucleon.

Pregnancy and patients with preexisting lupus nephritis: 15 years of experience at a single center in Korea.

We investigated obstetric outcomes and comorbidities during pregnancy in females with preexisting lupus nephritis (LN) and identified predictors for renal flare. In cases of renal flare during pregnancy, we assessed the long-term post-delivery renal outcome. We performed a retrospective analysis of 183 systemic lupus erythematosus (SLE) pregnancies including blood chemistry, urinalysis, urinary protein, and disease activity recorded at prepregnancy, during pregnancy, and at one month, six months, and one year post-delivery. Pregnancies with preexisting LN had a greater frequency of adverse obstetric outcomes and maternal comorbidity. Renal flares occurred in 50.7% of pregnancies with preexisting LN, 89.2% of which were reactivations. Renal flare among pregnancies with SLE was predicted based on preexisting lupus nephritis (OR 17.73; 95% CI, 5.770-54.484), an active disease prior to pregnancy (OR 2.743; 95% CI, 1.074-7.004), and prepregnancy eGFR < 90 ml/min/1.73 m(2) (OR 11.151; 95% CI, 3.292-37.768). Persistent LN one year after delivery was observed in 33.3% of pregnancies. The median follow-up time after delivery was 5.9 (3.1-9.7) years and chronic kidney disease (CKD) occurred in 21.4% of pregnancies with renal flare. In patients with renal flare, failing to achieve a ≥ 50% reduction in urine protein levels within six months, longer total duration of renal flare, and acute kidney injury at renal flare was associated with CKD development. Females with preexisting LN should achieve remission before pregnancy. When patients experience renal flares during pregnancy, it is important to reduce the proteinuria level by >50% within six months and to achieve early remission for excellent long-term renal outcomes.

Hydroxychloroquine and pregnancy on lupus flares in Korean patients with systemic lupus erythematosus.

We investigated the clinical and laboratory characteristics of pregnancies with systemic lupus erythematosus (SLE) and identified lupus flare predictors during pregnancy. Additionally, we examined lupus activity and pregnancy outcomes in SLE patients who continued, discontinued or underwent no hydroxychloroquine (HCQ) treatment during pregnancy. We retrospectively analyzed 179 pregnancies in 128 SLE patients at Seoul St. Mary's Hospital, Korea, between 1998 and 2012 and then assessed the clinical profiles and maternal and fetal outcomes. Overall, 90.5% of pregnancies resulted in a successful delivery and were divided into two groups: those who experienced lupus flares (80 pregnancies, 44.7%) and those who did not (99 pregnancies, 55.3%). Increased preeclampsia, preterm births, low birth weight, intrauterine growth restriction (IUGR), and low 1-minute Apgar scores occurred in pregnancies with lupus flares compared to pregnancies in quiescent disease. Lupus flares were predicted by HCQ discontinuation, a history of lupus nephritis, high pre-pregnancy serum uric acid and low C4 levels. Our study indicates that achieving pre-pregnancy remission and continuing HCQ treatment during pregnancy are important for preventing lupus flares.

The effects of oncostatin M on trophoblast cells: influence on matrix metalloproteinases-2 and -9, and invasion activity.

Oncostatin M (OSM), a cytokine of the interleukin-6 (IL-6) family, can either promote or inhibit cell growth in various normal and tumor cells and is expressed in rheumatoid arthritis, multiple sclerosis, multiple myeloma, and other inflammatory conditions. We investigated one of the possible mechanisms involved in trophoblast invasion using the human placental cell line derived from first trimester extravillous trophoblasts (HTR8SVneo): modulation of matrix metalloproteinase (MMP)-2 and -9 expression and enzymatic activity. And we addressed also the effects of exogenous OSM on the in vitro invasion activity of HTR8SVneo cells. We found that OSM enhanced the constitutive RNA and protein expressions of MMP-2 and MMP-9 in HTR8SVneo cell lines. Also, OSM treatment increased significantly the enzymatic activity of MMP-2 on gelatin zymography. The effects OSM on enzymatic activity of MMP-9 was not significant. We found that OSM increased invasion activities of HTR8SVneo cells in time-dependent and dose-dependent manners. This study suggests that OSM enhances invasion activities of extravillous trophoblasts during the first trimester through the increased enzyme activity of gelatinases, especially MMP-2.

Phase analysis identifies compound heterozygous deletions of the PARK2 gene in patients with early-onset Parkinson disease.

Exon rearrangements and point mutations are common in PARK2, the most important causative gene of autosomal recessive early-onset Parkinson disease (EOPD). However, gene dosage analysis alone cannot conclusively determine the phase of exon rearrangements and the incidence of molecularly confirmed parkin-type EOPD may be underestimated. To fully characterize the mutation spectrum, we performed sequencing and gene dosage analyses of SNCA, PARK2, PINK1, and PARK7 in 114 unrelated EOPD patients with onset age ≤40 years. Mutational phase of exon rearrangements was determined by reverse-transcriptase PCR (RT-PCR) and sequence analysis using a patient's own RNA. Fourteen different PARK2 mutations (3 point mutations plus 11 exon rearrangements) were identified in 18 patients, comprising 1 homozygote (0.9%), 13 compound heterozygotes (11.4%), 3 single heterozygotes (2.6%), and 1 with unknown phase (0.9%). By phase determination, more than 80% (5 of 6) of patients with apparently contiguous multi-exon deletions and 30% (5 of 18) of all PARK2 mutation carriers were additionally diagnosed as compound heterozygotes, respectively. This study shows that compound heterozygous mutations constituted a significant portion of patients with apparently contiguous multi-exon deletions. Phase determination is a prerequisite to molecular diagnosis for autosomal recessive EOPD, especially in subjects with PARK2 exon rearrangements.

Factors influencing career choices in radiology trainees in Queensland, Australia.

The aim of this study was to investigate factors influencing career choices in radiology trainees. We distributed a 27-question written survey to all radiology registrars in Queensland. The questions investigated whether radiology was their first specialty choice, career satisfaction, ideal working conditions and attitudes regarding having children during the time of training. Forty-four of 51 surveys were returned (86% participation rate, 73% men, P = 0.048055) with 100% reporting a high job satisfaction; 28% of male registrars compared to 8% of female registrars did extra work outside of training to earn extra money (P = 0.000003), and 17% of female registrars took a leave of absence during their training, while no male registrar did (P = 0.087923). Only one female trainee worked part-time (P = 0.272727). In addition, 58% of female registrars planned a pregnancy (P = 0.731789) before completion of training; 83% of women versus 75% of men had no children (P = 0.329263). Only 5% of trainees agreed that it was easy to arrange part-time training, only 14% stated that it was easy to negotiate flexible work schedules and 7% agreed that it was easy to return to work after a period of absence. 'Time spent with immediate family' was rated the most important lifestyle factor, followed by 'work hours' and 'on-call duty'. The least important factors were 'being away from extended family', 'availability of part-time work' and whether 'work was in a rural location'. Overall job satisfaction is high among radiology trainees. Nevertheless, lifestyle factors, particularly those related to work time, are becoming more important for career decisions. This should be taken into account when designing and structuring radiology training to ensure that it is considered an attractive career choice.

Electron tunneling in carbon nanotube composites.

Nanocomposites, such as polymer blending with carbon nanotubes (CNTs), have been shown to have a drastic reduction in the resistivity and become conductive when the CNTs concentration has reached a certain percolation threshold. The reduction could be more than a millionth of the original polymer material. This has been realized as the formation of an infinite cluster of connected CNTs or pathways. Therefore, the conductivity of a nanocomposite should follow that of CNTs. Here we show that the resistivity of a nanocomposite is not governed by the interconnected CNTs, but the polymer between neighboring CNTs. That is, polymer-CNTs exhibit the nature of a conducting polymer, which can be explained as the tunneling of electrons one by one from the first CNT electrode to the next-nearest CNT electrode, forming a CNT/polymer pathway. A conduction model based on the tunneling of electrons passing, one by one, through the polymer gap between two neighboring CNT electrodes is formulated and derived. This model can accurately predict the significant reduction of the polymer-CNTs' resistivity with the addition of CNTs. The temperature effect can be readily incorporated to account for resistivity variation with the temperature of this nanocomposites.

Piezoresistive characteristics of MWNT nanocomposites and fabrication as a polymer pressure sensor.

Polyimide (PI)-carbon nanotube composites were fabricated by in situ polymerization using multi-wall carbon nanotubes (MWNT) as fillers. The composite film was characterized by some analytical instruments to ensure its structure and good dispersion of the MWNTs in the composites. The electrical resistivity of this composite was found to vary significantly with both the temperature and the stress in the material. The PI-MWNT composites possess a very linear piezoresistive nature which can be used as a good pressure sensor material, provided with proper temperature compensation. Fabrication of a micropolymer pressure sensor using this nanocomposite sensing material is demonstrated and sensor performance is evaluated. The sensor has a higher sensitivity than a polysilicon sensor, rapid response, and is thermally stable. The sensor is suitable for mass production, and can be widely applied or integrated in a microfluidic system or biochip where pressure information is required.

Investigation of the association between 677C>T and 1298A>C 5,10-methylenetetra- hydrofolate reductase gene polymorphisms and normal-tension glaucoma.

PURPOSE: Homozygous polymorphism of the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene and resultant hyperhomocysteinaemia have been established as an independent risk factor for vascular diseases. There are evidences that vascular abnormalities are involved in the pathogenesis and progression of normal-tension glaucoma (NTG). In the present study, we were to find out the associations between 677C>T and 1298A>C polymorphisms of the MTHFR gene and NTG. METHODS: This was a retrospective, case-controlled study enrolling 78 NTG patients and 100 controls. DNA from peripheral blood lymphocytes was extracted and the genotypes of polymorphisms (677C>T and 1298A>C) in the MTHFR gene were determined using PCR followed by restriction enzyme digestion. The frequencies of the polymorphic genotypes in the patients with NTG and controls were compared. RESULTS: The frequencies of the polymorphisms of the MTHFR gene (677C>T and 1298A>C) in the NTG patients were not significantly different from those of controls. But the younger NTG patients (age at diagnosis < or = 45 years) showed significantly higher prevalence of 677C>T polymorphism than the older NTG patients (age at diagnosis > 45 years) (TT genotype, 38.9 vs 11.9%, P=0.006, OR=4.71, 95% CI=1.49-14.9) and than the younger control subgroup (TT genotype, 38.9 vs 6.1%, P=0.001, OR=9.86, 95% CI=2.23-42.4). CONCLUSIONS: The 677C>T polymorphism was significantly associated with NTG in the younger patients, while 1298A>C polymorphism was not. This suggests that 677C>T polymorphism of the MTHFR gene can be a genetic risk factor of NTG in Korean population.

[Negative endoscopy and MSCT findings in patients with acute lower gastrointestinal hemorrhage. Value of (99m)Tc erythrocyte scintigraphy]. / Negative Endoskopie sowie Mehrzeilendetektor-CT bei Patienten mit akuter unterer Gastrointestinalblutun. Wertigkeit der Szintigraphie mit (99m)Tc-markierten Erythrozyten.

PURPOSE: To evaluate the clinical use of (99m)Tc red blood cell imaging (RBC imaging) in patients presenting with acute lower gastrointestinal (GI) bleeding and negative endoscopy and multislice computed tomography (MSCT) findings. PATIENTS AND METHODS: In 31 consecutive patients with acute lower GI bleeding in whom the endoscopy findings were negative or the procedure was not feasible, dual-phase MSCT of the abdomen was performed [collimation 4x1 mm (arterial phase), 4x2.5 mm (venous phase)]. MSCT was followed by a (99m)Tc red blood cell scan in patients in whom no active bleeding was visible by CT. Images were created within 24 h after administration of the tracer, depending on the clinical symptoms. The results of the imaging modalities were correlated with clinical course and surgical treatment. RESULTS: In 20 of 31 patients MSCT showed no active bleeding and a (99m)Tc red blood cell scan was performed. In 8 of 20 patients RBC imaging was also negative. Of these eight patients five were stable and did not require further diagnostic work-up; in the other three bleeding persisted and these patients required surgical treatment. In 12 of 20 patients active bleeding was demonstrated using a (99m)Tc red blood cell scan. Of 12 patients with positive RBC scintigraphy findings, 8 underwent surgery, where the site of bleeding was confirmed. CONCLUSION: In patients with acute lower GI bleeding with negative or nondiagnostic endoscopy or MSCT findings, (99m)Tc red blood cell imaging is a useful tool in an emergency algorithm, improving the overall bleeding detection rate.

[Localization of bleeding using 4-row detector-CT in patients with clinical signs of acute gastrointestinal hemorrhage]. / Blutungslokalisation mittels 4-Zeilen-Spiral-CT bei Patienten mit klinischen Zeichen einer akuten gastrointestinalen Hämorrhagie.

PURPOSE: There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy. MATERIALS AND METHODS: 58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment. RESULTS: 20 of the 58 patients (34 %) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100 % correlation regarding the bleeding site. In 38 of the 58 patients (66 %), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53 %) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention. CONCLUSION: Compared to other diagnostic methods MSCT is a fast, widely-available and low-risk technique for the localization of active GI hemorrhage. The clinical use seems to be justified since in more than one third of the patients, MSCT demonstrates the site of bleeding and provides decisive information for further interventional therapy. Concerning those patients, in whom MSCT is negative (38 out of 58 patients), only every second patient requires any additional diagnostic work-up.

[MRI-morphology and staging of congenital mesoblastic nephroma: evaluation of a collection with 20 patients]. / MRT-Morphologie und Staging des kongenitalen mesoblastischen Nephroms: Auswertung einer Fallsammlung mit 20 Patienten.

PURPOSE: To differentiate classic and cellular type of congenital mesoblastic nephroma (CMN) in MRI and to evaluate MRI for staging according to the Societe Internationale de Oncologie Pediatrique (SIOP). MATERIAL AND METHODS: MRI examinations of 20 children with CMN (age 1st to 16th months, classic type n = 11, cellular type n = 7, mixed type n = 2) were analyzed retrospectively. Cysts, necrosis, hemmorhage in the tumor, signal intensity, tumor structure, thrombosis and dilatation of renal vein, crossing of the body midline, peripheral contrast-enhancement, tumor volume and existence of a tumor pseudocapsule in contrast to the residual kidney were described. The radiologic stage was compared with the histopathologic stage (infiltration of perirenal fat and infiltration of the renal sinus). RESULTS: Tumors of the classic type (mean volume 67.9 ml) had necrosis in 1 case, crossed the midline in 1 case, had no cysts or bleeding, and had a peripheral contrast-enhancement in 1 case, and were heterogeneous in 9 cases. The cellular type (mean volume 302.8 ml) had tumor necrosis in 6 cases, bleeding in 3 cases, cysts in 3 cases, crossed the midline in 4 cases, and peripheral contrast enhancement in 2 cases, and was predominantly heterogeneous. Mixed tumor types (7 ml and 202 ml) had tumor necrosis in 1 case and crossed the midline in 1 case, a peripheral contrast enhancement in 2 cases and a homogenous structure in 1 case. The signal intensity in T1 w and T2 w images was not specific. The renal vein was inconspicuous in all children. The evaluation of the infiltration in perirenal fatty tissue was true positive in 1 case, true negative in 10 cases, false negative in 4 cases and false positive in 5 cases. The infiltration of the renal hilus was true positive in 10 children, false positive in 8 cases and true negative in 2 cases. CONCLUSION: A typical finding of CMN in MRI is a heterogeneous tumor without demarcation from the rest of the kidney parenchyma by a pseudocapsule. The cellular type of CMN tends to have a higher tumor volume and shows more necrosis, bleeding and cysts than the classic type in MRI. A peripheral contrast-enhancement in MRI is not characteristic for any type of CMN. Local tumor staging is not possible with MRI.

Mitochondrial DNA content is decreased in autosomal dominant optic atrophy.

BACKGROUND: Autosomal dominant optic atrophy (ADOA) is the commonest form of inherited optic neuropathy. Mutations in the OPA1 gene encoding a dynamin-related mitochondrial protein underlie ADOA and may perturb the biogenesis and maintenance of mitochondria. OBJECTIVE: To investigate the mutation spectrum of the OPA1 gene and assess alterations in mitochondrial content caused by OPA1 mutations. METHODS: Sixteen Korean patients with clinically suspected ADOA were studied. The mutation spectrum of the OPA1 gene was analyzed by PCR single-strand conformation polymorphism and sequencing, and mitochondrial DNA (mtDNA) content was quantified by real-time PCR. RESULTS: Eight different mutations were found, including five novel mutations. Quantitative real-time PCR analysis showed excellent linearity and precision for the determination of mtDNA copy numbers. The number of mtDNA copies per cell in patients with OPA1 gene mutations (ages 7 to 40) was significantly lower than those in all normal control subjects (p = 0.037), particularly lower than in normal control subjects ages 10 to 39 (p = 0.022). CONCLUSION: The mutation spectrum of the OPA1 gene disclosed marked genetic heterogeneity and the mitochondrial DNA content was found to be lower in autosomal dominant optic neuropathy, which provides direct evidence for a pathogenetic role of mutations of the OPA1 gene.

Portal vein erosion and acute abdominal hemorrhage as a complication of acute pancreatitis.

The case of a 35-year-old male with portal vein erosion and acute life-threatening abdominal hemorrhage as a complication of acute pancreatitis is reported. Erosion of arterial walls is the most common complication of pancreatitis and pancreatic pseudocysts, and erosion of the portal vein leading to a fistula between the pancreas and the portal vein is very rare. Diagnosis was made by multislice spiral computed tomography, and nonsurgical treatment was elected, leading to complete recoverage.