Usefulness of transperineal shear wave elastography of levator ani muscle in women with stress urinary incontinence.

This study aimed to quantitatively assess the quality of levator ani muscle (LAM) using shear wave elastography (SWE) and to evaluate the association between the elasticity of LAM and stress urinary incontinence (SUI). The study population included 32 women with SUI and 34 women with normal pelvic support. The thickness of LAM, bladder neck descent (BND), and urethral funneling (UF) were assessed by transperineal ultrasound. LAM elasticity was measured by SWE at rest and during the maximal Valsalva maneuver. Age, menopause, BND, and UF showed a positive correlation with SUI. There was no significant between-group difference in the elastic modulus values of LAM at rest. The thickness of LAM in women with SUI was greater than that in control group at rest and during the maximal Valsalva maneuver (P < 0.001). The elastic modulus values of Emax and Emean were significantly increased from rest to the maximal Valsalva maneuver in all participants (56.24 vs 82.43 kPa and 47.92 vs 72.37 kPa, P < 0.001). The change of these variables from rest to the maximal Valsalva maneuver in the control group was more obvious than that in the SUI group (34.09 vs 17.87 kPa and 31.55 vs 16.82 kPa, P < 0.05). The elasticity of LAM, as quantified by SWE, may potentially be used as an index for predicting SUI.

[Method and accuracy of determining the jaw position of repositioning splint with the aid of digital technique].

OBJECTIVE: To establish the workflow of determining the jaw position of repositioning splint with the aid of digital technique, and to evaluate the accuracy of this workflow and compare the accuracy of raising different vertical dimensions in vitro. METHODS: A volunteer was recruited. The data of full-arch scans, cone beam computed tomography (CBCT) image and ultrasonic jaw motion tracking of the volunteer were acquired. The full-arch scans were merged with the CBCT image, which were then matched to the jaw motion tracking reference system. The jaw position of repositioning splint was determined when the anterior teeth opening was 3 mm and the condyle was in centric relation of the fossa in the sagittal plane. A digital repositioning splint was designed in the software based on virtual articulator and fabricated with additive manufacturing technique. After the splint was tried in, another CBCT image was taken and a qualitative analysis was conducted to compare the position of condyle between these two CBCT images. In the in vitro study, standard dental plaster casts with resin ball markers attached to the base were mounted onto a fully adjustable articulator in the intercuspal position. The dental casts were scanned by an extraoral scanner to establish digital models. The ultrasonic jaw motion tracking device was used to obtain simulated jaw movements on the articulator, which was repeated for three times. The digital models and data of jaw movements were merged in one coordination with the aid of bite forks. The jaw position of repositioning splint was determined by adjusting data of jaw movements, each of which was used to determine three vertical jaw positions 4 mm, 5 mm, and 6 mm with the horizontal jaw position of protrusion 2 mm. The virtual articulators with differently adjusted jaw movements were applied in designing repositioning splints, and the final repositioning splints and virtual jaw relationships were exported in STL format. Then the repositioning splints were fabricated with additive manufacturing technique and tried in plaster casts on the mechanical articulator, which were scanned and the jaw relationships on the mechanical articulator were exported later. The virtual jaw relationships and scanned jaw relationships were registered according to lower models and displacement of upper models was calculated. Ball markers were fit to acquire the coordinates of centers and absolute difference values of centers along three coordinating axes X, Y, and Z were calculated. One-way analysis of variance was conducted using SPSS 18.0 software to compare deviations of the three different vertical jaw relationships in two-side test and the significance level was 0.05. RESULTS: With the aid of multi-source data fusion and individualized jaw motion, the clinical workflow of determining jaw position of repositioning splint was preliminarily established. The designed jaw position was realized on the right and the condyle was more inferior than the designed position on the left. Both displacement of the upper models and absolute difference values of centers showed no significant differences (P>0.05) in different vertical jaw dimensions. The displacement of the upper models was (0.25±0.04) mm. The absolute difference values of centers along the three coordinating axes X, Y, and Z were respectively (0.08±0.01) mm, (0.30±0.02) mm, and (0.21±0.04) mm. CONCLUSION: A novel method of determining the jaw position of repositioning splint with the aid of digital technique is established. It is proved to be feasible by try-in after multi-data fusion, computer-aided design and computer-aided manufacturing. As is shown in vitro, it is accurate to apply this method in adjusting jaw position. Further clinical trial will be designed to evaluate its clinical effect.

Nonlinear optical properties of MoS2-WS2 heterostructure in fiber lasers.

As a saturable absorption material, the heterostructure with the van der Waals structure has been paid much attention in material science. In general, the heterogeneous combination is able to neutralize, or even exceed, the individual material's advantages in some aspects. In this paper, which describes the magnetron sputtering deposition method, the tapered fiber is coated by the MoS2-WS2 heterostructure, and the MoS2-WS2 heterostructure saturable absorber (SA) is fabricated. The modulation depth of the prepared MoS2-WS2 heterostructure SA is measured to be 19.12%. Besides, the theoretical calculations for the band gap and carrier mobility of the MoS2-WS2 heterostructure are provided. By employing the prepared SA, a stable and passively erbium-doped fiber laser is implemented. The generated pulse duration of 154 fs is certified to be the shortest among all fiber lasers based on transition mental dichalcogenides. Results in this paper provide the new direction for the fabrication of ultrafast photon modulation devices.

A method of identifying priority spatial patterns for the management of potential ecological risks posed by heavy metals.

An approach of identifying priority spatial patterns in response to different ecological risk levels associated with heavy metals (HM) is proposed. First, ecological hotspots (EH) are delineated by integrating NDVI-based assessment with the impact assessment of anthropogenic impact sources. Second, the HM potential ecological risks index (PERI) is calculated and spatially interpolated. Finally, the EH with different PERI values are identified through logic calculation. Study results show that 45.2% of the study region has low HM risks, 53.2% with moderate HM risks, and only 1.6% with high HM risks. In addition, the percentage of EH with low HM risks is 6.5%; the percentage with moderate HM risks is 5.4%; and the percentage with high HM risks is 0.4%. The EH with low and moderate HM ecological risks are proposed to be the regions in priority for management. This approach is potentially useful to HM ecological risk assessment and HM contamination management around the world.

Using heavy metals to detect the human disturbances spatial scale on Chinese Yellow Sea coasts with an integrated analysis.

An integrated approach involving landuse patterns obtained from landuse data and heavy metal contents of the top 10 cm surface soil layer samplings was proposed to detect the characteristic spatial scale of non-point source human disturbances on the Yellow Sea coast in China. Circular plots, with radii of 200, 500, 1000, 1500, and 2000 m were set up to represent five spatial scales. We proposed a human impact index (HII) using the landuse data to model the human disturbances. Multivariate statistics of the 10 heavy metals, Cr, Co, Fe, Mn, Ni, V, Zn, Cu, Ti, and Sr, were done. Finally curve estimation between HII and heavy metals was also done. The results showed that: (1) multivariate statistics, including principal component analysis, cluster analysis and the 1-tailed Pearson correlation analysis showing that elements Cr, Cu, Fe, Mn, Ni, V, Zn, and Co could be interpreted as anthropogenic elements and (2) of all the heavy metals showing statistical significance from the curve estimation, in general, the 1000 m scale HII had the best modeling result. We concluded that the characteristic spatial scale of human disturbances on Yellow Sea coast might be 1000 m.

Evaluation of potential habitat with an integrated analysis of a spatial conservation strategy for David's deer, Elaphurus davidians.

How to assess the potential habitat integrating landscape dynamics and population research, and how to reintroduce animals to potential habitats in environments highly human disturbed are still questions to be answered in conservation biology. According to behavioral research on Elaphurus davidians, we have developed a suitability index and a risk index to evaluate the potential habitats for the deer. With these indices, we conducted two transect assessments to evaluate the gradient change of the target region. Then, taking rivers as border lines, we tabulated the forest areas, high grassland area and total area and then compared the forest and high grassland area in each subregion. Furthermore, we computed the land use transfer matrix for the whole Yancheng coast during 1987-2000. We also computed human modified index (HMI) in six subregions. Lastly with a geographical information system support we obtained the spatial distribution of the indices and evaluation of the whole potential habitats from a neighborhood analysis. The transect assessment showed that the suitability of the coastal area was higher than that of the inland area for the deer, while the southern area was higher than the northern. Landscape metrics and HMI analysis showed that different landscape patterns and different anthropogenic disturbance existed within the region, and the increasing human disturbance was the key factor causing the pattern dynamics. The evaluation of potential habitats showed that there was an estimated carrying capacity of no more than 10,000 for David's deer reintroduction into the natural area. Also the reintroduction strategy was discussed. This integrated approach linked the population research and the landscape metrics, and the dataset with different scale; thus, it is an approach likely to be useful for the protection of other large animal in a landscape highly disturbed by humans.

The potential role of phagocytic capacity in the osteolytic process induced by polyethylene wear particles.

Osteolysis induced by ultra-high molecular weight polyethylene wear particles is the major cause of long-term failure of artificial joints. We examined the effects of wear particles on bioactivity by analysing the biophysical aspects of particle phagocytosis. We estimated the maximum number of internalized particles (the phagocytic capacity) for particles of various sizes and shapes. We demonstrated that elongated particles had a smaller phagocytic capacity than spherical particles of the same volume. A review of the literature showed that the ratio of particle concentration (number of particles/number of cells) to phagocytic capacity is critical for particle-induced biological responses. When this ratio was < 1, the biological response was approximately proportional to the ratio itself. When this ratio was > 1, limited changes in the biological response were observed. The saturation level of the phagocytic capacity for a particle population appears to reflect the degree of polyethylene particle-induced biological response.

Pediatric Salmonella enterocolitis in a teaching hospital in Taitung: A four-year analysis.

In order to understand the childhood Salmonella enterocolitis in Taitung, we retrospectively collected the patients with the diagnosis of acute enterocolitis who were admitted to the pediatric wards of Taitung branch of Mackay Memorial Hospital from January 1, 1995 to December 31, 1998. Salmonella enterocolitis accounted for 16.8% of the total cases of acute enterocolitis. The mean age of the patients was 14.6 +/- 14.1 months old. Seventy-nine patients were male and 78 patients were female. Eighty-two patients lived in the urban area and 75 patients lived in the suburbs. The mean duration from onset of illness to admission was 2.6 +/- 1.9 days. The mean duration of hospitalization was 6.6 +/- 4.8 days. The peak incidence was in August and September. The most common clinical manifestations were fever (74.5%) and blood stool (46.5%). In 157 patients, Salmonella serogroup B was isolated from stool in 115 patients. The rate of bacteremia was 4.5%. Serogroup D accounted for 28.6% of the bacteremia. Two patients developed meningitis and one patient had osteomyelitis. Of 88 patients examined for rotavirus, 12 had positive results. There was neither bowel perforation nor mortality recorded in our study.

Intestinal pseudo-obstruction followed by major clinical features of Kawasaki disease: report of one case.

Kawasaki Disease (KD) or atypical KD (AKD) rarely presents with intestinal obstruction or pseudo-obstruction. Others have reported gastrointestinal symptoms appearing with and up to 4 weeks after the occurrence of major clinical symptoms of KD. However, we presented a 1-year-old boy with prolonged fever who was found to have pyuria and liver dysfunction on the fourth day of fever. He developed a picture of intestinal pseudo-obstruction including bilious vomiting and abdominal distention on his fifth day of fever, four days before he developed the fissured lips. Because of the emergence of four major clinical criteria of KD, coronary artery dilatation, and aseptic meningitis, AKD was initially diagnosed and prompted the use of intravenous immunoglobulin on the tenth day of fever. Hydrops of the gallbladder, leukocytosis, increased ESR, and thrombocytosis were noted during hospitalization. These atypical features rarely develop all together in one patient with KD or AKD. Nevertheless, our patient had early intestinal pseudo-obstruction with almost all of the above unusual systemic manifestations and the late occurrence of clinical features of KD. We demonstrate that intestinal pseudo-obstruction in KD may develop earlier than other major clinical features and may improve under the conservative treatment. Surgery should be reserved for those who have complete intestinal obstruction presenting with significant peritoneal signs.

Segmental dilatation of the ileum as an unusual cause of gastrointestinal bleeding: report of one case.

We report a case of segmental dilatation of the ileum in a 10-month-old male infant. Intermittent loose black-colored stool passage and normocytic anemia were noted at the initial visits to our hospital. There was no symptom or sign of intestinal obstruction such as abdominal distention or vomiting. On physical examination, he was found to be pale but his abdomen was soft and flat. Digital examination revealed brownish stool tinged with black-colored oil-like stool but no polyp. Laboratory studies excluded coagulopathy, hemolytic anemia and lead poisoning. During hospitalization, he was treated with nothing per mouth, intravascular fluids, ranitidine, and transfusion of packed red blood cells. All examinations including panendoscopy, Technetium-99m (99mTc)-pertechnetate Meckel's diverticulum scan, and double contrast colon series revealed no organic lesion except that 99mTc-red blood cell bleeding scans showed abnormal bleeding in the small intestine. Because of his persistent gastrointestinal bleeding with unknown cause, we did an exploratory laparotomy when the patient was 13 months old and idiopathic segmental dilatation of the ileum was confirmed. The dilated segment is supposed to be idiopathic because of histologically proven normal muscle layers without ectopic tissue. This case suggests that segmental dilatation of the ileum can only present as gastrointestinal bleeding without intestinal obstruction.

Prenatal sonographic detection of adrenal hemorrhage confirmed by postnatal surgery.

We report a case of adrenal hemorrhage in a newborn first detected by sonography at a menstrual age of 21 weeks 4 days. An echogenic mass was noted above the right kidney. The mass became larger and hypoechoic on follow-up sonograms after birth. The mass was also seen on abdominal CT. Because it was difficult to differentiate the lesion from cystic neuroblastoma and because it shrank only modestly by 2 months after birth, we performed a surgical exploration when the patient was 2 months old, and adrenal hemorrhage was confirmed. This case suggests that adrenal hemorrhage can occur as early as the second trimester of pregnancy.