Phase Angle and Frailty Are Important Prognostic Factors in Critically Ill Medical Patients: A Prospective Cohort Study.

OBJECTIVES: To investigate whether phase angle (PhA) measured by bioelectrical impedance analysis (BIA) and frailty are associated with the outcomes of critical illnesses. DESIGN: A single-center prospective cohort study. SETTING: Medical intensive care unit (ICU) in Seoul National University Hospital, Seoul, Republic of Korea. PARTICIPANTS: 97 patients who were admitted to the medical ICU. MEASUREMENTS: On admission, PhA was measured by BIA, and frailty was assessed by the Korean Modified Barthel Index (KMBI) scoring system. Patients were classified according to PhA and KMBI scores, and their impact on the outcomes of critical illnesses was evaluated. RESULTS: The patients' mean age was 62.4 ± 16.4 years, and 56 of the patients (57.7%) were men. Having a high PhA above 3.5 at the time of ICU admission was associated with lower in-hospital mortality (adjusted OR 0.42, p = .042), and a shorter duration of ICU stay (5.6 days vs. 9.8 days, p = .016) compared to those with a low PhA. Other indices measured by BIA were not significantly associated with outcomes of critical illnesses. Frailty (KMBI > 60) was associated with more mechanical ventilation days (2.3 days vs. 7.1 days; p = .018). CONCLUSION: Both PhA and frailty are important prognostic factors predicting the outcomes of critical illnesses. Low PhA scores were associated with increased mortality and a longer duration of ICU stay, and frailty was associated with more mechanical ventilation days.

Automatic facial pore analysis system using multi-scale pore detection.

BACKGROUND/PURPOSE: As facial pore widening and its treatments have become common concerns in the beauty care field, the necessity for an objective pore-analyzing system has been increased. Conventional apparatuses lack in usability requiring strong light sources and a cumbersome photographing process, and they often yield unsatisfactory analysis results. This study was conducted to develop an image processing technique for automatic facial pore analysis. METHODS: The proposed method detects facial pores using multi-scale detection and optimal scale selection scheme and then extracts pore-related features such as total area, average size, depth, and the number of pores. Facial photographs of 50 subjects were graded by two expert dermatologists, and correlation analyses between the features and clinical grading were conducted. We also compared our analysis result with those of conventional pore-analyzing devices. RESULTS: The number of large pores and the average pore size were highly correlated with the severity of pore enlargement. In comparison with the conventional devices, the proposed analysis system achieved better performance showing stronger correlation with the clinical grading. CONCLUSION: The proposed system is highly accurate and reliable for measuring the severity of skin pore enlargement. It can be suitably used for objective assessment of the pore tightening treatments.

First Report of Bean common mosaic virus in Cudrania tricuspidata in Korea.

Cudrania tricuspidata (Moraceae) is a deciduous tree widely distributed in East Asia, including China, Korea, and Japan. It produces delicious fruit, and its cortex and root bark have been used as a traditional medicine to treat neuritis and inflammation. As C. tricuspidata has become known as a functional food, its cultivation area and production gradually have increased in Korea. However, information of viral disease in C. tricuspidata is very limited. In September 2012, open-field-grown C. tricuspidata trees showing virus-like symptoms of mosaic, yellowing, and distortion on the leaves were found in Naju, Korea. The fruit production in the diseased trees decreased to 20 to 40% of that in healthy trees. To identify causal agent(s), total RNA was isolated from the symptomatic leaves and used to generate a transcriptome library using the TruSeq Stranded Total RNA with Ribo-Zero Plant kit (Illumina, San Diego, CA) according to the manufacturer's instruction. The transcriptome library was analyzed by next-generation sequencing (NGS) using an Illumina HiSeq2000 sequencer. NGS reads were quality filtered and de novo assembled by the Trinity pipeline, and the assembled contigs were analyzed against the viral reference genome database in Genbank by BLASTn and BLASTx searches (3). The entire NGS procedure was perofrmed by Macrogen Inc. (Seoul, South Korea). Among the analyzed contigs, one large contig (10,043 bp) was of viral origin. Nucleotide blast searches showed that the contig has a maximum identity of 89% (with 100% coverage) to the isolate MS1 (Genbank Accession No. EU761198) of Bean common mosaic virus (BCMV), which was isolated from Macroptilium atropurpureum in Australia. The presence of BCMV was confirmed by a commercially available double-antibody sandwich (DAS)-ELISA kit (Agdia, Elkhart, IN). To confirm the BCMV sequence obtained by NGS, two large fragments covering the entire BCMV genome were amplified by reverse transcription-polymerase chain reaction (RT-PCR) using two sets of specific primers (5'-AAAATAAAACAACTCATAAAGACAAC-3' and 5'-AGACTGTGTCCCAGAGCATTTC-3' to amplify the 5' half of the BCMV genome; 5'-GCATCCTGAGATTCACAGAATTC-3' and 5'-GGAACAACAAACATTGCCGTAG-3' to amplify the 3' half of the BCMV genome) and sequenced. To obtain the complete genome sequence, the 5' and 3' terminal sequences were analyzed by the 5' and 3' rapid amplification of cDNA ends (RACE) method as described previously (1). The assembled full-length sequence of BCMV isolated from C. tricuspidata was 10,051 nucleotides in length without a poly(A) tail. It was deposited in Genbank under the accession number KM076650. BCMV, a member of the genus Potyvirus, is one of the most common viruses naturally infecting legumes, including Phaseolus vulgaris (2). In general, BCMV is known to have a restricted host range outside legume species (2). Therefore, the identification of BCMV from C. tricuspidata in this report is very exceptional. Because BCMV is easily transmitted by various aphids like other potyviruses, a large-scale survey may be required for exact investigation of the BCMV incidence in C. tricuspidata to prevent rapid spread of the virus. To the best of our knowledge, this is the first report of BCMV in C. tricuspidata. References: (1) H.-R. Kwak et al. Plant Pathol. J. 29:274, 2013. (2) M. Saiz et al. Virus Res. 31:39, 1994. (3) S.-E. Schelhorn et al. PLoS Comput. Biol. 9:e1003228, 2013.

Transverse stability of the proximal segment after bilateral sagittal split ramus osteotomy for mandibular setback surgery.

This study aimed to evaluate the correlation between the transverse displacement of the proximal segment after bilateral sagittal osteotomy for mandibular setback and the amount and design of the mandibular setback. Patients who underwent either bilateral sagittal split ramus osteotomy (BSSRO) alone or two-jaw surgery were selected, and cephalographic postero-anterior (PA) measurements were taken pre-operatively (T1), immediately post-operatively (T2), and at follow-up (T3). The inter-gonal (IG) and inter-ramal (IR) width increased immediately after surgery, but decreased to the initial value during follow-up (P=0.002; IR, P=0.046). Only the immediate IG changes after surgery correlated with the amount of mandibular setback (P=0.009). The IG changes were significant in the symmetric group, but not in the asymmetric group. There was no difference in the IG and IR changes between the symmetric group and the asymmetric group. The immediate IG change in two-jaw patients with symmetric setback showed correlation with the setback amount. The gonial width of the deviated group showed more significant changes than that of the non-deviated group. There was no difference in the unilateral gonial width between the deviated and the non-deviated group, but the difference was significant for the unilateral ramal angle between the two groups. These correlations will be helpful in predicting post-surgical results for patients.

A low-risk ZnT-8 allele (W325) for post-transplantation diabetes mellitus is protective against cyclosporin A-induced impairment of insulin secretion.

SLC30A8 encodes the ß-cell-specific zinc transporter-8 (ZnT-8) expressed in insulin secretory granules. The single-nucleotide polymorphism rs13266634 of SLC30A8 is associated with susceptibility to post-transplantation diabetes mellitus (PTDM). We tested the hypothesis that the polymorphic residue at position 325 of ZnT-8 determines the susceptibility to cyclosporin A (CsA) suppression of insulin secretion. INS (insulinoma)-1E cells expressing the W325 variant showed enhanced glucose-stimulated insulin secretion (GSIS) and were less sensitive to CsA suppression of GSIS. A reduced number of insulin granule fusion events accompanied the decrease in insulin secretion in CsA-treated cells expressing ZnT-8 R325; however, ZnT-8 W325-expressing cells exhibited resistance to the dampening of insulin granule fusion by CsA, and transported zinc ions into secretory vesicles more efficiently. Both tacrolimus and rapamycin caused similar suppression of GSIS in cells expressing ZnT-8 R325. However, cells expressing ZnT-8 W325 were resistant to tacrolimus, but not to rapamycin. The Down's syndrome candidate region-1 (DSCR1), an endogenous calcineurin inhibitor, overexpression and subsequent calcineurin inhibition significantly reduced GSIS in cells expressing the R325 but not the W325 variant, suggesting that differing susceptibility to CsA may be due to different interactions with calcineurin. These data suggest that the ZnT-8 W325 variant is protective against CsA-induced suppression of insulin secretion. Tolerance of ZnT-8 W325 to calcineurin activity may account for its protective effect in PTDM.

Neoplastic transformation in vitro after exposure to low doses of mammographic-energy X rays: quantitative and mechanistic aspects.

The induction of neoplastic transformation in vitro after exposure of HeLa x skin fibroblast hybrid cells to low doses of mammography-energy (28 kVp) X rays has been studied. The data indicate no evidence of an increase in transformation frequency over the range 0.05 to 22 cGy, and doses in the range 0.05 to 1.1 cGy may result in suppression of transformation frequencies to levels below that seen spontaneously. This finding is not consistent with a linear, no-threshold dose- response curve. The dose range at which possible suppression is evident includes doses typically experienced in mammographic examination of the human breast. Experiments are described that attempt to elucidate any possible role of bystander effects in modulating this low-dose radiation response. Not unexpectedly, inhibition of gap junction intercellular communication (GJIC) with the inhibitor lindane did not result in any significant alteration of transformation frequencies seen at doses of 0.27 or 5.4 cGy in these subconfluent cultures. Furthermore, no evidence of a bystander effect associated with factors secreted into the extracellular medium was seen in medium transfer experiments. Thus, in this system and under the experimental conditions used, bystander effects would not appear to be playing a major role in modulating the shape of the dose-response curve.

Topographic anatomy of the deep temporal nerves, with references to the superior head of lateral pterygoid.

Commonly, the nerve branches from the anterior mandibular nerve trunk pass between the roof of infratemporal fossa and the superior head of lateral pterygoid. However, varied courses of the mandibular nerve branches can be frequently observed. The purpose of this study was to clarify the positional relationships and the clinical relevance of the course variations of the branches of the anterior mandibular nerve trunk with reference to the surrounding anatomical structures. Thirty-six hemi-sectioned heads were studied in detail. In 20 cases, the posterior deep temporal nerve had a common trunk with the masseteric nerve and was then divided anteriorly (15 cases) or posteriorly (five cases). In 16 cases, the posterior deep temporal nerve arose from the mandibular nerve trunk independently. Based on the branching patterns of the middle deep temporal nerve, type A (one twig of the middle deep temporal nerve) was most frequent and occurred in 41.7%. Similarly, type B (two twigs), type C (three twigs) and type D (four twigs) were observed in 36.1%, 16.7%, and 5.5%, respectively. The twigs of the middle deep temporal nerve, which pierced the muscle fibers of the superior head of lateral pterygoid, were found in 21 cases (58.3%). Cases in which the middle deep temporal nerve pierced through all areas of the superior head were most frequent (56.5%). These results suggest that the piercing patterns of the middle deep temporal nerve show there is a possibility that it may be compressed during the actions of the superior head of lateral pterygoid.

High-dose-rate brachytherapy in the treatment of carcinoma of the prostate.

BACKGROUND: Although radical prostatectomy for localized disease is considered as a standard of care, external-beam radiotherapy and brachytherapy are equally effective. We report on the technique and preliminary results of high-dose-rate (HDR) brachytherapy using a temporary iridium-192 implant technique. METHODS: The authors reviewed the literature on the techniques, treatment protocols, and results of HDR brachytherapy in the treatment of carcinoma of the prostate, and they report their own protocols, technique, and results. RESULTS: The combination of HDR brachytherapy and external irradiation has been well tolerated by all 200 patients in our series, with less than 3% grade 3 late complications and with 95% PSA relapse-free survival with a median follow-up of 24 months. CONCLUSIONS: HDR brachytherapy may be the most conformal type of irradiation in the treatment of carcinoma of the prostate regardless of tumor size, anatomical distortion, and organ mobility.

Subunit interaction of vacuolar H+-pyrophosphatase as determined by high hydrostatic pressure.

Vacuolar H+-pyrophosphatase (H+-PPase) from etiolated hypocotyls of mung bean (Vigna radiata L.) is a homodimer with a molecular mass of 145 kDa. The vacuolar H+-PPase was subjected to high hydrostatic pressure to investigate its structure and function. The inhibition of H+-PPase activity by high hydrostatic pressure has a pressure-, time- and protein-concentration-dependent manner. The Vmax value of vacuolar H+-PPase was dramatically decreased by pressurization from 293.9 to 70.2 micromol of PPi (pyrophosphate) consumed/h per mg of protein, while the Km value decreased from 0.35 to 0.08 mM, implying that the pressure treatment increased the affinity of PPi to vacuolar H+-PPase but decreased its hydrolysis. The physiological substrate and its analogues enhance high pressure inhibition of vacuolar H+-PPase. The HPLC profile reveals high pressure treatment of H+-PPase provokes the subunit dissociation from an active into inactive form. High hydrostatic pressure also induces the conformational change of vacuolar H+-PPase as determined by spectroscopic techniques. Our results indicate the importance of protein-protein interaction for this novel proton-translocating enzyme. Working models are proposed to interpret the pressure inactivation of vacuolar H+-PPase. We also suggest that association of identical subunits of vacuolar H+-PPase is not random but proceeds in a specific manner.

High-pressure effects on vacuolar H+-ATPase from etiolated mung bean seedlings.

A high-hydrostatic-pressure technique was employed to study the structure-function relationship of plant vacuolar H+-ATPase from etiolated mung bean seedlings (Vigna radiata L.). When isolated vacuolar H+-ATPase was subjected to hydrostatic pressure, the activity of ATP hydrolysis was markedly inhibited in a time-, protein concentration- and pressure-dependent manner. The pressure treatment decreased both Vmax and Km of solubilized vacuolar H+-ATPase, implying an increase in ATP binding affinity, but a decrease in the ATP hydrolysis activity. Physiological substrate, Mg2+-ATP, augmented the loss of enzymatic activity upon pressure treatment. However, ADP, AMP, and Pi exerted substantial protective effects against pressurization. Steady-state ATP hydrolysis was more sensitive to pressurization than single-site ATPase activity. The inactivation of solubilized vacuolar H+-ATPase by pressure may result from changes in protein-protein interaction. The conformational change of solubilized vacuolar H+-ATPase induced by hydrostatic pressure was further determined by spectroscopic techniques. The inhibition of vacuolar H+-ATPase under pressurization involved at least two steps. Taken together, our work indicates that subunit-subunit interaction is crucial for the integrity and the function of plant vacuolar H+-ATPase. It is also suggested that the assembly of the vacuolar H+-ATPase complex is probably not random, but follows a sequestered pathway.

Coat protein gene and 3'-noncoding region of a new Korean isolate of cymbidium mosaic virus.

A new Korean isolate of cymbidium mosaic virus (denoted as CymMV-K2), a member of potexviruses, was identified and isolated from a Korean cultivar of Cymbidium species When the nucleotide sequence of the 3'-terminal region of the viral RNA was compared with those of the corresponding regions of two Singaporean isolates (denoted as CymMV-S1 and CymMV-S2) and a Korean isolate (denoted as CymMV-K1), the nucleotide sequence of the coat protein gene of CymMV-K2 was highly homologous to other cymbidium mozaic viruses (92.9%-96.7% homology). The coat protein of CymMV-K2 and CymMV-S2 consists of 223 amino acids, while the coat protein of CymMV-K1 and CymMV-S1 consists of 220 amino acids. This difference was caused by deletions of 5 nucleotides in the coat protein open reading frame (ORF) of CymMV-S1 and CymMV-K1, when compared with CymMV-K2 and CymMV-S2. These deletions result in changes of the deduced amino acid sequence and the length of the coat protein. The 3'-noncoding region of the CymMV-K2, which contains sequences involved in the replication and polyadenylation of viral RNA, was compared with those of other cymbidium mosaic viruses. No canonical polyadenylation signal was found in the 3'-noncoding region of CymMV-K2, whereas in other CymMVs AAUAAA boxes, are present at the end of RNA with their AAA portions as the first A residue of the poly(A) tail.

Phrenic nerve transfer in the repair of brachial plexus injuries: an animal model.

UNLABELLED: Ten young mongrel dogs underwent unilateral denervation of the brachial plexus. In six dogs, a 2-cm segment of phrenic nerve autograft was sutured to either the resected musculocutaneous nerve or the radial nerve. A hemoclip was applied to either musculocutaneous or radial nerve in the control groups. Five months postoperatively, the grafted musculocutaneous nerve demonstrated less fibrous tissue and less muscle atrophy of the biceps when compared to the control group with clipped nerve. In the group with the grafted radial nerve, the electromyographic findings of multiphasic action potential and muscle contraction from electric stimulation suggested reinnervation of the radial nerve. IN CONCLUSION: phrenic nerve transfer may be used to repair specific damages to nerve trunk with histological, electromyographic and clinical recovery.

Adaptive basis matrix for the morphological function processing opening and closing.

A method for adaptation of the basis matrix of the gray-scale function processing (FP) opening and closing under the least mean square (LMS) error criterion is presented. We previously proposed the basis matrix for efficient representation of opening and closing (see IEEE Trans. Signal Processing, vol.43, p.3058-61, Dec. 1995 and IEEE Signal Processing Lett., vol.2, p.7-9, Jan. 1995). With this representation, the opening and closing operations are accomplished by a local matrix operation rather than cascade operation. Moreover, the analysis of the basis matrix shows that the basis matrix is skew symmetric, permitting to derive a simpler matrix representation for opening and closing operators. Furthermore, we propose an adaptation algorithm of the basis matrix for both opening and closing. The LMS and backpropagation algorithms are utilized for adaptation of the basis matrix. At each iteration of the adaptation process, the elements of the basis matrix are updated using the estimation of gradient to decrease the mean square error (MSE) between the desired signal and the actual filter output. Some results of optimal morphological filters applied to two-dimensional (2-D) images are presented.

Fast recursive algorithms for morphological operators based on the basis matrix representation.

A real-time implementation method for the most general morphological system, the so-called grayscale function processing (FP) system is presented. The proposed method is an extension of our previous works (1993, 1995) using the matrix representation of the FP system with a basis matrix (BM) and a block basis matrix (BBM) composed of grayscale structuring elements (GSE). In order to further improve the computational efficiency of the basis matrix representation, we propose recursive algorithms based on the observation of the BM and BBM. The efficiency of the proposed algorithms is gained by avoiding redundant steps in computing overlapping local maximum or minimum operations. It is shown that, with the proposed scheme, both opening and closing can be determined in real time by 2N-2 additions and 2N-2 comparisons, and OC and CO by 4N-4 additions and 4N-4 comparisons, when the size of the GSE is equal to N. It is also shown that the proposed recursive opening and closing require only 3N-3 memory elements.

Morphological pyramids with alternating sequential filters.

The aim of this paper is to find a relationship between alternating sequential filters (ASF) and the morphological sampling theorem (MST) developed by Haralick et al. (1987). The motivation behind this approach is to take advantage of the computational efficiency offered by the MST to implement morphological operations. First, we show alternative proofs for opening and closing in the sampled and unsampled domain using the basis functions. These proofs are important because they show that it possible to obtain any level of a morphological pyramid in one step rather than the traditional two-step procedure. This decomposition is then used to show the relationship of the open-closing in the sampled and unsampled domain. An upper and a lower bound, for the above relationships, are presented. Under certain circumstances, an equivalence is shown for open-closing between the sampled and the unsampled domain. An extension to more complicated algorithms using a union of openings and an intersection of closings is also proposed. Using the Hausdorff metric, it is shown that a morphologically reconstructed image cannot have a better accuracy than twice the radius of the reconstruction structuring element. Binary and gray scale examples are presented.

The kinetics of formation and dissolution of uric acid crystals.

The kinetics of crystallization and dissolution of uric acid have been studied at temperatures from 15 to 45 C, using a highly reproducbile seeding technique. The rates of reaction have been followed by a precision conductometric method. The mineralization rate follows an equation second-order in relative supersaturation and the experimental evidence points to a surface controlled crystal growth. In contrast, the rapid dissolution of seed crystals into undersaturated uric acid solutions seems to be controlled by diffusion of electrolyte through the hydrodynamic boundary layer at the crystal surface. The activation energy for dissolution, 13.1 +/- 2.6 kJ/mole, is close to that expected for bulk diffusion. Values are reported for the solubility product and dissociation constant for uric acid from 15 to 45 C.