Influence of psychological intervention on patients undergoing spinal anesthesia: a randomized trial.

OBJECTIVE: The aim of this study is to evaluate the effects of positive intervention on the anxiety and the physiological and psychological aspects among preoperative and post-surgical patients with spinal anesthesia. PATIENTS AND METHODS: A randomized trial was conducted with an intervention group (n=58) and a control group (n=59). In the intervention group, the patients were well-informed of the details during spinal anesthesia. Multiple methods were performed to control anxiety before surgery, and nurses were not allowed to discuss the condition during surgery. Anesthesiologists were invited to visit patients to avoid excessive anxiety. RESULTS: The intervention group showed lower scores of State-Trait Anxiety Inventory (STAI) (p<0.05) than the control group 24 hours post-operation. Physiological indices such as systolic blood pressure, low frequency (LF) power, high frequency (HF) power and ration of LF/HF showed better surgery recovery (p<0.05) than the control group. The length of post-anesthesia care unit stay was also significantly shortened in the intervention group (p=0.001) compared with the control group. Positive intervention may alleviate the anxiety in surgical patients receiving spinal anesthesia and improve the physiological and psychological outcomes clinically. CONCLUSIONS: Our results provide evidence indicating that proper intervention can be promoted clinically to improve the satisfaction and quality of life of patients undergoing spinal anesthesia.

Preoperative Evaluation of Patients with Hemifacial Spasm by Three-dimensional Time-of-Flight (3D-TOF) and Three-dimensional Constructive Interference in Steady State (3D-CISS) Sequence.

PURPOSE: The purpose of this study was to investigate and evaluate the accuracy and the preoperative diagnostic value of high-resolution magnetic resonance imaging (MRI) techniques, three-dimensional time-of-flight (3D-TOF) and three-dimensional constructive interference in steady state (3D-CISS) sequence, solely or in combination for the detection of the relationship between the facial nerve and adjacent vessels in patients with hemifacial spasm (HFS). METHODS: A total of 95 patients with primary HFS were subject to 3D-TOF and 3D-CISS MRI. The MR images were then used to evaluate the anatomical neurovascular relationships, and the results were compared with the surgical findings. We categorized the neurovascular relationship into three types: compression, contact, and neighboring or distant. Compression and/or contacts between root exit zone (REZ) and vessels were defined as positive, whereas neighboring or distant was considered to be negative. RESULTS: 3D-TOF combined with 3D-CISS assessment showed that 94 of 95 patients had artery compression or contact at REZ, whereas the remaining patient had compression at the peripheral branch of the facial nerve but not at REZ. The positive rates and the overall accuracy were 98.95 and 100 %, respectively, for the 3D-TOF combined with 3D-CISS assessment; 92.63 and 93.68 %, respectively, for the 3D-TOF assessment; and 85.26 and 86.32 %, respectively, for the 3D-CISS assessment. The positive rates and overall accuracy for the 3D-TOF combined with 3D-CISS assessment was significantly higher than those for the 3D-TOF or 3D-CISS assessment. CONCLUSIONS: Combination of 3D-TOF with 3D-CISS imaging well delineates the relationship between the facial nerve and adjacent vessels in terms of increased positive rates and accuracy.

Performance enhancement using a non-uniform vertical electric field and polymer networks for in-plane switching of multi-pretilt, vertically aligned liquid crystal devices.

A simple and reproducible alignment method for fabricating vertically aligned (VA) liquid crystal (LC) cells with a multi-pretilt structure is developed. A non-uniform vertical electric field is employed in the LC/monomer mixed cells during the photocuring process, and two pretilt domains with a functional small pretilt angle (∼1.6°) in the stabilized VA LC/polymer cells are achieved. The enhanced electro-optical performance of the cell driven by an in-plane switching field is demonstrated. Compared to the pure cell, the 2 wt.% pretilt angle cell shows 36%, 64%, and 76% improvement in the optical switch, the gray-level rise time, and the gray-level fall time responses, respectively, which are obtained at a low driving voltage (≤12 V). When applied to LC devices, the proposed method not only effectively benefits the LC molecular alignment, but it also significantly boosts the electro-optical performance.

Efficiency dip observed with InGaN-based multiple quantum well solar cells.

The dip of external quantum efficiency (EQE) is observed on In(0.15)Ga(0.85)N/GaN multiple quantum well (MQW) solar cells upon the increase of incident optical power density. With indium composition increased to 25%, the EQE dip becomes much less noticeable. The composition dependence of EQE dip is ascribed to the competition between radiative recombination and photocurrent generation in the active region, which are dictated by quantum-confined Stark effect (QCSE) and composition fluctuation in the MQWs.

Adverse effect on syngeneic islet transplantation by transgenic coexpression of decoy receptor 3 and heme oxygenase-1 in the islet of NOD mice.

Decoy receptor 3 (DcR3) blocks both Fas ligand- and LIGHT-induced pancreatic ß-cell damage in autoimmune diabetes. Heme oxygenase 1 (HO-1) possesses antiapoptotic, anti-inflammatory, and antioxidative effects that protect cells against various forms of attack by the immune system. Previously, we have demonstrated that transgenic islets overexpressing DcR3 or murine HO-1 (mHO-1) exhibit longer survival times than nontransgenic islets in syngeneic islet transplantation. In this study, we evaluated whether DcR3 and mHO-1 double-transgenic islets of NOD mice could provide better protective effects and achieve longer islet graft survival than DcR3 or mHO-1 single-transgenic islets after islet transplantation. We generated DcR3 and mHO-1 double-transgenic NOD mice that specifically overexpress DcR3 and HO-1 in islets. Seven hundred islets isolated from double-transgenic, single-transgenic, or nontransgenic NOD mice were syngeneically transplanted into the kidney capsules of newly diabetic female recipients. Unexpectedly, there was no significant difference in the survival time between double-transgenic or nontransgenic NOD islet grafts, and the survival times of double-transgenic NOD islet grafts were even shorter than those of DcR3 or mHO-1 single-transgenic islets. Our data indicate that transplantation of double-transgenic islets that coexpress HO-1 and DcR3 did not result in a better outcome. On the contrary, this strategy even caused an adverse effect in syngeneic islet transplantation.

Solar energy harvesting scheme using syringe-like ZnO nanorod arrays for InGaN/GaN multiple quantum well solar cells.

Syringe-like ZnO nanorod arrays (NRAs) synthesized by a hydrothermal method were applied as the light-harvesting layer on InGaN-based multiple quantum well (MQW) solar cells. Theoretical calculations show that the NRAs with an abrupt shrinkage of tip diameter can further suppress surface reflectance in comparison with the flat NRAs. InGaN-based MQW solar cells with the syringe-like NRAs exhibit greatly improved conversion efficiencies by 36%. These results are attributed to the improved flatness of the refractive index profile at the air/device interface, which results in enhanced light trapping effect on the device surface.

Transgenic expression of murine chemokine decoy receptor D6 by islets reveals the role of inflammatory CC chemokines in the development of autoimmune diabetes in NOD mice.

AIMS/HYPOTHESIS: Autoimmune diabetes results from a progressive destruction of insulin-producing beta cells in the pancreatic islets by chemokine-attracted lymphocytes. Because islet cells in NOD mice produce chemokines during the development of autoimmune diabetes, we investigated the role of inflammatory CC chemokines in disease progression in these mice. METHODS: We generated a transgenic NOD mouse model that overproduces the inflammatory CC chemokine decoy receptor D6 in pancreatic islets. RESULTS: The frequency of diabetes and insulitis scores of transgenic mice were decreased significantly, compared with non-transgenic control littermates. Transgenic expression of D6 (also known as Ccbp2) did not affect systemic lymphocyte development or alter: (1) the T cell subsets such as T helper (Th)1, Th2 and T regulatory cells; or (2) antigen-presenting cells such as dendritic cells or macrophages. The percentages and numbers of T and B lymphocytes were decreased significantly in the pancreas. Activation status, autoantigen-specific proliferation and diabetogenicity of lymphocytes were also markedly reduced. CONCLUSIONS/INTERPRETATION: Inflammatory CC chemokines play a critical role in the development of autoimmune diabetes. Transgenic expression of D6 in pancreatic islets of NOD mice reduced this pathogenic process by suppressing activation of autoreactive lymphocytes and by reducing migration of lymphocytes to the pancreas.

Transgenic expression of haem oxygenase-1 in pancreatic beta cells protects non-obese mice used as a model of diabetes from autoimmune destruction and prolongs graft survival following islet transplantation.

AIMS/HYPOTHESIS: Haem oxygenase 1 (HO-1) has strong anti-apoptotic, anti-inflammatory and antioxidative effects that help protect cells against various forms of immune attack. We investigated whether transgenic expression of Ho-1 (also known as Hmox1) in pancreatic beta cells would protect NOD mice from autoimmune damage and prolong graft survival following islet transplantation. METHODS: To evaluate the protective effect of beta cell-specific HO-1 in autoimmune diabetes, we used an insulin promoter-driven murine Ho-1 construct (pIns-mHo-1) to generate a transgenic NOD mouse. Transgene expression, insulitis and the incidence of diabetes in mice were characterised. Lymphocyte composition, the development of T helper (Th)1, Th2 and T regulatory (Treg) cells, T cell proliferation and lymphocyte-mediated disease transfer were analysed. The potential effects of transgenic islets and islet transplantation on apoptosis, inflammation and the generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) were evaluated. RESULTS: Transgenic mice showed less severe insulitis and a lower incidence of diabetes than non-transgenic control littermates. Lymphocyte composition and functions were not affected. Islets from transgenic mice expressed lower levels of proinflammatory cytokines/chemokines, proapoptotic gene expression and amounts of ROS/RNS, and were more resistant to TNF-α- and IFN-γ-induced apoptosis. Islet grafts from transgenic mice also survived longer in diabetic recipients than control islets. CONCLUSIONS/INTERPRETATION: Transgenic overexpression of Ho-1 in beta cells protected NOD mice from diabetes and delayed the autoimmune destruction of islet grafts, providing valuable insight into the development of better strategies for clinical islet transplantation in patients with type 1 diabetes.

Prenatally detected tumor mass in the adrenal gland.

BACKGROUND/PURPOSE: Screening programs using urinary vanillylmandelic acid have detected neuroblastomas in early infancy with some success. With the widespread use of ultrasonography in modern obstetric practice, use of ultrasonography to screen for fetal neuroblastoma seems to be reasonable and practical. METHODS: Seven fetuses had suprarenal masses detected by maternal ultrasound scan at 32 to 37 weeks' gestation between 1993 and 1998. They were delivered normally if the pregnancy was uncomplicated, especially if it was without maternal preeclampsia or fetal hydrops. Each mass was further confirmed by ultrasound scan, computed tomography, or magnetic resonance imaging in the neonatal period. Tumor excision was performed at the age of 6 to 38 days of life. RESULTS: The size of the masses measured ranged from 2.0x2.0 cm to 4.5x4.5 cm. The diagnosis was adrenal hemorrhage in 1 neonate, Evan's stage I neuroblastoma in 3, and stage IV-S neuroblastoma in 3. All of the specimens with a diagnosis of neuroblastoma showed a favorable histology by the Shimada classification system. Infants with stage I disease were treated with tumor excision only, and they had survived without disease by 14, 18, and 25 months of follow-up. One infant with stage IV-S neuroblastoma was treated further with minimal chemotherapy and has survived without disease at the 66-month follow-up examination. Another child with stage IV-S neuroblastoma has survived with local recurrence and increasing liver metastasis and was still on chemotherapy at the 2-month follow-up examination. The third child with stage IV-S disease presented with massive hepatomegaly and bone marrow involvement, and disseminated intravascular coagulopathy had developed. The patient died on the 5th day of life without surgical intervention. CONCLUSIONS: The increasing use of obstetric ultrasonography has made the prenatal screening of neuroblastomas possible. The prognosis of infants with a suprarenal mass may be improved with this early detection and early surgical intervention.

Antenatal depiction of the fetal ear with three-dimensional ultrasonography.

OBJECTIVE: To evaluate the feasibility of examining the fetal ear with three-dimensional ultrasound. METHODS: In 125 pregnancies between 19 and 38 weeks of gestation, fetal ears were evaluated by three-dimensional ultrasound. The volume images with surface rendering were analyzed to depict the morphology, lying axis, orientation, and cranial location of the fetal ears. RESULTS: Three-dimensional images of one or both ears were successfully reconstructed in 105 fetuses. Among them, 18 fetuses had anomalous ears. The anomalous ears, including microtia, low-set ear with slope axis, abnormal ear orientation, and edematous ear, were confirmed after delivery. Three-dimensional ultrasound consistently displayed fetal ear abnormalities with greater accuracy and clarity. CONCLUSION: Because anomalous ears may be a part of complex fetal malformations, it is important to recognize ear abnormalities. Due to the complexity of the fetal ear, three-dimensional ultrasound offers more important information than two-dimensional ultrasound, which simply gives auricular geometry. We suggest that three-dimensional ultrasound can be used better to examine the fetal ear and may prove to be useful for prenatal diagnosis and genetic counseling.

Application of the surface rendering technique of three-dimensional ultrasound in prenatal diagnosis and counselling of Klippel-Trenaunay-Weber syndrome.

Klippel Trenaunay-Weber syndrome is a complex developmental disorder characterized by a triad of cutaneous haemangioma, varicosities of the body, and unilateral limb hypertrophy. We describe the prenatal diagnosis of Klippel-Trenaunay-Weber syndrome at 15 weeks' gestation using the surface rendering technique of three-dimensional ultrasound. The vivid three-dimensional images of the affected fetus are invaluable in prenatal diagnosis and parental counselling.

Renal vascular resistance in normal children--a color Doppler study.

To investigate the relationship between age and renal vascular resistance and to establish normative data of the systolic/diastolic ratio (S/D ratio), pulsatility index (PI), and resistant index (RI) of the renal artery in the normal pediatric population, we studied 252 normal children aged newborn to 13 years (a total of 449 kidneys) with a color Doppler unit. After the normality of the kidney was established, color flow mapping was performed to localize the segmental portion of the renal artery. Flow velocity waveforms were then obtained by pulsed Doppler, and S/D ratio, PI, and RI were calculated. Multiple regression analysis confirmed the age dependence of the S/D ratio, PI, and RI of the renal artery in normal children. Renal vascular resistance continuously declines after birth and stabilizes at the age of 102-130 months. Normative data for S/D ratio, PI, and RI of the renal artery in normal children were established for each age group. Since renal vascular resistance decreases with age and stabilizes at 8-10 years, we suggest using different normal ranges for each age group when studying renal vascular resistance in pediatric patients.

Sonographic characteristics of adenofibroma of the endometrium following tamoxifen therapy for breast cancer: two case reports.

Adenofibroma of the endometrium is thought to be a rare benign variant of the mixed mesodermal tumor, and its preoperative diagnosis is difficult. We describe the sonographic characteristics of two cases of adenofibroma of the endometrium. In both cases the patient was receiving prolonged tamoxifen therapy following surgery for breast cancer. Sonographically, this rare disease is observed as an intracavitary mass containing multiple small cysts with low-resistance intratumor blood flow. The unique sonographic findings make the preoperative diagnosis possible.

Concordant body stalk anomaly in monozygotic twinning--early embryo cleavage disorder.

We describe a case of concordant body stalk anomaly in monozygotic twins that manifested with umbilical cord agenesis, evisceration of abdominal contents, and multiple gastrointestinal, genitourinary, and skeletal anomalies. Body stalk anomaly in twin gestation is extremely rare and poses an embryological interest. We suggest that the hypothesis of 'incomplete twinning' might contribute to the pathogenesis of this syndrome complex.

Agenesis of the ductus venosus in a case of monochorionic twins which mimics twin-twin transfusion syndrome.

We describe a pair of monochorionic twins with clinical manifestation of twin-twin transfusion syndrome, including discordant fetal growth, hydrops of the larger twin, and the 'stuck twin' phenomenon of the smaller twin. In the hydropic twin, we found agenesis of the ductus venosus and an abnormal umbilical vein draining directly into the inferior vena cava. There was also marked enlargement of the right atrium, representing the volume overload on it. We believe that the agenesis of the ductus venosus in the larger twin may have contributed to the 'unbalanced shunting' between the monochorionic twins. This then led to a clinical picture mimicking that seen in the authentic twin-twin transfusion syndrome.

Extrauterine twin-twin transfusion syndrome after birth in conjoined twins.

Cross-circulation of conjoined twins in utero has been demonstrated and the extent of its severity has varied. Significant 'extrauterine' twin-twin transfusion syndrome after birth, however, caused by an unbalanced shunting within the circulation has not been reported. In a case of omphalopagus conjoined twins complicated by hypovolemia in one twin and hypervolemia in the other, we demonstrated by color Doppler imaging an aberrant vessel from the hepatic artery of one twin to the hepatic vein of the other. Unbalanced shunting through this aberrant vessel was suspected and urgent separation of the conjoined twins was undertaken. Circulatory changes after birth leading to 'extrauterine twin-twin transfusion syndrome' are discussed. A possible explanation of the pathophysiology of intrauterine twin-twin transfusion syndrome is also given.

Successful medical treatment for staphylococcal vertebral osteomyelitis complicated by spinal epidural abscess, psoas abscess and meningitis: a case report.

A 42 year-old farmer was transferred to our hospital for recently exaggerated lower back pain. Neurological examination revealed an L4 radiculopathy on the right side. Meningitis developed after admission. MRI showed L4-5 osteomyelitis and discitis with contiguous spinal epidural abscess and right psoas abscess. Blood culture and CSF culture both grew Staphylococcus aureus. Because the patient refused to receive a drainage procedure, we gave him antibiotics which resulted in a favorable outcome.

Neonatal renal venous thrombosis--a case report describing serial sonographic changes.

Neonatal renal venous thrombosis (NRVT) is a serious complication of newborns. Ultrasound is most useful in detecting NRVT. However, there is no detailed description of the evolution of ultrasound finding in NRVT. Here we report a patient with NRVT with complete ultrasound follow-up. Perivascular streaks were first seen at 3 days of age with a diffusely enlarged and echogenic right kidney. Echolucency then gradually appeared over the medulla area with shrinking renal size. Concomitant loss of renal function was evidenced by dimercaptosuccinic acid scan. The kidney became contracted at the age of 1 year. Since the pathognomonic perivascular streaks were present for only a few days, early ultrasound scanning should be performed for every newborn suspected of having NRVT.

Intrauterine intervention in a case of recurrent meconium peritonitis.

We present a case of recurrent meconium peritonitis detected in the second trimester and treated by intrauterine intervention. Antenatal ultrasound findings included fetal ascites and intra-abdominal calcification. Aspiration of fetal ascites under ultrasound guidance and determination of the bilirubin concentration established the diagnosis of meconium peritonitis. Paracentesis was repeated to remove irritating intestinal contents and to decrease pressure on the fetal thorax. Although the exact cause of the meconium peritonitis remains unknown, the recurrence of the condition suggests a genetic basis. A possibility of cystic fibrosis was not considered because the clinical picture did not suggest it. Intrauterine intervention helped to establish the diagnosis of meconium peritonitis and may have contributed to the good outcome.