Comparison of flexural strength according to thickness between CAD/CAM denture base resins and conventional denture base resins

Purpose@#The purpose of this study is to compare the flexural strength of CAD/CAM denture base resins with conventional denture base resins based on their thicknesses. @*Materials and Methods@#For the conventional denture base resins, Lucitone 199® (C-LC) was used. DIOnavi - Denture (P-DO) and DENTCA Denture Base II (P-DC) were taken for the 3D printing denture base resins. For the prepolymerized PMMA resins, Vipi Block Gum (M-VP) and M-IVoBase® CAD (M-IV) were used. The final dimensions of the specimens were 65.0 mm x 12.7 mm x 1.6 mm / 2.0 mm / 2.5 mm. The 3-point bend test was implemented to measure the flexural strength and flexural modulus. Microscopic evaluation of surface of fractured specimen was conducted by using a scanning electron micro-scope (SEM). After testing the normality of the data, one-way ANOVA was adopted to evaluate the differences among sample groups with a significance level of P = 0.05. The Tukey HSD test was performed for post hoc analysis. @*Results@#Under the same thicknesses, there are significant differences in flexural strength between CAD/CAM denture base resins and conventional denture base resins except for P-DO and C-LC. M-VP showed higher flexural strength than conventional denture base resins, P-DC and M-IV displayed lower flexural strength than conventional denture base resins. Flexural modulus was highest in M-VP, followed by C-LC, P-DO, P-DC, M-IV, significant differences were found between all materials. In the comparison of flexural strength according to thickness, flexural strength of 2.5 mm was significantly higher than that of 1.6 mm in C-LC. Flexural strength of 2.5 mm and 2.0 mm was significantly higher than that of 1.6 mm in P-DC and M-VP. In M-IV, as the thickness increases, significant increase in flexural strength appeared.SEM analysis illustrates different fracture surfaces of the specimens. @*Conclusion@#The flexural strength of different CAD/CAM denture base resins used in this study varied according to the composition and properties of each material. The flexural strength of CAD/ CAM denture base resins was higher than the standard suggested by ISO 20795-1:2013 at a thickness of 1.6 mm or more though the thickness decreased. However, for clinical use of dentures with lower thickness, further researches should be done regarding other properties at lower thickness of denture base resins.

Comparison of flexural strength according to thickness between CAD/CAM denture base resins and conventional denture base resins

Purpose@#The purpose of this study is to compare the flexural strength of CAD/CAM denture base resins with conventional denture base resins based on their thicknesses. @*Materials and Methods@#For the conventional denture base resins, Lucitone 199® (C-LC) was used. DIOnavi - Denture (P-DO) and DENTCA Denture Base II (P-DC) were taken for the 3D printing denture base resins. For the prepolymerized PMMA resins, Vipi Block Gum (M-VP) and M-IVoBase® CAD (M-IV) were used. The final dimensions of the specimens were 65.0 mm x 12.7 mm x 1.6 mm / 2.0 mm / 2.5 mm. The 3-point bend test was implemented to measure the flexural strength and flexural modulus. Microscopic evaluation of surface of fractured specimen was conducted by using a scanning electron micro-scope (SEM). After testing the normality of the data, one-way ANOVA was adopted to evaluate the differences among sample groups with a significance level of P = 0.05. The Tukey HSD test was performed for post hoc analysis. @*Results@#Under the same thicknesses, there are significant differences in flexural strength between CAD/CAM denture base resins and conventional denture base resins except for P-DO and C-LC. M-VP showed higher flexural strength than conventional denture base resins, P-DC and M-IV displayed lower flexural strength than conventional denture base resins. Flexural modulus was highest in M-VP, followed by C-LC, P-DO, P-DC, M-IV, significant differences were found between all materials. In the comparison of flexural strength according to thickness, flexural strength of 2.5 mm was significantly higher than that of 1.6 mm in C-LC. Flexural strength of 2.5 mm and 2.0 mm was significantly higher than that of 1.6 mm in P-DC and M-VP. In M-IV, as the thickness increases, significant increase in flexural strength appeared.SEM analysis illustrates different fracture surfaces of the specimens. @*Conclusion@#The flexural strength of different CAD/CAM denture base resins used in this study varied according to the composition and properties of each material. The flexural strength of CAD/ CAM denture base resins was higher than the standard suggested by ISO 20795-1:2013 at a thickness of 1.6 mm or more though the thickness decreased. However, for clinical use of dentures with lower thickness, further researches should be done regarding other properties at lower thickness of denture base resins.

Cosmetic outcomes of cesarean section scar; subcuticular suture versus intradermal buried suture

OBJECTIVE: The objective of the study was to compare cosmetic outcomes and overall satisfaction rate of cesarean section scar between conventional subcuticular suture and intradermal buried vertical mattress. METHODS: Patients were enrolled to the study by chart review. A scar assessment was obtained retrospectively through a telephone survey. The patient component of the patient and observer scar assessment scale (POSAS) was utilized along with the overall satisfaction of the patient regarding their cesarean section scar and their willingness to choose the same skin closure technique when anticipating their next cesarean section. RESULTS: A total of 303 cases of cesarean section was recruited, 102 finished telephone surveys were calculated for the analyses. Subcuticular suture was regarded as control group (n=52) and intradermal buried suture as test group (n=50). The PSAS score of the test group (mean, 21.8) was lower than that of the control group (mean, 28), with a statistical significance (P=0.02). Overall satisfaction rate did not differ between the two groups. Two parameters of the PSAS score and the level of overall satisfaction showed significant correlation (Pearson's r, −0.63; P < 0.01). CONCLUSION: We suggested the use of intradermal buried vertical mattress as a cosmetically superior skin closure method for application in cesarean sections over subcuticular stitch.

1q21.1 microdeletion identified by chromosomal microarray in a newborn with upper airway obstruction

A 1q21.1 microdeletion is an extremely rare chromosomal abnormality that results in phenotypic diversity and incomplete penetrance. Patients with a 1q21.1 microdeletion exhibit neurological-psychiatric problems, microcephaly, epilepsy, facial dysmorphism, cataract, and thrombocytopenia absent radius syndrome. We reported a neonate with confirmed intrauterine growth restriction (IUGR), micrognathia, glossoptosis, upper airway obstruction, facial dysmorphism, and eye abnormality at birth as well as developmental delay at the age of 1 year. These clinical manifestations, except for the IUGR and upper airway obstruction, in the neonate indicated a 1q21.1 microdeletion. Here, we report a rare case of a 1q21.1 microdeletion obtained via paternal inheritance in a newborn with upper airway obstruction caused by glossoptosis and tracheal stenosis.

Peptide YY producing strumal carcinoid tumor of the ovary in a postmenopausal woman: a rare cause of chronic constipation

Strumal carcinoid tumor of the ovary is a rare subtype of ovarian carcinoid tumors; it is characterized by an intimate mixture of thyroid and carcinoid tissues. We present a case of a 64-year-old woman who presented with the chief complaint of persistent, severe constipation for over 5 years; she was later found to have an ovarian strumal carcinoid tumor. Computed tomography showed a well-defined solid mass measuring 6.4 cm at the right adnexa. The patient underwent right salpingo-oophorectomy and was histopathologically diagnosed as having a strumal carcinoid tumor. Immunohistochemical examination showed immunoreactivity for peptide YY (PYY), which exerts an inhibitory effect on the peristaltic actions of the distal intestine. After surgery, the patient's constipation resolved rapidly, suggesting a correlation between PYY producing ovarian carcinoid tumor and constipation. This is the first case report of PYY producing primary strumal carcinoid tumor of the ovary associated with persistent, severe constipation from Korea.

Lymphoepithelioma-like carcinoma of the uterine cervix

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is exceedingly uncommon. We herein report a rare case of cervical LELC. A 45-year-old woman was admitted to gynecology department with vaginal bleeding for one month. Liquid-based cytology revealed atypical endometrial cells, not otherwise specified on her cervix. On a hysteroscopy, an endocervical mass was identified and the pathologic result was consistent with poorly differentiated squamous cell carcinoma. Magnetic resonance imaging and positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography revealed a 3.1-cm endocervical mass without distant metastasis or enlarged lymph nodes. The International Federation of Gynecology and Obstetrics stage was IB1. A radical hysterectomy and bilateral pelvic lymph node dissection were performed. The pathologic diagnosis was a poorly differentiated carcinoma, showing features of LELC. She has been followed for 8 months without adjuvant treatment since the surgery, during which time there has been no evidence of tumor recurrence or metastasis.

Prognostic value of preoperative lymphocyte-monocyte ratio in elderly patients with advanced epithelial ovarian cancer

OBJECTIVE: To investigate the prognostic significance of preoperative lymphocyte-monocyte ratio (LMR) in elderly patients with advanced epithelial ovarian cancer (EOC) receiving primary cytoreductive surgery and adjuvant platinum-based chemotherapy. METHODS: A total of 42 elderly patients (≥65 years) diagnosed with EOC who are receiving primary cytoreductive surgery and adjuvant platinum-based chemotherapy from 2009 to 2012 was included. LMR was calculated from complete blood cell count sampled before operation. Receiver operating characteristic (ROC) curves were used to calculate optimal cut-off values for LMR. Prognostic significance with respect to overall survival (OS) and progression-free survival (PFS) were determined using log-rank test and Cox regression analysis. RESULTS: The optimized LMR cut-off value determined by ROC curve analysis was 3.63 for PFS and OS. The high LMR group (LMR ≥3.63) was found to be significantly more associated with optimal debulking (P=0.045) and platinum response (P=0.018) than the low LMR group. In addition, Kaplan-Meier analysis revealed the LMR-high group was significantly more associated with high PFS and OS rates (P=0.023 and P=0.033, respectively), and univariate analysis revealed that a high LMR, histology type, and optimal debulking and platinum responses were significantly associated with prolonged PFS and OS. However, subsequent Cox multivariate analysis showed only optimal debulking and platinum response were independent prognostic factors of PFS or OS. CONCLUSION: This study suggests that LMR might be associated with treatment and survival outcomes in elderly patients with EOC receiving standard oncology treatment.

Regulation of retinal angiogenesis by endothelial nitric oxide synthase signaling pathway

Angiogenesis plays an essential role in embryo development, tissue repair, inflammatory diseases, and tumor growth. In the present study, we showed that endothelial nitric oxide synthase (eNOS) regulates retinal angiogenesis. Mice that lack eNOS showed growth retardation, and retinal vessel development was significantly delayed. In addition, the number of tip cells and filopodia length were significantly reduced in mice lacking eNOS. Retinal endothelial cell proliferation was significantly blocked in mice lacking eNOS, and EMG-2-induced endothelial cell sprouting was significantly reduced in aortic vessels isolated from eNOS-deficient mice. Finally, pericyte recruitment to endothelial cells and vascular smooth muscle cell coverage to blood vessels were attenuated in mice lacking eNOS. Taken together, we suggest that the endothelial cell function and blood vessel maturation are regulated by eNOS during retinal angiogenesis.

Regulation of retinal angiogenesis by phospholipase C-β3 signaling pathway

Angiogenesis has an essential role in many pathophysiologies. Here, we show that phospholipase C-β3 (PLC-β3) isoform regulates endothelial cell function and retinal angiogenesis. Silencing of PLC-β3 in human umbilical vein endothelial cells (HUVECs) significantly delayed proliferation, migration and capillary-like tube formation. In addition, mice lacking PLC-β3 showed impaired retinal angiogenesis with delayed endothelial proliferation, reduced endothelial cell activation, abnormal vessel formation and hemorrhage. Finally, tumor formation was significantly reduced in mice lacking PLC-β3 and showed irregular size and shape of blood vessels. These results suggest that regulation of endothelial function by PLC-β3 may contribute to angiogenesis.

Non-puerperal Uterine Inversion Presented with Hypovolemic Shock

We report a non-puerperal uterine inversion with nulliparous women caused by huge pedunculated submucosal fibroid. Massive bleeding from protruding mass through vagina brought the heart to stop in 42-year-old nulliparous woman. She became cardiopulmonary resuscitation survivor in emergency room and then underwent laparotomy which ended in successful myomectomy rather than hysterectomy considering her demand for future fertility. Meticulous and adequate fluid therapy and transfusion was also administered to recover from hypovolemic status. Pathologic report confirmed benign submucosal fibroid with degeneration, necrosis and abscess formation. Thus, clinician should be aware of uterine inversion when encountered with huge protruding vaginal mass and consider uterus-preserving management as surgical option when the future fertility is concerned.

Clinical Efficacy of Recombinant Activated Factor VII in Management of Postpartum Hemorrhage / 대한주산의학회잡지

PURPOSE: This study was aimed to investigate the clinical efficacy of recombinant activated factor VII (rFVIIa) for patients with intractable postpartum hemorrhage. METHODS: This was a retrospective study of ten patients who were treated with rFVIIa from July 2010 to February 2012 in one tertiary center. To evaluate each case, we used a standardized case record form. The primary outcome measures were response of rFVIIa, reduction of blood product requirement, changes of coagulation parameter. The response of rFVIIa was categorized to three groups: "complete responder", "partial responder", "poor responder". RESULTS: After the administration of rFVIIa, effect for bleeding was completely responded in 4 patients, partially responded in 6 patients, and poorly responded in none. A certain amount of reduction in blood product requirements was noted following rFVIIa administration, although no significant differences were observed statistically between before and after rFVIIa administration except RBC (P<0.01). Fibrinogen and INR were significantly reduced in all case types, but other coagulation parameters were not (P<0.01). CONCLUSION: The present results suggest that rFVIIa is a beneficial therapeutic option that could reduce blood loss and contribute to reduction of maternal morbidities and mortalities in patients with massive postpartum hemorrhage.

A Case of Reversible Cerebral Vasoconstriction Syndrome in a Patient Complicated with Preeclampsia / 대한주산의학회잡지

The reversible cerebral vasoconstriction syndromes (RCVS) is a group of conditions, which is characterized by a reversible segmental constriction, typically associated with recurrent thunderclap headaches, and is often complicated by ischemia or hemorrhagic stroke. Clinical situations, associated with the development of RCVS, include pregnancy or the postpartum period, as well as various medications and illicit drugs. However, vasoconstriction syndromes remain poorly characterized, under-recognized, and difficult to diagnose, because of the lack of specific diagnostic tests or diagnostic criteria. Therefore, we present a first case of reversible cerebral vasoconstriction syndrome of pregnancy complicated with preeclampsia, diagnosed by a magnetic resonance image and angiography, which results in chronic cerebral infarction, with a brief review of the relevant literature.

Prenatally Diagnosed Dural Sinus Thrombosis / 대한주산의학회잡지

Thrombosis of the dural sinus in the fetal period is an extremely rare congenital cerebrovascular condition. The exact etiologies and prognosis of dural sinus thrombosis in the fetal period are still unknown due to the extremely limited clinical information available. Therefore, we present a case of dural sinus thrombosis diagnosed by prenatal ultrasound and fetal magnetic resonance imaging that spontaneously regressed, with a brief review of the relevant literature.

Factors Influencing Drinking Behavior during Pregnancy in Korean Women / 신경정신의학

OBJECTIVES: Drinking alcohol during pregnancy can result in various negative consequences. Nevertheless, few studies have been conducted in Korea to investigate alcohol consumption and factors influencing drinking behavior during pregnancy in Korean women. A survey was therefore conducted on pregnant women to investigate whether they drank alcohol and to identify factors predictive of drinking behavior during pregnancy. METHODS: Pregnant women at less than 30 days before expected delivery were asked to complete a self-report questionnaire. Demographic and obstetric characteristics and smoking history were investigated in addition to their history of alcohol use. RESULTS: Six hundred and sixty five subjects of average age 30.8+/-3.8 years were enrolled. Five hundred fifty five (83.5%) and 163 subjects (24.5%), respectively, consumed alcohol before becoming pregnant and after they were aware of being pregnant. Ninety six (14.4% of 665 subjects) and 20 subjects (3.0% of 665 subjects), respectively, smoked before becoming pregnant and after they were aware of being pregnant. Those who had consumed alcohol before becoming pregnant (OR=12.13, p<0.001), those who smoked before becoming pregnant (OR=2.24, p=0.001) and those with a family history of smoking (OR=1.59, p< or =0.05) were found to be more likely to drink alcohol when pregnant. CONCLUSION: Three factors, alcohol drinking before becoming pregnant, cigarette smoking before becoming pregnant and a family history of cigarette smoking, are predictive of alcohol consumption during pregnancy. These results strongly suggest that an anti-drinking educational program should be devised to target women of child bearing potential and, in particular, those at high risk.

High Peritoneal Transport Status is Not an Independent Risk Factor for High Mortality in Patients Treated with Automated Peritoneal Dialysis

We undertook this study to elucidate whether baseline peritoneal membrane transport characteristics are associated with high mortality in incident automated peritoneal dialysis (APD) patients. This retrospective study includes 117 patients who started APD at Yonsei University Health System from 1996 to 2008 and had a PET within 3 months of APD initiation. High transporters were significantly older and had a higher incidence of cardiovascular disease. Patient survival for years 1, 3, and 5 were 85%, 64%, and 35% for high transporter and 94%, 81%, and 68% for non-high transporter group (P<0.01). Multivariate analysis revealed that age, diabetes, cardiovascular disease, serum albumin level, and residual renal function were independently associated with high mortality in APD patients. In contrast, high transport status was not a significant predictor for mortality in this population when the other covariates were included. Even though high transport was significantly associated with mortality in the univariate analysis, its role seemed to be influenced by other comorbid conditions. These findings suggest that the proper management of these comorbid conditions, as well as appropriate ultrafiltration by use of APD and/or icodextrin, must be considered as protective strategies to improve survival in peritoneal dialysis patients with high transport.

Rupture of Renal Artery Aneurysm Misdiagnosed as Postpartum Retroperitoneal Hematoma / 대한주산의학회잡지

Aneurysms in the renal artery are relatively rare and predominately asymptomatic. Histological data estimate that renal artery aneurysms (RAAs) are found in 0.1% of the general population. The most catastrophic complication of RAA is rupture, which occurs in less than 3% of patients. Nearly 30 cases of rupture of RAA (RRAA) during pregnancy have been reported in the international literature, but no RRAA diagnosed after labor has been reported. We report on the first case of acute RRAA after labor, which was initially misdiagnosed as postpartum retroperitoneal hematoma, and provide a brief review of the literature.

Localization of aquaporin-3 in mouse placenta and its role / 대한산부인과학회지

OBJECTIVE: Aquaporin (AQP) 3 is a small integral membrane protein that functions as a facilitated transporter of water and glycerol. To elucidate a role of AQP3 in placenta, changes in amniotic fluid composition and fetal growth were investigated using AQP3 null mice. METHODS: Embryonic day 14,5 gestational sacs of wild-type and AQP3 kncok-out pregnant mice, thirty each, were used for this study. AQP3 localization and expression were assessed by immunohistochemistry and western blot. RESULTS: AQP3 was highly expressed in basolateral membrane of visceral yolk sac cells of fetal membrane and syncytiotrophoblast cells of labyrinthine placenta. In contrast, AQP1 was expressed in apical membrane of visceral yolk sac cells and endothelial cells lining vasculature. There was no significant difference in normal placentation and differentiation from trophoblast stem cells between wild type and AQP3 null mice. However, AQP3 null mice had increased amount of amniotic fluid per gram of body weight and decreased osmorality of amniotic fluid with low concentrations of ions and solutes in amniotic fluid. In addition, AQP3 null mice pups were smaller than CD1 wild type mice. CONCLUSION: AQP3 plays an important role in amniotic water balance and nutrient supply to developing fetus by facilitating transplacental transport of water and glycerol.

Relationship between Ghrelin levels of maternal serum, umbilical vein and birth weight / 대한산부인과학회지

OBJECTIVE: Ghrelin is a newly isolated peptide from the stomach. Subsequent studies revealed that ghrelin is expressed in human placenta. Circulating ghrelin levels reflect acute and chronic energy balance in humans. However, it is not proven whether ghrelin plays a role during pregnancy. The purpose of this study was to compare relationship between ghrelin levels of maternal serum, umbilical vein and birth weight. METHODS: We measured maternal ghrelin levels (N=41) in each trimester and postpartum whose fetus were appropriate-for-gestational age. Also we checked cord blood ghrelin levels at delivery in appropriate-for-gestational age group (N=20) and small-for-gestational age group (N=20). RESULTS: Ghrelin was detected in all samples from maternal and cord blood. Maternal serum ghrelin levels showed a peak in the 2nd trimester (35.7+/-12.7 pg/mL) and decreased in the late 3rd trimester (26.5+/-10.3 pg/mL). An increase was observed again in postpartum, which was measured at one day after delivery. There was no significant correlation between maternal serum ghrelin level and birth weight (P>0.05), but there was statistically significant correlation between cord blood ghrelin level and birth weight (r=-0.411, P<0.05). CONCLUSION: Maternal serum ghrelin levels showed a peak around mid-gestation during pregnancy and then, decreased in the 3rd trimester, the time of increased maternal body weight. There was no association between maternal serum ghrelin level and birth weight. But small-for-gestational age neonates present with higher umbilical cord ghrelin level than that of appropriate-for-gestational age neonates. It is conceivable that ghrelin may play a physiologic role in fetal adaptation to intrauterine malnutritional state.

Influence of women's age on the outcome of in vitro fertilization and ovarian blood flow / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to assess the influence of women's age on the outcome of in vitro fertilization (IVF) and ovarian blood flow. METHODS: To investigate the influence of women's age on the outcome of IVF, 266 IVF cycles were analyzed according to their age. Number of oocytes retrieved, fertilization rate, clinical pregnancy rate, and implantation rate were analyzed. Pulsatility index (PI) of the intraovarian artery was measured by transvaginal color and pulsed Doppler on the day of hCG administration in 15 women of each age group in order to find the relationship between women's age and ovarian blood flow. RESULTS: There was no significant difference in fertilization rate but clinical pregnancy rate and PI were different significantly according to the women's aging. In particular, the pregnancy outcome and ovarian blood flow of women older than 38 years were significantly decreased compared to those of women younger than 38 years. CONCLUSIONS: As women's age increase, clinical pregnancy rate and ovarian blood flow were gradually decreased.

An Experience of the Fetal Stabilization

PURPOSE: The authors applied fetal stabilization and evaluated its efficacy as a therapeutic modality in the management of several congenital anomalies that can lead to perinatal respiratory distress, such as a congenital diaphragmatic hernia (CDH), large cervical lymphangioma or gastroschisis, etc. METHODS: Between Oct. 2000 and Dec. 2004, 12 newborns, with a congenital diaphragmatic hernia or gastroschisis, were observed and fetal stabilization was applied to 4 neonates. Their clinical characteristics were then retrospectively reviewed. The protocol of this procedure was as followed, (1) monitoring of the fetal respiratory movement and heart beat using Doppler ultrasonography, (2) the intravenous administration of morphine (20 to 30 mg) and diazepam (5 mg) to the mother, (3) proceed to a cesarean section when any interruptions in the fetal movement were confirmed, (4) an intravenous injection of a pancuronimum (0.5 mg) through the umbilical vein, (5) an immediate tracheal intubation before disruption of the placenta, (6) clamping of the umbilical cord, (7) attempt a mechanical ventilation after delivery, (8) maintain percutaneous intravenous catheterization (PIC) and (9) evaluation of the neonate. RESULTS: Of the 10 neonates with a CDH and the 2 with gastroschisis, fetal stabilization was applied to 3 CDH and 1 gastroschisis neonates, respectively. The survival rates were 85.7% that of conventional therapy, 66.7% for fetal stabilization in the CDH neonates and 100% for those with gastroschisis. Relatively, in those with a CDH where fetal stabilization was applied, large defects were observed and they were diagnosed at an earlier period, which could affect the mortality. CONCLUSION: In our experience, fetal stabilization seems to be useful as another alternative therapeutic modality for the control of respiratory distress in the management of a CDH and gastroschisis. However, further experiences with more clinical results will be required