Predictive modelling of level IIb lymph node metastasis in oral squamous cell carcinoma.

The aim of the present study was to examine the conditions, characteristics, and risk factors of level IIb lymph node metastases in oral squamous cell carcinoma and to formulate surgical criteria for level IIb lymph node dissection. We analyzed clinical and pathological records for 541 oral squamous carcinoma patients in relation to level IIb metastasis. Univariate and multivariate analyses were performed to detect risk factors for level IIb lymph node metastasis; a predictive model was built based on multivariate analysis and tested in a validation group. Univariate and multivariate analyses using the training group indicated that level IIa metastasis and Lymphovascular permeation (LVP) were two independent risk factors for level IIb lymph node metastasis. This model was built and tested in a validation group, the area under the curve being 0.697 (P < .0.001). The model's sensitivity was 66.7% and specificity was 77.4%. Nomogram incorporating validated variables was developed for level IIb metastasis prediction. Expected survival probabilites were analysed to specify significance of model's variable on patients' overall survival and recurrence. Level IIb dissection should be performed in patients with level IIa metastasis and LVP. However, thorough consideration of the oncologic safety of omitting level IIb dissection is compulsory.

FIBTEM Improves the Sensitivity of Hyperfibrinolysis Detection in Severe Trauma Patients: A Retrospective Study Using Thromboelastometry.

Rotational thromboelastometry (ROTEM) can only detect high-degree hyperfibrinolysis (HF), despite being frequently used in trauma patients. We investigated whether considering FIBTEM HF (the presence of maximal lysis (ML) > 15%) could increase ROTEM-based HF detection's sensitivity. This observational cohort study was performed at a level 1 trauma centre. Trauma patients with an Injury Severity Score (ISS) > 15 who underwent ROTEM in the emergency department between 2016 and 2017 were included. EXTEM HF was defined as ML > 15% in EXTEM. We compared mortality rates between EXTEM HF, FIBTEM HF, and non-HF patient groups. Overall, 402 patients were included, of whom 45% were men (mean age, 52.5 years; mean ISS, 27). The EXTEM HF (n = 37), FIBTEM HF (n = 132), and non-HF (n = 233) groups had mortality rates of 81.1%, 22.3%, and 10.3%, respectively. The twofold difference in mortality rates between the FIBTEM HF and non-HF groups remained statistically significant after Bonferroni correction (P = 0.01). On multivariable Cox regression analysis, FIBTEM HF was independently associated with in-hospital mortality (adjusted hazard ratio 2.15, 95% confidence interval 1.21-3.84, P = 0.009). Here, trauma patients with FIBTEM HF had significantly higher mortality rates than those without HF. FIBTEM be a valuable diagnostic method to improve HF detection's sensitivity in trauma patients.

Poison severity score and sequential organ failure assessment score: Carbon monoxide poisoning prognosis.

PURPOSE: We aimed to examine the utility of the Poison Severity Score (PSS) and Sequential Organ Failure Assessment (SOFA) score as early prognostic predictors of short-term outcomes in patients with carbon monoxide (CO) poisoning. We hypothesized that both the PSS and the SOFA score would be useful prognostic tools. METHODS: This was retrospective observational study of patients with CO poisoning who presented to the emergency department and were admitted for more than 24 hours. We calculated PSS, the initial SOFA score, a second (2nd) SOFA score, and a 24-hour delta SOFA score. The primary outcome was reported as the cerebral performance category (CPC) scale score at discharge. We classified those with CPC 1-2 as the good outcome group and those with CPC 3-5 as the poor outcome group. RESULTS: This study included 192 patients: 174 (90.6%) belonged to the good outcome group, whereas 18 (9.4%) belonged to the poor outcome group. The PSS (1.00 [0.00, 1.00] vs 3.00 [3.00, 3.00], p < 0.001), initial SOFA (1.00 [0.00, 2.00] vs 4.00 [3.25, 6.00], p < 0.001), 2nd SOFA score (0.00 [0.00, 1.00] vs 4.00 [3.00, 7.00], p < 0.001), and 24-hour delta SOFA score (-1.00 [-1.00, 0.00] vs 0.00 [-1.00, 1.00], p = 0.047) of the good outcome group were significantly higher than those of the poor outcome group. The areas under the receiver operating characteristic curve for PSS and the initial SOFA and 2nd SOFA scores were 0.977 (95% confidence interval [CI] 0.944-0.993), 0.945 (95% CI 0.903-0.973), and 0.978 (95% CI 0.947-0.994), respectively. CONCLUSION: The PSS, initial SOFA score, and 2nd SOFA score predict acute poor outcome accurately in patients with CO poisoning.

Three-Dimensional Analysis of Transverse Width of Hard Tissue and Soft Tissue After Mandibular Setback Surgery Using Intraoral Vertical Ramus Osteotomy: A Retrospective Study.

PURPOSE: Some clinicians are concerned that if an intraoral vertical ramus osteotomy (IVRO) is used to position the mandible posteriorly, the proximal segments should be positioned laterally to the distal segment, which could increase the transverse mandibular width, leading to esthetically unfavorable results. This study investigated short- and long-term postoperative transverse mandibular width changes in the soft and hard tissue after IVRO for mandibular prognathism. MATERIALS AND METHODS: The study comprised 44 patients who were treated with mandibular setback surgery using an IVRO. They were categorized into either the facial symmetry group or facial asymmetry group based on their preoperative levels of chin top deviation. Three-dimensional cone-beam computed tomography images were obtained at the preoperative, 1-month postoperative, and 12-month postoperative stages, designated as T1, T2, and T3, respectively. We set hard tissue width 1 (HW1) and hard tissue width 2 (HW2) as the sum of the distance at the bilateral ends of the angle and ramus, respectively, and set soft tissue width 1 (SW1) and soft tissue width 2 (SW2) as the sum of the distance at the bilateral ends of the soft tissue angle and ramus, respectively. RESULTS: Compared with the value at T1, the HW1 value increased by 8.16% (P < .05) and HW2 increased by 4.39% (P > .05) at T2; HW1 increased by 4.35% (P < .05) and HW2 increased by 2.95% (P > .05) at T3. Compared with the value at T1, the SW1 value increased by 2.49% and SW2 increased by 2.50% at T2; however, SW1 decreased by 0.85% and SW2 increased by 0.37% at T3. The soft tissue variations between T1 and T2, as well as between T2 and T3, were statistically significant. However, no significant difference was found between T1 and T3 (P > .05). No difference between the facially symmetrical and asymmetrical groups was found over time for soft and hard tissues (P > .05). CONCLUSIONS: Notably, IVRO does not seem to impact the transverse facial profile and enables reliable prediction of the esthetic results of surgery.

Effect of decompression for patients with various jaw cysts based on a three-dimensional computed tomography analysis.

OBJECTIVES: The aim of this study is to evaluate the effectiveness of decompression according to reduction parameters by measuring cystic volume changes using computed tomography (CT). STUDY DESIGN: We chose patients who had undergone decompression for a cystic lesion of the jaw at the Department of Oral and Maxillofacial Surgery in our dental hospital between 2006 and 2015. All patients had been examined by CT before and after decompression. We measured the volume of cystic lesions using the threshold method and evaluated the volumetric changes after decompression according to various parameters. RESULTS: The mean reduction rates of 46 cystic cases was 57.95%. There was a statistically significant difference in reduction rates by initial volume; the group with large initial volume reported higher reduction rates. CONCLUSION: Decompression is more effective in larger initial lesions when carried out more than 6 months. CT is an efficient method for evaluating the bony healing within the cyst cavity by measuring changes in cystic volume after decompression. However, due to its high cost and radiation dose, a comparative study using another diagnostic radiographic tool should be considered.

Transthoracic echocardiogram in syncope patients with normal initial evaluation.

OBJECTIVES: Despite the low diagnostic yield of echocardiogra0, it is often used in the evaluation of syncope. This study determined whether patients without abnormalities in the initial evaluation benefit from transthoracic echocardiogram (TTE) and the clinical factors predicting an abnormal TTE. METHODS: This study enrolled 241 patients presenting to the emergency department with syncope. The TTE results were analyzed based on risk factors suggesting cardiogenic syncope in the initial evaluation. RESULTS: Of the 115 patients with at least one risk factor, 97 underwent TTE and 27 (27.8%) had TTE abnormalities. In comparison, of the 126 patients without risk factors, 47 underwent TTE and only 1 (2.1%) had TTE abnormalities. Significantly different factors between patients with normal and abnormal TTE findings were entered in a multiple logistic regression analysis, which yielded age [adjusted odds ratio (aOR), 1.09; 95% CI, 1.02-1.15; p=0.006], an abnormal electrocardiogram (ECG) (aOR, 7.44; 95% CI, 1.77-31.26; p=0.010), and a brain natriuretic peptide (BNP) level of >100pg/mL (aOR, 2.64; 95% CI, 1.21-5.73; p=0.011) as independent predictors of TTE abnormalities. The cutoff value of age predicting an abnormal TTE was 59.0years (area under the curve, 0.777; p<0.001). CONCLUSION: A patient who is older than 59years or has an abnormal ECG or an elevated BNP level may benefit from TTE. Otherwise, TTE should be deferred in patients with no risk factors in the initial evaluation.

Emergency coronary angiography in out-of-hospital cardiac arrest patients without STEMI.

Current guideline recommends that immediate coronary angiography (CAG) should be considered in all postcardiac arrest patients in whom acute coronary syndrome is suspected. In the setting of out-of-hospital cardiac arrest (OHCA), obtaining clinical data such as chest discomfort and medical diseases associated with acute coronary syndrome can be difficult. Therefore, emergency physicians depend on electrocardiographic findings after return of spontaneous circulation (ROSC) when they have to decide whether emergency CAG should be performed. In clinical practice, the usefulness of emergency CAG evaluation of OHCA patients without ST-segment elevation myocardial infarction is debatable. We describe 2 OHCA patients who did not exhibit ST-segment elevation after ROSC and received underwent emergency CAG.

Life's Experiences of Middle-aged Divorced Women with Higher Education and Profession.

PURPOSE: Today, an increasing number of divorce is shifting family forms and gender role practices. The purpose of this qualitative study was to understand life's experiences of middle-aged divorced women with higher education and profession lives in Korea. METHODS: For this study, 6 middle-aged divorced women with similar backgrounds were recruited from December 2013 to June 2014, using in-depth individual interviews. Data analysis was performed using Giorgi's phenomenological methodology. RESULTS: Individual interviews revealed the following 15 meaning of themes and 5 themes. 1) A woman considering herself to be ashamed that she has not lived an ordinary life. 2) The destiny of a woman not having a fortune. 3) An exhilarated mood like a teenage girl's 4) Suppressing an instinctive desire of sex. 5) Being a mother as a woman head of household. CONCLUSION: This study provides deep understanding of middle-aged divorced women with higher levels of education and professional lives of women who experienced difficult times and overcame their problems. Based on the results of this study, nursing strategies for enhancing quality of life need to be created and implemented for all professional women by Korean community networking gradually.

Fast monitoring of indoor bioaerosol concentrations with ATP bioluminescence assay using an electrostatic rod-type sampler.

A culture-based colony counting method is the most widely used analytical technique for monitoring bioaerosols in both indoor and outdoor environments. However, this method requires several days for colony formation. In this study, our goal was fast monitoring (Sampling: 3 min, Detection: < 1 min) of indoor bioaerosol concentrations with ATP bioluminescence assay using a bioaerosol sampler. For this purpose, a novel hand-held electrostatic rod-type sampler (110 mm wide, 115 mm long, and 200 mm tall) was developed and used with a commercial luminometer, which employs the Adenosine triphosphate (ATP) bioluminescence method. The sampler consisted of a wire-rod type charger and a cylindrical collector, and was operated with an applied voltage of 4.5 kV and a sampling flow rate of 150.7 lpm. Its performance was tested using Staphylococcus epidermidis which was aerosolized with an atomizer. Bioaerosol concentrations were measured using ATP bioluminescence method with our sampler and compared with the culture-based method using Andersen cascade impactor under controlled laboratory conditions. Indoor bioaerosol concentrations were also measured using both methods in various indoor environments. A linear correlation was obtained between both methods in lab-tests and field-tests. Our proposed sampler with ATP bioluminescence method may be effective for fast monitoring of indoor bioaerosol concentrations.

Real-time monitoring of bioaerosols via cell-lysis by air ion and ATP bioluminescence detection.

In this study, we introduce a methodology for disrupting cell membranes with air ions coupled with ATP bioluminescence detection for real-time monitoring of bioaerosol concentrations. A carbon fiber ionizer was used to extract ATP from bacterial cells for generating ATP bioluminescence. Our methodology was tested using Staphylococcus epidermidis and Escherichia coli, which were aerosolized with an atomizer, and then indoor bioaerosols were also used for testing the methodology. Bioaerosol concentrations were estimated without culturing which requires several days for colony formation. Correlation equations were obtained for results acquired using our methodology (Relative Luminescent Unit (RLU)/m(3)) and a culture-based (Colony Forming Unit (CFU)/m(3)) method; CFU/m(3)=1.8 × measured RLU/m(3) for S. epidermidis and E. coli, and CFU/m(3)=1.1 × measured RLU/m(3) for indoor bioaerosols under the experimental conditions. Our methodology is an affordable solution for rapidly monitoring bioaerosols due to rapid detection time (cell-lysis time: 3 min; bioluminescence detection time: <1 min) and easy operation.

Toxicity and synergic repellency of plant essential oil mixtures with vanillin against Aedes aegypti (Diptera: Culicidae).

In all triplicate tests of six plant essential oils and of vanillin mixtures, we corroborated strong insecticidal and repellent activities against adult Aedes aegypti (L.). Essential oils with potent toxic fumigant activities also exhibited repellency. Compared with N, N-diethyl-3-methylbenzamide, 5% of the essential oil concentrations of cassia, lemongrass, lemon eucalyptus, and xanthoxylum oils did not show repellent effects. However, a composition oflemongrass oil, xanthoxylum oil, and vanillin (1:3:1, vol:vol:wt) provided 270 min of complete protection time (CPT) compared with 247.5 min CPT with 15% N, N-diethyl-3-methylbenzamide. The CPT depended on concentration, presence ofvanillin, or on both factors. When we applied a mixture of lemongrass oil: xanthoxylum oil: vanillin (1:1:1, vol:vol:wt) to the Viscopearl formulation, or porous cellulose beads, it provided gradual release of volatile compounds, thus showing >90% of repellency for 2 h. The behavioral and electrophysiological approaches we drew upon in our current study demonstrated that plant essential oil mixtures combined with vanillin showed strong and durable repellency to the mosquito. We claim that such combinations of plant essential oils and vanillin found in current study propose a viable commercial product suitable for future application in protecting a person from mosquito bites.

Ordered complex nanostructures from bimodal self-assemblies of diblock copolymer micelles with solvent annealing.

We report the formation of ordered complex nanostructures from single-layered films of mixtures of polystyrene-poly(2-vinylpyridine) (PS-P2VP) and polystyrene-poly(4-vinylpyridine) (PS-P4VP) diblock copolymer micelles by THF (tetrahydrofuran) annealing. We first examined the influence of THF vapor on PS-P2VP and PS-P4VP micelles in their single-layered films. Due to the different solubility of PS-P2VP and PS-P4VP copolymers in THF, a hexagonal array of PS-P2VP micelles was changed into cylindrical nanodomains, but that of PS-P4VP micelles was not changed. The different influence of THF on PS-P2VP and PS-P4VP micelles was combined in single-layered films of mixtures of both micelles. For the purpose, we prepared mixture solutions of independently prepared small PS-P2VP and large PS-P4VP micelles. Then, bimodal self-assemblies of micelles were prepared from the mixtures, for which the hexagonal array of large PS-P4VP micelles was surrounded by small PS-P2VP micelles. When the bimodal self-assembly was annealed by THF vapor, PS-P2VP micelles were transformed into cylindrical nanodomains, but their reorganization was guided by hexagonally arranged PS-P4VP micelles. As a result, we were able to produce ordered complex nanostructures in the form of a hexagonal array of PS-P4VP micelles surrounded by PS-P2VP cylinders, which was further utilized for the synthesis of Au nanoparticles.

Effect of an air cleaner with electrostatic filter on the removal of airborne house dust mite allergens.

PURPOSE: The effects of air cleaners on the removal of airborne indoor allergens, especially house dust mites (HDM), are still controversial. The objective of this study is to evaluate the effect of an air cleaner with an electrostatic filter on the removal of airborne mite allergens. MATERIALS AND METHODS: A dried HDM culture medium that contained mite body particles and excretions was dispersed in a chamber equipped with an electrostatic air cleaner. The number of airborne particles was recorded continuously by a dust spectrometer for 60 minutes. Airborne particles in the chamber were collected on a sampling filter at a flow rate of 10 L/min and the Der f 1 concentration in the filter extracts was measured by two-site ELISA. RESULTS: The air cleaner efficiently removed airborne HDM particles. The air cleaner removed airborne HDM particles (size 2-12.5 µm) 11.4 ± 2.9 fold (cleaner operating for 15 minutes), 5.4 ± 0.7 fold (cleaner operating for 30 minutes), and 2.4 ± 0.2 fold (cleaner operating for 60 minutes) more than the removal of HDM particles by natural settle down. Removal kinetics differed according to the particle size of the airborne particles. The air cleaner decreased the concentration of Der f 1 in the extraction of airborne particles collected on the air sampling filter by 60.3%. CONCLUSION: The electrostatic air cleaner can remove airborne HDM allergens and may be useful as a supplementary environmental control tool for HDM sensitized respiratory allergic patients.

Micellar nanotubes and AAO nanopores decorated with nanoparticles.

We demonstrated that anodized aluminum oxide (AAO) enables the fabrication of micellar nanotubes and nanopores decorated with nanoparticles. Block copolymer micelles containing precursors of nanoparticles were coated on the nanopores of AAO, from which we were able to select nanotubes containing nanoparticles or nanopores decorated with nanoparticles by removing the AAO template or the copolymer. Upon removal of the AAO, the micellar nanotubes with nanoparticles were produced, whereas the nanopores of AAO were decorated with nanoparticles by eliminating the copolymer. Since a variety of nanoparticles can be synthesized in addition to full control over the size and spacing of nanoparticles by the copolymer micellar approach, the methodology demonstrated here can allow fabricating functional nanotubes or nanopores with a selection of the type and size of nanoparticles.

Synthesis of atypical nanoparticles by the nanostructure in thin films of triblock copolymers.

We report the synthesis of atypical nanoparticles in donut shape with or without additional spherical nanoparticles attached on them by using the donut-like nanostructure formed in a thin film of triblock copolymers. In a high-humidity condition, a spin-coated film of triblock copolymer had donut-like holes consisting of the periphery and the center. By selective coordination of precursors of nanoparticles to the periphery of the holes, donut-like oxide nanoparticles were synthesized by oxygen plasma treatment on the film. Moreover, we were able to attach spherical nanoparticles on the donut-like nanoparticles by incorporating the other type of precursors to the center of the holes. Thus, beyond the synthesis of typical spherical nanoparticles, the results here extend potentials of the block copolymer approach to control the shape and complexity of nanoparticles.

DNA . RNA heteroduplex containing 8-oxo-7,8-dihydroguanosine: base pairing, structures, and thermodynamic stability.

Oligoribonucleotides containing 8-oxo-7,8-dihydroguanosine (8-oxoG) and 8-oxo-7,8-dihydro-2'-O-methylguanosine (8-oxoG-Me) were synthesized. The base pairing properties of 8-oxoG and 8-oxoG-Me in oligoribonucleotide in cDNA synthesis by reverse transcriptases were studied. dCMP was preferentially incorporated into the site opposite 8-oxoG or 8-oxoG-Me than into other dNMPs. TMP and dCMP were inserted preferentially into sites opposite 8-oxoG or 8-oxoG by reverse transcriptases. HIV-RT did not incorporate TMP, but RAV2-RT incorporated 50% more TMP than dCMP into the site opposite 8-oxoG. In the site opposite 8-oxoG-Me TMP was substantially incorporated by HIV-RT or RAV2-RT. Thermodynamic analysis of the DNA.RNA heteroduplex containing 8-oxoG revealed that 8-oxoG and 8-oxoG-Me formed base pairs with cytidine and thymidine with similar stability. The thermodynamic parameter (DeltaG degrees ) demonstrated that the formation of duplexes between 8-oxoG or 8-oxoG-Me and cytidine or thymidine is more thermodynamically favorable than with adenosine and guanosine. However, differences in the melting temperature and DeltaG degrees 's of 8-oxoG/dC and 8-oxoG/T were much smaller than between G/dC and G/T. CD spectra showed that DNA . RNA containing 8-oxoG or 8-oxoG-Me duplexes showed similarities between the A-type RNA and B-type DNA conformations.