Primary site identification in children with OSA

Study Objectives: Obstructive sleep apnea (OSA) is a respiratory disorder caused by the obstruction of the upper airway during sleep. The identification of the primary site of OSA is essential to determine treatment strategy. This study aimed to establish computational fluid dynamics (CFD) analysis for determining the clinical severity of OSA and the primary site of OSA. Methods: Twenty children (mean age, 6 years) were divided into OSA and control groups according to their apnea hypopnea index. Three-dimensional airways were constructed from computed tomography data. The pharyngeal airway morphology and the pressure and velocity of the upper airway were evaluated using CFD analysis. Results: The maximum velocity and pressure of the upper airway in the OSA group were significantly correlated with the severity of OSA (rs = 0.741, P < 0.001; rs = 0.653, P = 0.002). A velocity higher than 12 m/s indicated the primary site of OSA. In addition, we found that the primary site of OSA is not necessarily the same as the collapsible conduit site. Conclusions: CFD analysis allows both the evaluation of the disease severity of OSA and the identification of the primary site of OSA in children. The primary site of OSA is not necessarily the same as the collapsible conduit site; therefore, CFD analysis can be used to identify the appropriate intervention for treating OSA

Effect of atherothrombotic aorta on outcomes of total aortic arch replacement

ObjectiveThe effect of an atherothrombotic aorta on the short- and long-term outcomes of total aortic arch replacement, including postoperative neurologic deficits, remains unknown. We evaluated this relationship and also elucidated the synergistic effect of multiple other risk factors, in addition to an atherothrombotic aorta, on the neurologic outcome.MethodsA group of 179 consecutive patients undergoing total aortic arch replacement were studied. An atherothrombotic aorta was present in 34 patients (19%), more than moderate leukoaraiosis in 71 (39.7%), and significant extracranial carotid artery stenosis in 27 (15.1%). In-hospital deaths occurred in 2 patients, 1 (2.9%) of 34 patients with and 1 (0.7%) of 145 patients without an atherothrombotic aorta (P = .26). Permanent neurologic deficits occurred in 4 (2.2%) and transient neurologic deficits in 17 (9.5%) patients. Multivariate analysis demonstrated that the risk factors for transient neurologic deficits were an atherothrombotic aorta (odds ratio, 4.4), extracranial carotid artery stenosis (odds ratio, 5.5), moderate/severe leukoaraiosis (odds ratio, 3.6), and cardiopulmonary bypass time (odds ratio, 1.02). To calculate the probability of transient neurologic deficits, the following equation was derived: probability of transient neurologic deficits = {1 + exp [7.276 − 1.489 (atherothrombotic aorta) − 1.285 (leukoaraiosis) − 1.701 (extracranial carotid artery stenosis) − 0.017 (cardiopulmonary bypass time)]}−1. An exponential increase occurred in the probability of transient neurologic deficits with presence of an atherothrombotic aorta and other risk factors in relation to the cardiopulmonary bypass time. Survival at 3 years after surgery was significantly reduced in patients with vs without an atherothrombotic aorta (75.0% ± 8.8% vs 89.2% ± 3.1%, P = .01).ConclusionsPatients with an atherothrombotic aorta and associated preoperative comorbidities might be predisposed to adverse short- and long-term outcomes, including transient neurologic deficits

Identification and Characterization of Transcription Factors Regulating Arabidopsis \u3ci\u3eHAK5\u3c/i\u3e

Potassium (K) is an essential macronutrient for plant growth and reproduction. HAK5, an Arabidopsis high-affinity K transporter gene, plays an important role in K uptake. Its expression is up-regulated in response to K deprivation and is rapidly down-regulated when sufficient K levels have been re-established. To identify transcription factors regulating HAK5, an Arabidopsis TF FOX (Transcription Factor Full-length cDNA Over-eXpressor) library containing approximately 800 transcription factors was used to transform lines previously transformed with a luciferase reporter gene whose expression was driven by the HAK5 promoter. When grown under sufficient K levels, 87 lines with high luciferase activity were identified, and endogenous HAK5 expression was confirmed in 27 lines. Four lines overexpressing DDF2 (Dwarf and Delayed Flowering 2), JLO (Jagged Lateral Organs), TFII_A (Transcription initiation Factor II_A gamma chain) and bHLH121 (basic Helix–Loop–Helix 121) were chosen for further characterization by luciferase activity, endogenous HAK5 level and root growth in K-deficient conditions. Further analysis showed that the expression of these transcription factors increased in response to low K and salt stress. In comparison with controls, root growth under low K conditions was better in each of these four TF FOX lines. Activation of HAK5 expression by these four transcription factors required at least 310 bp of upstream sequence of the HAK5 promoter. These results indicate that at least these four transcription factors can bind to the HAK5 promoter in response to K limitation and activate HAK5 expression, thus allowing plants to adapt to nutrient stress. Includes supplementary figure and table

Preparation of goat milk anti-Saccharomyces cerevisiae immunoglobulin G (IgG)-rich fraction and immunological functions of mice orally administered a mixture of the antigen and its specific IgG-rich fraction

ArticleMilk Science. 58(3):119-128 (2009)journal articl

Totally Laparoscopic Gastrectomy for Gastric Cancer Associated with Recklinghausen's Disease

This paper documents the first case of gastric cancer associated with Recklinghausen's disease, which was successfully treated by a totally laparoscopic operation. A 67-year-old woman with Recklinghausen's disease was referred to this department to undergo surgical treatment for early gastric cancer. The physical examination showed multiple cutaneous neurofibromas throughout the body surface, which made an upper abdominal incision impossible. Laparoscopic surgery requiring only small incisions was well indicated, and a totally laparoscopic distal gastrectomy with lymph node dissection was performed. Billroth I reconstruction was done intra-abdominally using a delta-shaped anastomosis. The patient followed a satisfactory postoperative course with no complications. Since the totally laparoscopic gastrectomy has many advantages over open surgery, it should therefore be preferentially used as a less invasive treatment in the field of gastric cancer

Adult T-Cell Leukemia/Lymphoma with Gastric Lesion

A case of adult T-cell leukemia/lymphoma with a gastric tumor is presented. The patient was a 72-year-old woman who had been admitted to our hospital because of epigastric pain. Upper gastrointestinal endoscopy disclosed polypoid region in the antrum of the stomach. Specimens taken from this region revealed malignant lymphoma. Although the patient was serologically positive for human T-cell leukemia virus type I antibody. A chest X-ray, abdominal ultrasonography, and whole body computed tomography revealed no lymphadenopathy. We diagnosed her to have primary gastric malignant lymphoma and thus performed a total gastrectomy with regional lymph node excision and a splenectomy. Both histological and immunohistochemical studies of the resected specimen showed the lymphoma to be a diffuse pleomorphic type with a T cell phenotype. A radical surgical resection could be performed. At nine months postoperatively, she was again admitted to our hospital because of abdominal pain. Both ultrasonography and computed tomography revealed lymph node swelling around the surrounding the para aorta. She was treated with systematic chemotherapy. Unfortunately, she died at one year after the operation