The purpose of this study is to compare and to evaluate the effects of the degree of saturation on the progression of artificial root caries lesion. A total of 8 human premolars without any defects and cracks selected and the cementum were removed and the teeth were cleaned with ultrasonic device and pumice without fluoride. Each tooth was sectioned into 6 pieces and they were ground with #800 sandpaper until they had a thickness of 200microm. Specimens were applied with nail vanish except for the 2-3 mm window area after application of bonding agent. Under the constant pH, the specimens were divided into 6 groups (degree of saturation; 0.1415, 0.1503, 0.1597, 0.1676, 0.1771, 0.1977). Each group was immersed in acid buffer solution for 1, 2, 3, 5 days under controlled temperature (25degrees C) and imbibed in water and examined using the polarizing microscope. The results were as follows 1. Although the degree of saturation of demineralization solution decreased, the depth of penetration in the dentin was constant. 2. Erosion was observed on the surface of all the teeth in the group I, II. In the group III, IV, V, surfaces were not changed. The teeth in the group VI showed the more mineralized surface but not the shape of the dentinal tubules distinctively. 3. In all groups, the lesion progressed rapidly at the first day of the experiment, but increased gradually as time elapsed.
Bicuspid ; Dental Cementum ; Dentin* ; Fluorides ; Humans ; Hydrogen-Ion Concentration ; Root Caries ; Tooth ; Ultrasonics ; Water

BACKGROUND: Diffusion-perfusion mismatch (DPM) on MRI has been considered an ischemic penumbra. However, several reports have demonstrated limitation of DPM on MRI as a predictable marker of the ischemic penumbra. In this study, we investigated the relationship between DPM and the clinical progression in acute ischemic stroke patients. METHODS: We consecutively recruited fifty-seven patients showing acute ischemic stroke (within 24 hours) in the middle cerebral artery (MCA) territory. The clinical outcomes were determined by serial measurement of National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during 30 days after their ischemic event. We also evaluated the relationship among the parameters of perfusion MRI and the clinical worsening in patients with DPM on initial MRI. RESULTS: Nineteen (33.3%) patients had DPM on MRI within 24 hours after stroke onset. Even though the frequency of clinical worsening for 30 days after stroke onset was higher in DPM group (26%) than in non-DPM group (11%), it did not reach statistical significance (p=0.143). However, extent of MCA stenosis (p<0.001) and time to peak (TTP) delay on MRI (p<0.001) were significantly greater in patients with DPM than in those without DPM. Among several parameters of the perfusion MRI, only relative cerebral blood volume (rCBV) was significantly related to the clinical worsening (62.9+/-24.7% vs 96.1+/-19.2%, p=0.007) in patients with DPM. CONCLUSIONS: This study shows that DPM on MRI does not always predict the clinical worsening in acute ischemic stroke. To overcome this problem, we should analyze rCBV map based DPM as well as TTP map based DPM.
Blood Volume ; Brain ; Constriction, Pathologic ; Diffusion ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Perfusion ; Stroke ; Thymine Nucleotides

BACKGROUND: Prediction of therapeutic response to radioactive iodine (RAI) in Graves disease is poorly understood. Although thyrotropin binding inhibitor immunoglobulin (TBII) level is a strong index for relapse after antithyroid drug treatment, conflicting results are described regarding its prognostic significance in Graves disease treated with RAI. This study is to evaluate possible prognostic factors including TBII wbich affect the outcome of RAI therapy in Graves disease. METHODS: Two hundred and one patients with Graves disease who were followed for over 12 months after RAI treatment were studied retrospectively. The subjects were divided into hypothyroid, euthyroid and hyperthyroid groups, based on the thyroid function evaluated at 12 months after RAI therapy. We evaluated the association of clinical parameters including patients age, goiter size, degree of hyperthyroidism and TBII index with outcome of RAI treatment. RESULTS: In Graves disease, response rate to RAI was 70.1% (hypothyroid 22.4% and euthyroid 47.7%) until 12th month. The mean age of hypothyroid group was 40+/-11 years, significantly older than that other groups (euthyroid: 33+/-12, hyperthyroid: 35+/-13, p<0.05). Initial level of thyroid function, duration of antithyroid drug treatment prior to RAI, goiter size and dosage of RAI were not significantly different between the groups. There were 61 patients who had both TBII tests before and after RAI. Twelve had negative TBII and 49 had positive TBII before RAI admini-stration. The rate of unremitted hyperthyroidism after RAI therapy was significantly lower in patients with negative TBII than in those with positive TBII prior to RAI treatment( 0% versus 46.9%, p<0.05). CONCLUSION: Graves patients with positive TBII prior to RAI therapy were associated with lower therapeutic response to RAI than those with negatve TBII. And old age was associated with the development of early hypothyroidism after RAI therapy. These results suggest these factors be also considered in the treatment of Graves disease with RAI.
Goiter ; Graves Disease* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Immunoglobulins ; Iodine* ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyrotropin

PURPOSE: The purpose of this study was to evaluate the usefulness of applying computer-aided diagnosis (CAD) to breast ultrasound (US), depending on the reader's experience with breast imaging. METHODS: Between October 2015 and January 2016, two experienced readers obtained and analyzed the grayscale US images of 200 cases according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon and categories. They additionally applied CAD (S-Detect) to analyze the lesions and made a diagnostic decision subjectively, based on grayscale US with CAD. For the same cases, two inexperienced readers analyzed the grayscale US images using the BI-RADS lexicon and categories, added CAD, and came to a subjective diagnostic conclusion. We then compared the diagnostic performance depending on the reader's experience with breast imaging. RESULTS: The sensitivity values for the experienced readers, inexperienced readers, and CAD (for experienced and inexperienced readers) were 91.7%, 75.0%, 75.0%, and 66.7%, respectively. The specificity values for the experienced readers, inexperienced readers, and CAD (for experienced and inexperienced readers) were 76.6%, 71.8%, 78.2%, and 76.1%, respectively. When diagnoses were made subjectively in combination with CAD, the specificity significantly improved (76.6% to 80.3%) without a change in the sensitivity (91.7%) in the experienced readers. After subjective combination with CAD, both of the sensitivity and specificity improved in the inexperienced readers (75.0% to 83.3% and 71.8% to 77.1%). In addition, the area under the curve improved for both the experienced and inexperienced readers (0.84 to 0.86 and 0.73 to 0.80) after the addition of CAD. CONCLUSION: CAD is more useful for less experienced readers. Combining CAD with breast US led to improved specificity for both experienced and inexperienced readers.
Breast Neoplasms ; Breast* ; Diagnosis* ; Diagnosis, Computer-Assisted ; Information Systems ; Sensitivity and Specificity ; Ultrasonography*

No abstract available.
Nephritis* ; Positron-Emission Tomography and Computed Tomography* ; Succimer*

BACKGROUND: Occasionally, combinations of antibiotics are used for the treatment of scrub typhus. However, the effectiveness of such combined therapies has rarely been evaluated. To date, no experimental studies have been performed; only 1 clinical study has assessed the efficacy of combined doxycycline and rifampin therapy. To elucidate the efficacies of other antibiotic combinations, we performed an experiment to evaluate the in vitro efficacy of antibiotic combinations against Orientia tsutsugamushi. MATERIALS AND METHODS: O. tsutsugamushi strain Boryong was inoculated into the ECV304 cell line. The infected cells were cultured in antibiotic-containing media for 3-5 days and stained with FS15, a monoclonal antibody reacting against the linear epitope on the 56-kDa major outer membrane protein of O. tsutsugamushi. Thereafter, antimicrobial susceptibility was measured by flow cytometry and expressed as a growth index (total mass of Orientia). The growth indices of doxycycline (0.1 microg/mL), azithromycin (0.1 microg/mL), rifampin (0.0125 microg/mL), cefotaxime (2 and 20 microg/mL), and their various combinations (doxycycline+cefotaxime, doxycycline+rifampin, azithromycin+cefotaxime, and rifampin+cefotaxime) were measured. The above mentioned antibiotic concentrations, except for that of cefotaxime, represent the minimal inhibitory concentrations of each antibiotic. RESULTS: The growth indices of doxycycline (4.67% and 0.52%), rifampin (2.35% and 0.26%), and azithromycin (7.54%) were within the range of full suppression of O. tsutsugamushi; in contrast, cefotaxime (87.60%) was in effective. The growth indices of doxycycline+rifampin were 0.10% and 0.10%, which were similar to those obtained with doxycycline or rifampin alone. The growth indices of doxycycline+cefotaxime were 3.99% and 3.65% in low-dose cefotaxime (2 microg/mL), and 3.69% and 4.40% in high-dose cefotaxime (20 microg/mL). The growth indices of rifampin+cefotaxime (2.19% and 2.19% at 2 microg/mL; 1.84% and 2.04% at 20 microg/mL cefotaxime) were similar to those obtained with rifampin alone (2.35% and 0.26%). Azithromycin+cefotaxime (11.06-14.63%) showed higher growth indices than azithromycin alone; this suggests that this combination may be antagonistic. Conclusions: The anti-Orientia efficacies of doxycycline+rifampin, doxycycline+cefotaxime, and rifampin+cefotaxime were not antagonistic. The efficacy of the azithromycin+cefotaxime combination needs to be confirmed by more sensitive methods to exclude the possibility of antagonistic interactions between the antibiotics.
Anti-Bacterial Agents ; Azithromycin ; Cefotaxime ; Cell Line ; Doxycycline ; Drug Therapy, Combination ; Flow Cytometry ; Membrane Proteins ; Orientia tsutsugamushi ; Rifampin ; Scrub Typhus ; Sprains and Strains

BACKGROUND: Occasionally, combinations of antibiotics are used for the treatment of scrub typhus. However, the effectiveness of such combined therapies has rarely been evaluated. To date, no experimental studies have been performed; only 1 clinical study has assessed the efficacy of combined doxycycline and rifampin therapy. To elucidate the efficacies of other antibiotic combinations, we performed an experiment to evaluate the in vitro efficacy of antibiotic combinations against Orientia tsutsugamushi. MATERIALS AND METHODS: O. tsutsugamushi strain Boryong was inoculated into the ECV304 cell line. The infected cells were cultured in antibiotic-containing media for 3-5 days and stained with FS15, a monoclonal antibody reacting against the linear epitope on the 56-kDa major outer membrane protein of O. tsutsugamushi. Thereafter, antimicrobial susceptibility was measured by flow cytometry and expressed as a growth index (total mass of Orientia). The growth indices of doxycycline (0.1 microg/mL), azithromycin (0.1 microg/mL), rifampin (0.0125 microg/mL), cefotaxime (2 and 20 microg/mL), and their various combinations (doxycycline+cefotaxime, doxycycline+rifampin, azithromycin+cefotaxime, and rifampin+cefotaxime) were measured. The above mentioned antibiotic concentrations, except for that of cefotaxime, represent the minimal inhibitory concentrations of each antibiotic. RESULTS: The growth indices of doxycycline (4.67% and 0.52%), rifampin (2.35% and 0.26%), and azithromycin (7.54%) were within the range of full suppression of O. tsutsugamushi; in contrast, cefotaxime (87.60%) was in effective. The growth indices of doxycycline+rifampin were 0.10% and 0.10%, which were similar to those obtained with doxycycline or rifampin alone. The growth indices of doxycycline+cefotaxime were 3.99% and 3.65% in low-dose cefotaxime (2 microg/mL), and 3.69% and 4.40% in high-dose cefotaxime (20 microg/mL). The growth indices of rifampin+cefotaxime (2.19% and 2.19% at 2 microg/mL; 1.84% and 2.04% at 20 microg/mL cefotaxime) were similar to those obtained with rifampin alone (2.35% and 0.26%). Azithromycin+cefotaxime (11.06-14.63%) showed higher growth indices than azithromycin alone; this suggests that this combination may be antagonistic. Conclusions: The anti-Orientia efficacies of doxycycline+rifampin, doxycycline+cefotaxime, and rifampin+cefotaxime were not antagonistic. The efficacy of the azithromycin+cefotaxime combination needs to be confirmed by more sensitive methods to exclude the possibility of antagonistic interactions between the antibiotics.
Anti-Bacterial Agents ; Azithromycin ; Cefotaxime ; Cell Line ; Doxycycline ; Drug Therapy, Combination ; Flow Cytometry ; Membrane Proteins ; Orientia tsutsugamushi ; Rifampin ; Scrub Typhus ; Sprains and Strains

Neuroendocrine tumor is a very heterogenous group arising from the neuroendocrine cells. Especially, large cell neuroendocrine tumor of the ovary is a extremely rare aggressive neoplasm, characteristically arising in association with a surface epithelial tumor. This report describes a mixed type of large cell neuroendocrine carcinoma and adenocarcinoma of the ovary. A 63-year old woman presented with abdominal distension and discomfort underwent staging laparotomy under the impression of ovarian cancer. The operation revealed an small ovarian mass with invasion of multiple region in peritoneal cavity by the tumor. Immunohistochemical and ultrastructural analysis confirmed the neuroendocrine nature of the tumor. The adenocarcinoma in this case is mixture of mucinous and endometrioid type. A diagnosis of stage IIIc mixed large cell neuroendocrine tumor and adenocarcinoma of the ovary was rendered. She is subsequently being treated with Paclitaxel and Carboplatin combination chemotherapy.
Adenocarcinoma* ; Carboplatin ; Carcinoma, Neuroendocrine ; Diagnosis ; Drug Therapy, Combination ; Female ; Humans ; Laparotomy ; Middle Aged ; Mucins ; Neuroendocrine Cells ; Neuroendocrine Tumors* ; Ovarian Neoplasms ; Ovary* ; Paclitaxel ; Peritoneal Cavity

PURPOSE: To investigate the predictive role of maximum standardized uptake value (SUVmax) of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in nasopharyngeal cancer patients treated with intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: Between October 2006 and April 2016, 53 patients were treated with IMRT in two institutions and their PET/CT at the time of diagnosis was reviewed. The SUVmax of their nasopharyngeal lesions and metastatic lymph nodes (LN) was recorded. IMRT was delivered using helical tomotherapy. All patients except for one were treated with concurrent chemoradiation therapy (CCRT). Correlations between SUVmax and patients’ survival and recurrence were analyzed. RESULTS: At a median follow-up time of 31.5 months (range, 3.4 to 98.7 months), the 3-year overall survival (OS) and disease-free survival (DFS) rates were 83.2% and 77.5%, respectively. In univariate analysis, patients with a higher nodal pre-treatment SUVmax (≥ 13.4) demonstrated significantly lower 3-year OS (93.1% vs. 55.5%; p = 0.003), DFS (92.7% vs. 38.5%; p < 0.001), locoregional recurrence-free survival (100% vs. 50.5%; p < 0.001), and distant metastasis-free survival (100% vs. 69.2%; p = 0.004), respectively. In multivariate analysis, high pre-treatment nodal SUVmax (≥ 13.4) was a negative prognostic factor for OS (hazard ratio [HR], 7.799; 95% confidence interval [CI], 1.506–40.397; p = 0.014) and DFS (HR, 9.392; 95% CI, 1.989–44.339; p = 0.005). CONCLUSIONS: High pre-treatment nodal SUVmax was an independent prognosticator of survival and disease progression in nasopharyngeal carcinoma patients treated with IMRT in our cohort. Therefore, nodal SUVmax may provide important information for identifying patients who require more aggressive treatment.
Cohort Studies ; Diagnosis ; Disease Progression ; Disease-Free Survival ; Electrons ; Fluorodeoxyglucose F18* ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Nasopharyngeal Neoplasms ; Positron-Emission Tomography and Computed Tomography* ; Radiotherapy, Intensity-Modulated* ; Recurrence

Papillary carcinoma, the commonest thyroid malignancy, has an indolent clinical course and carries a good prognosis. Metastasis usually occurs to regional lymph nodes, including cervical and upper mediastinal nodes. Distant metastasis is uncommon, lung and bone being the commonest sites. Brain metastasis from papillary thyroid cancer is rare, with a frequency of less than 1% in several reported series and an extremely poor prognosis. The first case was a 74-year-old female patient with papillary cancer who took total thyroidectomy followed by 131I therapy 1 month later. Two days after 131I therapy, she developed headache, vomiting and left hemiplegia. Brain MRI and 131I whole body scan showed solitary brain metastasis in right parietal lobe. After a few weeks her condition improved enough to maintain her usual daily activity despite mild motor weakness. The second one, a 64-year-old female patient presented with headache and vomiting. Two years previously, she had taken total thyroidectomy and 131I ablation therapy after diagnosis of thyroid papillary cancer. Eight months before, she had undergone radical neck dissection because of relapse in cervical lymph nodes. Brain MRI revealed multple metastatic lesions including cerebellum. This patient did not report for follow-up after 2 months of discharge.
Aged ; Brain* ; Carcinoma, Papillary ; Cerebellum ; Diagnosis ; Female ; Follow-Up Studies ; Headache ; Hemiplegia ; Humans ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Neck Dissection ; Neoplasm Metastasis* ; Parietal Lobe ; Prognosis ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Vomiting ; Whole Body Imaging