Cushing syndrome (CS) is rare in pregnancy, and few cases have been reported to date. Women with untreated CS rarely become pregnant because of the ovulatory dysfunction induced by hypercortisolism. It is difficult to diagnose CS in pregnancy because of its very low incidence, the overlap between the clinical signs of hypercortisolism and the physiological changes that occur during pregnancy and the changes in hypothalamus-pituitary-adrenal axis activity that occur during pregnancy and limit the value of standard diagnostic testing. However, CS in pregnancy is associated with poor maternal and fetal outcomes; therefore, its early diagnosis and treatment are important. Here, we report two patients with CS that was not diagnosed during pregnancy, in whom maternal and fetal morbidity developed because of hypercortisolism.

PURPOSE: To investigate treatment outcome and long term complication after surgery and radiotherapy (RT) for pituitary adenoma. MATERIALS AND METHODS: From 1990 to 2009, 73 patients with surgery and RT for pituitary adenoma were analyzed in this study. Median age was 51 years (range, 25 to 71 years). Median tumor size was 3 cm (range, 1 to 5 cm) with suprasellar (n = 21), cavernous sinus extension (n = 14) or both (n = 5). Hormone secreting tumor was diagnosed in 29 patients; 16 patients with prolactin, 12 patients with growth hormone, and 1 patient with adrenocorticotrophic hormone. Impairment of visual acuity or visual field was presented in 33 patients at first diagnosis. Most patients (n = 64) received RT as postoperative adjuvant setting. Median RT dose was 45 Gy (range, 45 to 59.4 Gy). RESULTS: Median follow-up duration was 8 years (range, 3 to 22 years). In secreting tumors, hormone normalization rate was 55% (16 of 29 patients). For 25 patients with evaluable visual field and visual acuity test, 21 patients (84%) showed improvement of visual disturbance after treatment. The 10-year tumor control rate for non-secreting and secreting adenoma was 100% and 58%, respectively (p < 0.001). Progression free survival rate at 10 years was 98%. Only 1 patient experienced endocrinological recurrence. Following surgery, 60% (n = 44) suffered from pituitary function deficit. Late complication associated with RT was only 1 patient, who developed cataract. CONCLUSION: Surgery and RT are very effective and safe in hormonal and tumor growth control for secreting and non-secreting pituitary adenoma.
Adenoma ; Adrenocorticotropic Hormone ; Cataract ; Cavernous Sinus ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Growth Hormone ; Humans ; Pituitary Neoplasms* ; Prolactin ; Radiotherapy* ; Recurrence ; Treatment Outcome ; Visual Acuity ; Visual Fields

Purpose: The purpose of the study was to analyze how swallowing tongue pressure affects the biomechanics of a velopharyngeal obturator prosthesis and compare its displacement across different occlusal rest positions. Materials and Methods: A 3D geometric model consisting of the maxilla, teeth, soft palate, and a portion of the pharynx was developed based on the CBCT and MRI data.A defect was created by the resection of soft palate portion. Two experimental models were generated based on two different velopharyngeal obturator designs: one “with mesial occlusal rests” (Model 1) and the other with “distal occlusal rests” (Model 2). A pressure of 25 kPa was applied at the surface of the bulb of the obturator prosthesis opposite the base of the tongue to simulate tongue pressure during swallowing. The maximum von-Mises stress and displacement values of two types of obturator prostheses were analyzed and compared. Results: The maximum von-Mises stress in the metal framework, located at the posterior palatal strap, was slightly higher in model 1 (64.9 MPa) than in model 2 (54.2 MPa). In both models, the acrylic resin obturator bulb exhibited a maximum stress value of 4.3 MPa. There was no significant difference in prosthesis displacement between the two models, with 31.3 µm for model 1 and 33.6 µm for model 2. Conclusion Swallowing tongue pressure had a minor impact on the biomechanics of a velopharyngeal obturator prosthesis, and distal occlusal rests showed a slightly better biomechanical response compared to mesial occlusal rests.

No abstract available.
Brain* ; Hemangioma, Cavernous* ; Humans ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms*

Purpose: . The purpose of the study was to fabricate a prototype robotic simulator for dental education, to test whether it could simulate mandibular movements, and to assess the possibility of the stimulator responding to stimuli during dental practice. Materials and methods: . A virtual simulator model was developed based on segmentation of the hard tissues using cone-beam computed tomography (CBCT) data. The simulator frame was 3D printed using polylactic acid (PLA) material, and dentiforms and silicone face skin were also inserted. Servo actuators were used to control the movements of the simulator, and the simulator’s response to dental stimuli was created by pressure and water level sensors.A water level test was performed to determine the specific threshold of the water level sensor. The mandibular movements and mandibular range of motion of the simulator were tested through computer simulation and the actual model. Results: . The prototype robotic simulator consisted of an operational unit, an upper body with an electric device, a head with a temporomandibular joint (TMJ) and dentiforms. The TMJ of the simulator was capable of driving two degrees of freedom, implementing rotational and translational movements. In the water level test, the specific threshold of the water level sensor was 10.35 ml. The mandibular range of motion of the simulator was 50 mm in both computer simulation and the actual model. Conclusion . Although further advancements are still required to improve its efficiency and stability, the upper-body prototype simulator has the potential to be useful in dental practice education.

BACKGROUND: The decidua has been implicated in the “terminal pathway” of human term parturition, which is characterized by the activation of pro-inflammatory pathways in gestational tissues. However, the transcriptomic changes in the decidua leading to terminal pathway activation have not been systematically explored. This study aimed to compare the decidual expression of developmental signaling and inflammation-related genes before and after spontaneous term labor in order to reveal their involvement in this process. METHODS: Chorioamniotic membranes were obtained from normal pregnant women who delivered at term with spontaneous labor (TIL, n = 14) or without labor (TNL, n = 15). Decidual cells were isolated from snap-frozen chorioamniotic membranes with laser microdissection. The expression of 46 genes involved in decidual development, sex steroid and prostaglandin signaling, as well as pro- and anti-inflammatory pathways, was analyzed using high-throughput quantitative real-time polymerase chain reaction (qRT-PCR). Chorioamniotic membrane sections were immunostained and then semi-quantified for five proteins, and immunoassays for three chemokines were performed on maternal plasma samples. RESULTS: The genes with the highest expression in the decidua at term gestation included insulin-like growth factor-binding protein 1 (IGFBP1), galectin-1 (LGALS1), and progestogen-associated endometrial protein (PAEP); the expression of estrogen receptor 1 (ESR1), homeobox A11 (HOXA11), interleukin 1β (IL1B), IL8, progesterone receptor membrane component 2 (PGRMC2), and prostaglandin E synthase (PTGES) was higher in TIL than in TNL cases; the expression of chemokine C-C motif ligand 2 (CCL2), CCL5, LGALS1, LGALS3, and PAEP was lower in TIL than in TNL cases; immunostaining confirmed qRT-PCR data for IL-8, CCL2, galectin-1, galectin-3, and PAEP; and no correlations between the decidual gene expression and the maternal plasma protein concentrations of CCL2, CCL5, and IL-8 were found. CONCLUSIONS: Our data suggests that with the initiation of parturition, the decidual expression of anti-inflammatory mediators decreases, while the expression of pro-inflammatory mediators and steroid receptors increases. This shift may affect downstream signaling pathways that can lead to parturition.
Chemokines ; Cytokines ; Decidua ; Estrogen Receptor alpha ; Estrogens ; Female ; Galectin 1 ; Galectin 3 ; Galectins ; Gene Expression* ; Genes, Homeobox ; Humans ; Immunoassay ; Interleukin-8 ; Interleukins ; Leukocytes ; Membranes ; Microdissection ; Parturition* ; Plasma ; Pregnancy ; Pregnant Women ; Progesterone ; Real-Time Polymerase Chain Reaction ; Receptors, Progesterone ; Receptors, Steroid ; Sexual Development ; Transcriptome*