BACKGROUND: The Maasai are the most widely known African ethnic group located in Kenya and northern Tanzania. Most spend their days either barefoot or in their traditional shoes made of car tires. Although they walk long distances of up to sixty kilometers a day, they do not suffer from any foot ailments. Little is known about their foot structure and gait. The goal of this investigation was to characterize various aspects of Maasai foot in standing and walking. METHODS: Foot length, calf circumference, hindfoot alignment, step length, cadence, and walking velocity were obtained from 1,096 adult Maasai people (545 males and 551 females; mean age, 40.28 +/- 14.69 years; age range, 16 to 65 years). All included subjects were from rural areas, where the primary terrain was sandy soil, who spend most of their lifetime barefoot, walking. They all denied any medical history or previous symptoms related to foot problems. A trained clinician scanned all feet for deformities. Static (standing) and dynamic (walking) Harris mat footprints were taken to determine the distribution of forefoot pressure patterns during walking. RESULTS: The average foot length was 250.14 +/- 18.12 mm (range, 210 to 295 mm) and calf circumference was 32.50 +/- 3.22 cm (range, 25 to 41 cm). The mean hindfoot alignment was 6.21degrees +/- 1.55degrees of valgus. Sixty-four subjects (5.84%) had bilateral flat-shaped feet with a low medial longitudinal arch that exactly matched the broad pattern of their static footprints. Step length, cadence, and walking velocity were 426.45 +/- 88.73 cm (range, 200 to 690 cm), 94.35 steps/min (range, 72 to 111 steps/min), and 40.16 +/- 8.36 m/min (range, 18.20 to 63.36 m/min), respectively. A total of 83.39% subjects showed unilateral or bilateral deformities of multiple toes regardless of age. The most frequent deformity was clawing (98.79%) of which the highest incidence occurred with the fifth toe (93.23%). Dynamic footprints showed even pressure patterns throughout the forefoot (64.87%), followed by lateral forefoot pressure concentration patterns (21.81%). CONCLUSIONS: Our study shows the distinct parameters that provide more insight into the Maasai foot.
Adolescent ; Adult ; Aged ; Biomechanical Phenomena ; Ethnic Groups ; Female ; Foot/*anatomy & histology/*physiology ; Foot Deformities, Acquired/*epidemiology/ethnology ; Gait/*physiology ; Humans ; Kenya ; Male ; Middle Aged ; Rural Population ; Tanzania ; Walking/*physiology ; Young Adult

OBJECTIVE:The purpose of this study was to investigate the role of sonographic findings and tumor markers in predicting malignancy of adnexal masses in pregnancy. METHODS:From January 1995 to September 2005, 190 cases of adnexal masses were operated during pregnancy. We reviewed their sonographic findings and medical records retrospectively. Sonographic features and tumor markers were correlated with malignant pathology. Pregnancy and neonatal outcomes were also studied after treatment of adnexal mass during pregnancy. RESULTS:From 190 cases, there were 10 cases (5.3%) of malignant tumor or tumors of borderline malignancy. In the 180 cases of benign adnexal mass, the most common type was mature cystic teratoma (36.7%). Preoperative sonographic findings were available in 110 cases. The median size was 6.3 cm for benign masses and 7.7 cm for malignant masses (p=0.05). Mixed echogenecity, septa and mural nodule were more frequently found in malignant masses (p=0.003, 0.029, 0.013, respectively). Tumor markers were available in 47 cases. In the 1st trimester, the level of serum CA-125 of the patients with benign masses were not different from those with malignant masses. However, in the 2nd and 3rd trimester, the difference was statistically significant (p=0.031). Forty- six patients underwent antepartum surgery and the overall pregnancy outcome was similar between the laparoscopic group and the laparotomy group. CONCLUSION:Mixed echogenecity, septa and mural nodule showed significant correlation with malignant adnexal mass in pregnancy.
Female ; Humans ; Laparotomy ; Medical Records ; Pathology* ; Pregnancy Outcome ; Pregnancy* ; Retrospective Studies ; Teratoma ; Biomarkers, Tumor ; Ultrasonography*

PURPOSE: We previously reported that forkhead transcription factors of the O class 1 (FOXO1) expression in gastric cancer (GC) was associated with angiogenesis-related molecules. However, there is little experimental evidence for the direct role of FOXO1 in GC. In the present study, we investigated the effect of FOXO1 on the tumorigenesis and angiogenesis in GC and its relationship with SIRT1. MATERIALS AND METHODS: Stable GC cell lines (SNU-638 and SNU-601) infected with a lentivirus containing FOXO1 shRNA were established for animal studies as well as cell culture experiments. We used xenograft tumors in nude mice to evaluate the effect of FOXO1 silencing on tumor growth and angiogenesis. In addition, we examined the association between FOXO1 and SIRT1 by immunohistochemical tissue array analysis of 471 human GC specimens and Western blot analysis of xenografted tumor tissues. RESULTS: In cell culture, FOXO1 silencing enhanced hypoxia inducible factor-1alpha (HIF-1alpha) expression and GC cell growth under hypoxic conditions, but not under normoxic conditions. The xenograft study showed that FOXO1 downregulation enhanced tumor growth, microvessel areas, HIF-1alpha activation and vascular endothelial growth factor (VEGF) expression. In addition, inactivated FOXO1 expression was associated with SIRT1 expression in human GC tissues and xenograft tumor tissues. CONCLUSION: Our results indicate that FOXO1 inhibits GC growth and angiogenesis under hypoxic conditions via inactivation of the HIF-1alpha-VEGF pathway, possibly in association with SIRT1. Thus, development of treatment modalities aiming at this pathway might be useful for treating GC.
Angiogenesis Modulating Agents ; Animals ; Anoxia ; Blotting, Western ; Carcinogenesis ; Cell Culture Techniques ; Cell Line ; Down-Regulation ; Forkhead Transcription Factors ; Heterografts ; Humans ; Lentivirus ; Mice ; Mice, Nude ; Microvessels ; RNA, Small Interfering ; Stomach Neoplasms* ; Tissue Array Analysis ; Transcription Factors* ; Vascular Endothelial Growth Factor A

OBJECTIVE: This study was performed to evaluate the results of conization by loop electrosurgical excision procedure (LEEP) and cold coagulation as a definitive treatment in the patients with FIGO stage Ia1 squamous cell carcinoma of the cervix. METHODS: One hundred eighty-seven patients were diagnosed as stage Ia1 cervical squamous cell carcinomas from 1995 to 2004 by conization with LEEP and cold coagulation. Fifty-nine patients who wanted to preserve fertility and/or refused further surgical treatment were followed-up without further treatment. Eleven patients of the 59 had involved ectocervical resection margins. All patients were followed-up with cervicovaginal smear and colposcopic examination at a regular interval. Disease recurrence was defined as a histologic diagnosis of dysplasia or more. RESULTS: The median follow-up period was 69.0 months (range 8 to 103). All 59 patients had no lymphvascular space invasion (LVSI). In four patients, the ectocervical margins were involved by dysplasia, in seven patients, by carcinoma in-situ. There were no specific differences in ages, depth of stromal invasion and HPV status between the groups with and without involved margins. All 59 patients did not recur during follow-up period. CONCLUSION: Conization with LEEP and cold coagulation was feasible and could be used as a definitive therapy for the patients with stage Ia1 cervical squamous cell carcinoma. This study suggests that conization might play a role in a patient with positive margins (dysplasia or CIS) when LVSI is not demonstrated.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Conization* ; Diagnosis ; Female ; Fertility ; Follow-Up Studies ; Humans ; Recurrence

BACKGROUND: Stress echocardiography have been emerged as an important non-invasive diagnostic tool to detect coronary artery disease. Previous studies indicated that adenosine triphosphate(ATP) is a potent coronary vasodilator as adenosine, the time of action onset and half-life is shorter than dipyridamole, the duration of adverse effect is transient and the use of aminophylline is not needed when side effects develop. The purpose of this study was to evaluate the feasibility and diagnostic accuracy of ATP stress echocardiography in patient with suspected coronary artery disease. METHOD: We investigated 20 patients(mean age 56+/-11, male 11, female 9) who underwent stress echocardiography with ATP infusion(0.15 mg/kg/min for 4 min) and quantitative coronary angiography(QCA). The digitized echocardiographic images were analyzed using wall motion score(1: normal, 2: hypokinesia, 3: akinesia, 4: dyskinesia) in 16 segments. Positivity of ATP stress echocardiography was based on the detection of transient regional wall motion abnormality. The hemodynamic changes and occurrence of adverse effects was carefully monitored. RESULTS: Forteen out of 20 patients had coronary artery disease(>50% diameter stenosis by QCA). Nine out of 14 patients had transient regional wall motion abnormality at coronary artery disease territory(sensitivity 64%). The mean wall motion score index in patients mth positive test was 1.01+0.01 at base and 1.20+0.08 during ATP infusion(p<0.05). Six out of 20 patients who had no regional wall motion abnormality had no coronary artery disease (specificity 100%) with overall diagnostic accuracy of 75%. ATP stress echocardiography showed good agreernent with QCA(kappa value 0.52). Side effect profile revealed chest pain in 6 patients(30%), facial flushing in 3 patients(15%), Wenchebach type AV block in 2 patients(10%) and significant ST-segrnent depression in 1 patients(5%). The mean heart rate, mean systolic and diastolic blood pressure, and mean rate-pressure product were not changed significantly. CONCLUSION: ATP stress echocardiography is feasible and has a diagnostic value similar to that of adenosine and dipyridamole for detecting coronary artery disease with low cost. In addition, it may have minimal side effects and insignificant clinical consequences.
Adenosine Triphosphate* ; Adenosine* ; Aminophylline ; Atrioventricular Block ; Blood Pressure ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Depression ; Dipyridamole ; Echocardiography ; Echocardiography, Stress* ; Female ; Flushing ; Half-Life ; Heart Rate ; Hemodynamics ; Humans ; Hypokinesia ; Male

PURPOSE: The purpose of this study was to evaluate the ultrasonographic and CT findings of various diseases that affect the intraparotid lymph node. MATERIALS AND METHODS: The subjects were 32 patients having various diseases involving the intraparotid lymph node. The final confirmed diagnoses were nonspecified benign inflammatory lymphadenopathy (n=20), metastasis (n=5), tuberculous lymphadenitis (n=4), and lymphoma (n=3). For the nonspecified benign inflammatory lymphadenopathy, there were multiple lesions in five patients and bilateral lesions in two patients, and a total of 26 lesions were included in this study. The pathologic proof of the diagnosis was made for 4 of 26 lesions, and by ultrasound follow-up on 22 of 26 lesions. All the patients underwent ultrasound. Color Doppler imaging was also performed in 19 patients and contrast-enhanced CT was also performed in 8 patients. All cases with metastasis, tuberculous lymphadenitis and lymphoma were pathologically confirmed and these patients were all examined with contrast-enhanced CT. RESULTS: For the nonspecified benign inflammatory lymphadenopathy, all the lesions were seen at the superficial lobe. All twenty six lesions were observed as well-defined ovoid or round hypoechoic nodules with posterior sonic enhancement on ultrasonography. A central echogenic hilum was seen in 12 of 26 inflammatory lymphadenopathies (46%), and a central hilar vascularity was noted in 13 of 19 inflammatory lymphadenopathies (68%) on color Doppler imaging. Contrast-enhanced CT showed well-defined nodules with homogeneous enhancement in most lesions. In 3 lesions, a central low density hilum was seen within a lymph node. In 12 cases with metastasis, tuberculous lymphadenitis and lymphoma, there were multiple lesions in 6 cases. CT revealed intraparotid masses with or without central necrosis and the associated multiple lymph node enlargements in the ipsilateral neck region, and their appearances were similar to that of parotid mass. CONCLUSION: Nonspecified benign inflammatory lymphadenopathy involving intraparotid lymph nodes often demonstrated characteristic ultrasonographic findings, including a central echogenic hilum on gray scale US and central hypervascularity on color Doppler ultrasonography. In the metastasic lesions, the tuberculous lymphadenitis and the lymphomas, the multiplicity of lesions and the associated enlarged lymph nodes in the ipsilateral neck region could be helpful in the differential diagnosis.
Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Diseases* ; Lymphoma ; Neck ; Necrosis ; Neoplasm Metastasis ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node ; Ultrasonography ; Ultrasonography, Doppler, Color

OBJECTIVE: To investigate the effect of multiple courses of antenatal corticosteroid (ACS) therapy on perinatal outcomes, especially the respiratory distress syndrome (RDS), of the premature neonates. METHODS: We retrospectively evaluated the pregnancy and neonatal outcomes of 622 singleton pregnancies delivered at 24-34 weeks of gestation from January 1996 to December 2005. Subjects were categorized into three groups according to ACS exposure: (1) a non-user group (n=234), (2) a single-course group (n=299) and (3) a repeated-course group (n=89). Univariate and multiple logistic regression analyses were used for the incidences of RDS. RESULTS: Pregnancy outcomes including gestational age at delivery, occurrence of clinical and histological chorioamnionitis, birth weight, neonatal intensive care unit (NICU) admission rate, duration of NICU stay and neonatal mortality were similar in the three groups. The incidence of RDS was significantly lower in ACS user groups than the non-user group, with lowest incidence in multiple-course group (44.9% vs. 37.8% vs. 12.4%, p<0.001). The incidence of bronchopulmonary dysplasia and overall neonatal composite morbidity were also lowest in multiple-course group. Multivariate analysis showed that multiple courses of ACS were associated with reduced incidence of RDS (OR 0.100, 95% CI 0.042, 0.240, p<0.001) independently with gestational age at delivery, admission-to-delivery interval and premature rupture of membranes. CONCLUSION: Multiple courses of ACS administered to women with risk of preterm delivery were found to be associated with decreased incidence of RDS of the premature neonates.
Birth Weight ; Bronchopulmonary Dysplasia ; Chorioamnionitis ; Female ; Gestational Age ; Humans ; Incidence ; Infant ; Infant Mortality ; Infant, Newborn* ; Intensive Care, Neonatal ; Logistic Models ; Membranes ; Multivariate Analysis ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Rupture

BACKGROUND: Coronary artery bypass grafting without cardiopulmonary bypass (Off-Pump Coronary Artery Bypass Grafting, OPCAB) causes significant hemodynamic derangement by displacement of the beating heart. The purpose of this study was to analyze the hemodynamic changes caused in relation to grafted arteries by displacing the heart and stabilizing the coronary arteries in patients undergoing OPCAB. METHODS: Nineteen patients underwent OPCAB using two deep pericardial sutures and tissue stabilizers (Octopus Tissue Stabilization Syetem, Medtronic, USA). The hemodynamic variables were obtained after induction of anesthesia, after deep pericardial sutures, before and after anastomosis of each coronary artery during epicardial stabilizing, after sternal closure, and after postoperative 6 hours and 12 hours in the intensive care unit. RESULTS: The hemodynamic variables were maintained with the Trendelenburg position, volume loading and low dose vasopressors after deep pericardial stay sutures. Displacement of the heart and placement of the stabilizer on all coronary territories except the obtuse marginal artery before anastomosis showed no significant difference in hemodynamics compared with baseline. Positioning for the graft to the obtuse marginal artery decreased cardiac index (1.6+/-0.4 L/min/m2) and stroke index (27.6+/-9.9 L/beat/m2) and increased systemic vascular resistance (2318.9+/-673.7 dyne sec cm(-5)), resulting in hemodynamic compromise (P<0.01). There were no significant hemodynamic and electrocardiographic changes before or after grafting of other coronary arteries but there was a significant increase in cardiac index after postoperative 6 and 12 hours compared with baseline values (P<0.05). CONCLUSIONS: Although the complete revascularization of most coronary arteries is feasible on the beating heart without significant hemodynamic compromise with minimal vasopressor support, the positioning for the graft to the obtuse marginal artery needs special attention because two deep pericardial stay sutures and Octopus tissue stabilizers on the obtuse marginal artery territory induce significant hemodynamic disturbances.
Anesthesia ; Arteries ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Coronary Artery Disease ; Coronary Vessels ; Electrocardiography ; Head-Down Tilt ; Heart* ; Hemodynamics* ; Humans ; Intensive Care Units ; Octopodiformes ; Stroke ; Sutures ; Transplants* ; Vascular Resistance

OBJECTIVE: To investigate the maternal and neonatal outcomes in pregnancies complicated with idiopathic thrombocypenic purpura (ITP) and to identify antenatal factors to predict the neonatal thrombocytopenia. METHODS: We analyzed retrospectively maternal and neonatal outcomes of the32 pregnant women with ITP who were delivered over a 12-year period. RESULTS: The prevalence incidence of ITP in pregnancy was 0.87 per 1,000 live births in this study population. The diagnosis of ITP was made more before pregnancy than with afterduring during pregnancy (63% vs 37%). Maternal platelet transfusion was done in 62.5 % of pregnancies with ITP. Sixty nine percent of pregnancies with ITP received medical therapies; steroid only in 8 cases (25%), steroid + IVIG (intravenous immunoglobulin) in 6 cases (18.7%), IVIG only in 2 cases (6.2%), and steroid + IVIG + anti-Rh (anti-D) in 1 case (3.1%). Overall response rate (Plt > 50 x 10(9)/L) to medical treatment was 77%. Neonatal thrombocytopenia (Plt < 50 x 10(9)/Ll) was observed seen in 4 cases (14.2%) immunoglobulin. There was no correlation between the maternal and the neonatal platelet count. Moreover medical treatment during pregnancy did not make any difference in neonatal platelet count. There was one case of neonatal ICH (germinal matrix hemorrhage). CONCLUSION: Although neonatal thrombocytopenia occurred in 140% of pregnancies with ITP, no antenatal factor could predict neonatal thrombocytopenia.
Diagnosis ; Female ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Incidence ; Live Birth ; Platelet Count ; Platelet Transfusion ; Pregnancy* ; Pregnant Women ; Prevalence ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Retrospective Studies ; Thrombocytopenia, Neonatal Alloimmune

Group B subtype, A1B3, was observed in a 22-year-old blood donors by conventional serologic test. In our family study, his father demonstrated uncomplicated B phenotype and his mother typed as group A. We sequenced exon 6 and 7 of phenotypically A1B3 propositus and his family members by direct sequencing and PCR-based cloning. And we have identified a novel Bvar allele characterized by a 547G>A polymorphism present in propositus and his father. This suggests that the Bvar allele is expressed differently depending on the co-inherited ABO allele.
Alleles* ; Blood Donors ; Child* ; Clone Cells ; Cloning, Organism ; Exons ; Fathers* ; Humans ; Mothers* ; Phenotype ; Serologic Tests ; Young Adult