Study Objective: To prove transvaginal troca insertion has benefits in gynecologic laparoscopic surgery.Design: A retrospective studySetting: A tertiary university hospital.Patients: 10 patients who got laparoscopic surgery using transvaginal approach from December 2008 to April 2009. Seven patients was ovarian tumor, two patients tubal pregnancy, and one patient torsion of paratubal cyst.Intervention: LaparoscopyMeasurements and Main Results: We applied two or three 5 mm trocars on abdominal wall and one 15 mm trocar through posterior fornix of uterine cervix. We reviewed operating time, total hospital stay days, and intra- or postoperative complication. RESULTS: The average age of the patients was 32 ± 5.98 years and the mean operating time was 109.5 ± 29.39 minutes. Total hospital stay days were 6.1 ± 1.97 days and hospital stay was 4.0 ± 2.26 days after surgery. Hemovac inserted into pelvic cavity via transvaginal route was removed at postoperating 1.2 ± 0.42 days. No intra- or postoperative complication occurred.Conclusion: Laparoscopic treatment using transvaginal approach has some benefits in aspect of decreasing the risk of hernia and increasing the cosmetic satisfaction in gynecologic laparoscopic surgery. Study Objective: To prove transvaginal troca insertion has benefits in gynecologic laparoscopic surgery. Design: A retrospective study Setting: A tertiary university hospital. Patients: 10 patients who got laparoscopic surgery using transvaginal approach from December 2008 to April 2009. Seven patients was ovarian tumor, two patients tubal pregnancy, and one patient torsion of paratubal cyst. Intervention: Laparoscopy Measurements and Main Results: We applied two or three 5 mm trocars on abdominal wall and one 15 mm trocar through posterior fornix of uterine cervix. We reviewed operating time, total hospital stay days, and intra- or postoperative complication. RESULTS: The average age of the patients was 32 ± 5.98 years and the mean operating time was 109.5 ± 29.39 minutes. Total hospital stay days were 6.1 ± 1.97 days and hospital stay was 4.0 ± 2.26 days after surgery. Hemovac inserted into pelvic cavity via transvaginal route was removed at postoperating 1.2 ± 0.42 days. No intra- or postoperative complication occurred. Conclusion: Laparoscopic treatment using transvaginal approach has some benefits in aspect of decreasing the risk of hernia and increasing the cosmetic satisfaction in gynecologic laparoscopic surgery.

Based on its simple structure, base-fixed actuators, high payload capacity, high accuracy, and high mechanical rigidity, the 3-RRR mechanism1The 3-RRR denotes three kinematic chains that connect the end-effector (moving platform) of a parallel mechanism to the ground and R denotes a revolute joint. Per standard usage, the underline represents an actuated joint throughout this paper.1 is a practical planar parallel manipulator. However, the 3-RRR mechanism is known to have singular loci within its workspace affecting its use. A recent paper by these authors introduced a singularity avoidance algorithm for the 3-RRR mechanism using kinematic redundancy. This paper extends the earlier work and allows for determination of the required ranges of the kinematically redundant active prismatic joint variables of a mechanism to allow given trajectories to be singularity-free. Since for a kinematically redundant mechanism the initial configuration is crucial for redundancy resolution, the proposed algorithm uses permutations to consider all possible points where kinematic redundancy resolution begins. The efficacy of the algorithm is demonstrated through simulation.

Study Objective: Uuterine artery embolization(UAE) is being increasingly utilized to treat uterine fibroid. But, the effects on fertility preservation following UAE are still under investigation. We present a case of huge cervical myoma spontaneously removed by UAE. Design: Case report. Setting: Pochon CHA university, KOREA. Patients: A 26-year-old, nulliparous woman with menometrorrhagia who had a huge cervical myoma 10 cm in diameter. Profuse vaginal bleeding was detected and the level of hemoglobin was 6.3 g/dl. Pelvic MRI showed huge cervical myoma with broad base accompanying with hypervascularity. Intervention: Uterine artery embolization was performed bilaterally using polyvinyl alcohol(PVA) particles. Measurements and Main Results: UAE was performed because of possibility of massive bleeding during operation. Postembolization, the patient had no further vaginal bleeding. 29 days later, MRI showed 50% volume reduction. The cervical myoma was shrinked, soft and expulsed from cervix to just above the vaginal oriface. 35 days after UAE, the huge cervical myoma was spontaneously separated from the uterus without any operation or procedure. No bleeding was noted and the cervix shows normal contour by pelvic examination. During 18 months follow-up after UAE, regular menstrual cycle and normal range of FSH & LH level were noted. Conclusion: UAE may be a safe, effective alternative to the established treatment options such as myomectomy or hysterectomy in the cases of being expected massive bleeding, even if the patient has to preserve fertility.

Study Objective: Magnetic resonance-guided focused ultrasound surgery facilitates resectoscopic myomectomy by volume reduction and bleeding control in a woman having a large symptomatic submucosal fibroid with broad base.

Study Objective: To evaluate the safety and efficacy of magnetic resonance image-guided focused ultrasound surgery (MRgFUS) in treating pedunculated subserosal myoma of the uterus.

This paper presents a method for kinematic redundancy resolution for serial-parallel manipulators using local optimization. The local optimization method is computationally efficient and thus suitable for real-time application. Furthermore, the developed method allows for incorporation of both active and passive joint limits. Accordingly, only feasible trajectory solutions are obtained. The method includes a rule-based, heuristic algorithm to provide smooth transitions between unconstrained and constrained motions. Details of the new algorithm are provided and the efficacy of the approach is established through simulation. Additionally, the algorithm is validated by comparison to a widely accepted global optimization method.

BACKGROUND:We evaluated the renoprotective effects of dual blockade of renin-angiotensin system (RAS) by using a low-dose combination of ACE inhibiter and angiotensin II receptor blocker in type 2 diabetic patients with advanced kidney disease. The amount of proteinuria and the urinary levels of bioassayable TGF-beta1 were used as surrogate markers of renal injury and sclerosis.METHODS:We performed a prospective double-blinded randomized crossover trial consisting of three 16-week treatment periods with ramipril alone (10 mg/day), candesartan alone (16 mg/day), and ramipril (5 mg/day) plus candesartan (8 mg/day) combination therapy. Twenty-one type 2 diabetic patients with overt nephropathy with a 24 h urinary protein excretion rate (UPER) of > 1.0 g/24 h and creatinine clearance (Ccr) of 30 to 59 ml/min/1.73 m2 completed the entire study.RESULTS:Subjects consisted of 10 female and 11 male patients with a mean age of 49 +/- 8 years and duration of diabetes ranging from 4 to 13 years. At baseline, 24-h blood pressures (BPs) were 133 +/- 6/81 +/- 7 mmHg, Ccr 40.6 +/- 4.1 ml/min/1.73 m2, 24-h UPER 4.1 +/- 1.9 g/24 h, and urinary TGF-beta1 level 28.4 +/- 16.1 pg/mg creatinine (cr). Although there was no comparable change in BP and plasma/urinary biochemical parameters, 24-h UPER was significantly reduced by the combination therapy (2.9 +/- 1.4 g/24 h) compared with that of ramipril (3.5 +/- 1.8 g/24 h) and of candesartan (3.3 +/- 2.0 g/24 h) single therapy (P < 0.05). Urinary TGF-beta1 level was reduced in all three therapies compared with that of the control (28.4 +/- 16.1 pg/mg cr) (P < 0.05). However, the combination therapy showed the most significant change (combination 19.6 +/- 10.6 pg/mg cr; ramipril 24.7 +/- 13.3 pg/mg cr; candesartan; 23.4 +/- 11.7 pg/mg cr). No significant or irreversible adverse effect was observed in the 21 patients who completed the entire study.CONCLUSIONS:The dual blockade of RAS with low-dose ramipril plus candesartan was found to be safe and offered additive benefits with respect to reducing proteinuria and urinary TGF-beta1 excretion in diabetic patients with advanced kidney disease. These benefits were evident as compared with single ramipril and candesartan therapies at doses two-fold greater. Further study on the dose-titration is mandatory in terms of safety and especially for maximizing renoprotection in this patient population.

We investigate numerically and semi-analytically the collapse of low-mass, rotating prestellar cores. Initially, the cores are in approximate equilibrium with low rotation (the initial ratio of thermal to gravitational energy is alpha(0)similar or equal to 0.5, and the initial ratio of rotational to gravitational energy is beta(0)= 0.02-0.05). They are then subjected to a steady increase in external pressure. Fragmentation is promoted - in the sense that more protostars are formed - both by more rapid compression, and by higher rotation (larger beta(0)).In general, the large-scale collapse is non-homologous, and follows the pattern described by Hennebelle et al. (Paper I) for non-rotating clouds, namely a compression wave is driven into the cloud, thereby increasing the density and the inflow velocity. The effects of rotation become important at the centre, where the material with low angular momentum forms a central primary protostar (CPP), whilst the material with higher angular momentum forms an accretion disc around the CPP. More rapid compression drives a stronger compression wave and delivers material more rapidly into the outer parts of the disc. Consequently, (i) there is more mass in the outer parts of the disc; (ii) the outer parts of the disc are denser (because the density of the material running into the accretion shock at the edge of the disc is higher); and (iii) there is less time for the gravitational torques associated with symmetry breaking to redistribute angular momentum and thereby facilitate accretion on to the CPP. The combination of a massive, dense outer disc and a relatively low-mass CPP renders the disc unstable against fragmentation, and leads to the formation of one or more secondary protostars. At their inception, these secondary protostars are typically four or five times less massive than the CPP.For very rapid compression there is no CPP and the disc becomes more like a ring, which then fragments into two or three protostars of comparable mass.For more rapid rotation (larger beta(0)), the outer disc is even more massive in comparison to the CPP, even more extended, and therefore even more prone to fragment.

Numerical simulations of the collapse of a slowly rotating cloud have been performed, assuming either isothermality, or a barotropic equation of state that reproduces the expected thermal behaviour of protostellar gas. A ring appears in the late stages of the collapse of a rotating cloud, and we have investigated the effect of differential rotation on the formation and fragmentation of this ring. In the simulations presented here, we have used Godunov-type particle hydrodynamics to avoid the side effects of artificial viscosity in a differentially rotating cloud. The initial state of a cloud is characterized by alpha(0)=T/\Omega\ and beta(0)=R/\Omega\, where T, Omega and are the thermal, gravitational and rotational energies, respectively.If the initial angular velocity, omega, of a cloud is proportional to r(-P), then in the isothermal simulations, a ring forms if P is larger than 0.5, provided beta(o)less than or similar to0.035.In the simulations using a barotropic equation of state, with alpha(o)=0.6 and beta(o)less than or similar to0.035, a ring is always formed, irrespective of whether Pless than or equal to0.5 or P>0.5. However, the mechanism and time of ring formation are different in the two extremes, as are the final configurations. Strong differential rotation (P>0.5) is more effective in inducing fragmentation than solid-body rotation (P = 0), in the sense that fragmentation tends to occur earlier and to produce more fragments when P is larger.

Godunov-type particle hydrodynamics (GPH) is described. GPH inherits many good features from smoothed particle hydrodynamics (SPH), but it uses a Riemann solver to obtain the hydrodynamic acceleration and the rate of change of the internal energy of each particle. The grid-free nature of GPH converts a multidimensional problem into a locally one-dimensional problem, so that one only has to solve a one-dimensional Riemann problem, even in a globally three-dimensional situation. By virtue of the Riemann solver, it is unnecessary to introduce artificial viscosity in GPH. We have derived four different versions of GPH, and have performed a von Neumann stability analysis to understand the nature of GPH. GPH is stable for all wavelengths, while SPH is unstable for certain wavelengths. We have also performed eight tests in order to evaluate the performance of GPH. The results show that GPH can describe shock waves without artificial viscosity and prevents particle penetration. Furthermore, GPH shows better performance than SPH in a test involving velocity shear. GPH is easily implemented from SPH by simple replacement of the artificial viscosity with a Riemann solver, and appears to have some useful advantages over standard SPH.

Recently, a family of multispecific organic anion transporters has been identified, and several isoforms have been reported. However, the physiologic and pharmacologic roles of each isoform, except OAT1, in the transepithelial transport of organic anions in the kidney remain to be elucidated. To address this issue, it is essential to determine the intrarenal distribution and membrane localization of each OAT isoform along the nephron. In this study, the intrarenal distributions of rOAT1, rOAT2, and rOAT3 were investigated by an immunofluorescence method that used frozen rat serial kidney sections. Confocal microscopic analysis showed that immunoreactivity for rOAT1 was detected exclusively in the proximal tubules (S1, S2, S3) in the cortex with basolateral membrane staining. rOAT2 was detected in the apical surface of the tubules in the medullary thick ascending limb of Henle's loop (MTAL) and cortical and medullary collecting ducts (CD). rOAT3 was localized in the basolateral digitation of the cell membrane in all the segments (S1, S2, and S3) of the proximal tubules, MTAL, cortical TAL, connecting tubules, and cortical and medullary CD. These results on the distribution of each OAT isoform will facilitate the understanding of the role of OATs in the renal processing of organic anions.

The calcium palmitate monolayer formed from palmitic acid on calcium-containing substrate can be examined regarding the study of hydration by applying the quartz crystal microbalance (QCM) technique. Monolayers of calcium palmitate were deposited on piezoelectric crystal plate by the Langmuir-Blodgett (LB) technique. Analysis of complete conversion to calcium palmitate was performed by identification of its infrared spectra. The estimation of the hydration for the multilayered calcium palmitate is compared with the data of the multilayered calcium stearate in the literature. The QCM measurement for determining hydration number is based on the results of McCaffrey, particularly employed in the treatment of drying in vacuum (R.R. McCaffrey, S. Bruckenstein, P.N. Prasad, Langmuir 2 (1986) 228). In our experiments, the frequency change of the oscillating quartz transducer for the skimmed calcium palmitate also increased after drying in vacuum. Hydration behavior of the multilayered calcium palmitate LB film is discussed, and it was shown that the hydration of calcium palmitate exists as monohydrate, though its hydrophobicity is relatively a little low compared with that of calcium stearate, which has a longer hydrocarbon chain length.

Various organs or skin from male ICR mice treated interaperitoneally with 2-chloroethyl ethyl sulfide (CEES) or its oxidation derivatives 2-chloroethyl ethyl sulfoxide (CESSO) and 2-chloroethyl ethyl sulfone were analysed for changes in two thiol-containing enzymes, namely glutathione S-transferase (GST) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH). CEES was more potent than its oxidation derivatives with respect to the decrease in organ weight and the loss in GAPDH activity, although the reverse was found in GST induction. Whereas the induction of GST was highest in the lung after multiple interaperitoneal intoxication with CEESO (8 and 32 mg/kg), the decrease in GAPDH activity after exposure to CEES (8 mg/kg body weight) was most remarkable in the spleen, the most susceptible organ to toxicity of CEES. GST and GAPDH activities in the skin of male hairless mice exposed subcutaneously to CEES (2 mg/kg body weight) were not altered significantly at 2-hr exposure, but decreased up to 60% of that of controls at 8 hr, when oedema formation was greatest. Taken together, it appears that GAPDH activity is a more sensitive biochemical parameter than GST activity in organs of mice treated with CEES or its oxidation products.

Purpose: The purpose of this study was to describe the magnetic resonance imaging (MRI) findings of cervical root avulsion and to compare the diagnostic accuracy of MRI with that of conventional myelography in patients with brachial plexus injury.Methods: Cervical spine MRI in 15 patients and conventional myelograms in 13 patients with cervical root avulsion were reviewed retrospectively. The MRI findings of avulsed roots were assessed in 42 roots of 15 patients in whom the injury had been confirmed by surgery or conventional myelography. In six surgically explored patients, the diagnostic accuracy of MRI was compared directly with that of conventional myelography.Results: The MRI features observed in 42 avulsed roots included focal. extradural CSF collection (pseudomeningocele) in 30 patients, focal thickening of the root in 20, and focal thickening of the dura in 8 patients. Magnetic resonance imaging demonstrated more pseudomeningoceles and provided more accurate information on other soft tissue injury than did conventional myelography. The sensitivity, specificity, and diagnostic accuracy of MRI for cervical root avulsion were 72.7%, 86.7%, and 80.8%, respectively, whereas those of conventional myelography were 83.3%, 100%, and 93.7%, respectively.Conclusions: At present, conventional myelography is superior to MRI in overall diagnostic accuracy for cervical root avulsion. However, technical refinements of MRI will enhance its diagnostic accuracy, so MRI may eventually obviate conventional myelography in patients with cervical root avulsion.

A possible participation of lysosomal hydrolases in the cytotoxicity of 2-chloroethylethyl sulfide in spleen lymphocytes was investigated using inhibitors of lysosomal phospholipases and proteases. Pepstatin (6 μM) and leupeptin (60 μM), inhibitors of lysosomal proteases, raised the viability of lymphocytes exposed to 2-chloroethylethyl sulfide from 63 to 87 and 88% of control, respectively. Serine protease inhibitors showed no significant effect on viability. Aminoglycoside inhibitors of lysosomal phospholipases were also found to prevent the decrease in viability of spleen lymphocytes exposed to 2-chloroethylethyl sulfide, and the effectiveness of these aminoglycosides (30 μM) was as follows: gentamicin > kanamycin > streptomycin, with viability increased to 89, 79 and 67%, respectively. In contrast to a co-operative action between leupeptin and gentamicin, the protection by pepstatin was reduced in the presence of gentamicin. Moreover, the order of the aminoglycosides in terms of the extent to which they antagonized the protective action of pepstatin was the same as their order of efficacy in preventing the cytotoxicity of CEES. It is suggested that inhibitors of lysosomal hydrolases reduce the cytotoxicity of 2-chloroethylethyl sulfide, presumably through lysosomal stabilization in spleen lymphocytes.

Recently, vinyl sulfones have been observed to selectively inhibit glyceraldehyde-3-phosphate dehydrogenase (GAPDH), which is an important ATP-generating enzyme in glycolysis. The possibility of using GAPDH as a biochemical parameter of cytotoxicity by vinyl sulfones was investigated using mouse lymphocytes. Incubation of lymphocyte GAPDH with ethylvinyl sulfone resulted in a pseudo-first-order loss of enzyme activity. The exposure of lymphocytes to ethylvinyl sulfone resulted in the decrease of GAPDH activity followed by ATP depletion and cell death, which were both dependent on the concentration of ethylvinyl sulfone. A further study on the time-dependent change indicated that cell death was preceded by ATP loss. Compared to ethylvinyl sulfone, divinyl sulfone was more than 8 times more potent in causing either ATP depletion or cell death.