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Cognitive impairments have been endemic to the HIV epidemic since its beginning and persist to this day. These impairments are attributed to HIV-induced neuroinflammation, the long-term effects of combination antiretroviral therapy, lifestyle factors (e.g., sedentary behavior, substance use), neuro-comorbidities (e.g., depression), age-associated comorbidities (e.g., heart disease, hypertension), and others causes. Normal aging and lifestyle also contribute to the development of cognitive impairment. Regardless of the etiology, such cognitive impairments interfere with HIV care (e.g., medication adherence) and everyday functioning (e.g., driving safely, financial management). With more than half of people with HIV (PWH) 50 years and older, and ~45% of all PWH meeting the criteria for HIV-Associated Neurocognitive Disorder (HAND), those aging PWH are more vulnerable for developing cognitive impairment. This article provides an update to a social work model to identify and monitor PWH for cognitive impairment. Within this update, the state of the science on protecting brain health and cognitive reserve within the context of neuroHIV is also presented. From this, implications for practice and policy to promote successful cognitive functioning in older PWH are provided.

Oral carbohydrate consumption before surgery improves insulin sensitivity, cardiac output and well-being, and shortens hospital stays without adverse effects. No work has compared higher-dose carbohydrate beverages made for preoperative consumption to common, commercial oral rehydration solutions with lower carbohydrate concentrations. We recruited low-risk women undergoing scheduled cesarean deliveries with planned spinal anesthesia. Participants were randomized to one of three groups: those who consumed Clearfast® beverage, those who consumed Gatorade Thirst Quencher® beverage, or fasting control. Participants in the two beverage groups received 710 mL of the appropriate beverage the night before surgery and 355 mL 2 h before surgery. Participants in the control group fasted after midnight the night before surgery. Two hours before surgery, we recorded baseline patient well-being using visual analogue scales, followed by beverage consumption for subjects in the beverage groups. One hour later, we repeated the same assessment. Additional recorded measures included cord blood glucose level, intraoperative variables, breastfeeding success, and a quality of recovery assessment administered 1 day after surgery. Forty-seven patients were recruited: 15 received Clearfast®, 17 received Gatorade Thirst Quencher®, and 15 patients fasted after midnight. Group differences in change in patient well-being using visual analog scales were analyzed using linear regression. Both beverage-consuming groups showed significant improvements in patient well-being using visual analog scales while fasted patients showed no change. Either a common oral rehydration beverage or a higher-dose carbohydrate beverage consumed preoperatively resulted in superior well-being compared to fasting. No differences in other outcomes were noted. This study was registered on ClinicalTrials.gov with clinical trial registration number: NCT02684513.

Silicon nitrides, deposited by capacitively coupled plasma (CCP)-type plasma enhanced atomic layer deposition (PEALD), are generally applied to today’s nanoscale semiconductor devices, and are currently being investigated in terms of their potential applications in the context of flexible displays, etc. During the PEALD process, 13.56 MHz rf power is generally employed for the generation of reactive gas plasma. In this study, the effects of a higher plasma generation frequency of 162 MHz on both plasma and silicon nitride film characteristics are investigated for the purpose of silicon nitride PEALD, using bis(diethylamino)silane (BDEAS) as the silicon precursor, and N2 plasma as the reactant gas. The PEALD silicon nitride film deposited using the 162 MHz CCP exhibited improved film characteristics, such as reduced surface roughness, a lower carbon percentage, a higher N/Si ratio, a lower wet etch rate in a diluted HF solution, lower leakage current, and higher electric breakdown field, and more uniform step coverage of the silicon nitride film deposited in a high aspect ratio trench, as compared to silicon nitride PEALD using 13.56 MHz CCP. These improved PEALD silicon nitride film characteristics are believed to be related to the higher ion density, higher reactive gas dissociation, and lower ion bombardment energy to the substrate observed in N2 plasma with a 162 MHz CCP.

Aim Fetal acetylcholine receptor inactivation syndrome (FARIS) occurs in offspring of mothers affected by myasthenia gravis (MG), from in-utero exposure to acetylcholine receptor (AChR)-antibodies targeting the fetal AChR γ-subunit. FARIS causes damage to the fetal neuromuscular junction which is crucial in muscle development, causing a persistent myopathy. FARIS may initially be mistaken for Transient Neonatal Myasthenia Gravis (TNMG), congenital neuromuscular disorders and one of the many causes of neonatal hypotonia. This study aimed to determine the clinical spectrum of FARIS and assess oral salbutamol as a novel pharmacological therapy. Methods Detailed review of antenatal and postnatal clinical features in novel FARIS cases seen in international neuromuscular centres. Antibody data analysis was performed at the Oxford neuroimmunology research laboratory. Oral salbutamol was trialled in five cases based on previously reported benefit in one of our patients. Results We identified 12 novel FARIS cases. At delivery resuscitation was required in all and intubation in nine, all had severe generalised hypotonia. Two infants with arthrogryphosis-multiplex-congenita phenotype died in the neonatal period. Among survivors, there was requirement for mechanical ventilation (n=9), NIPPV (n=2), oxygen (n=1), and supplemental NG/PEG feeding (n=12). The presence of severe generalised hypotonia with dysmorphic features prompted investigations for other neuromuscular, genetic and metabolic disorders which were negative. Common features included facial weakness (n=12) and limb contractures (n=9). Newly described disease features: diaphragmatic paresis (n=5), hearing impairment (n=3), CNS involvement (n=3), pyloric stenosis (n=2), extra-ocular eye restriction (n=2), non-progressive scoliosis (n=2), and jaw opening contracture(n=1). Motor development of patients improved with time. Respiratory complications (tracheostomy;n=2), feeding difficulties (PEG;n=2), facial weakness and speech impairment (from velopharyngeal incompetence) persisted in most. TNMG treatments(immunotherapy/pyridostigmine) were little or no benefit. Novel use of oral salbutamol improved fatiguability, ptosis, oromotor dysfunction, muscle tone, articulation and voice volume in all patients. In 8/12 pregnancies maternal myasthenia gravis hadn’t been established antenatally, and many mothers were pauci/asymptomatic. All had AChR-antibodies targeting the fetal γ-subunit confirming diagnosis. Where subsequent pregnancies were treated aggressively(immunotherapy), infants had improved outcomes. Conclusions This report demonstrates and expands the phenotypic spectrum of FARIS, and emphasises oral salbutamol therapy as a potentially beneficial treatment. FARIS should be considered (mothers or infants tested for fetal specific AChR-Abs) in infants presenting with neonatal hypotonia, myopathic features and/or a suggestive antenatal history, even in the absence of a maternal MG diagnosis. Aggressive treatment with immunotherapy in pregnancy may improve outcomes.

Introduction Pancreatic resection is technically difficult and has higher postoperative mortality and morbidity rates than those of other abdominal operations. As the incidence of postoperative morbidity and mortality has gradually decreased, some centers have reported remarkable achievements by attempting minimally invasive surgery. This study was performed to investigate the chronological trends of pancreatectomies by analyzing a large-scale database. Methods The medical records of 5,175 patients who underwent pancreatic resection between 1961 and 2019 at a single institution were collected and reviewed. The chronological trend of surgical outcome was investigated by dividing the period into 5-year intervals. To investigate the chronological change in survival outcomes of periampullary cancer, the survival data of 3,108 patients were analyzed. Results Patient age and the proportion of pancreatic cancer have increased over time. Pancreatic cancer was most common (35.9%) in 2015-2019, followed by pancreatic cyst (24.8%), common bile duct cancer (13.4%), and ampulla of Vater cancer (10.1%). The incidence of postoperative complications tended to decrease over time (26.0% in 2000-2004 and 20.8% in 2015-2019). A comparison of survival outcomes of periampullary malignancies by period revealed that pancreatic cancer significantly improved (5-year survival rate: 14.4% before 2000 vs. 15.2% in 2000-2009 vs. 29.0% after 2009, p < 0.001). Conclusions Postoperative complication rate and duration of recovery have improved in pancreatic resection over time. The proportion of minimally invasive pancreatectomies is gradually increasing. To improve outcomes in the future, active multidisciplinary approach and postoperative management are needed.

The purpose of this article is to review the available data regarding the application and therapeutic outcomes of laser therapy for the treatment of genitourinary syndrome of menopause (GSM). There have been several studies regarding the use of laser therapy for the treatment of GSM. Most of these studies show a trend toward safe and effective treatment in the short term (less than or equal to 12 weeks). However, these studies are lacking in randomization, blinding, placebo, and comparison groups. Although laser therapy for the treatment of the symptoms of GSM appears promising, there is currently a lack of high-level and long-term evidence regarding its safety and efficacy. There is also a lack of professional guidelines in the USA regarding this modality of treatment, specifically for GSM. Opportunities exist for future research in this area, specifically to determine safety and long-term outcomes of therapy.

Objectives/Hypothesis The clinical features and treatment outcomes of benign paroxysmal positional vertigo (BPPV) are known to be different depending on the type of and involved canal. This difference could be due to differences in the functional change of the otolith organ. Study Design Case series. Methods Forty-nine patients were diagnosed to primary BPPV; 18 were categorized as posterior canal canalolithiasis (PC canalolithiasis), and 31 were categorized as horizontal canal (HC) BPPV with canalolithiasis or cupulolithiasis (HC canalolithiasis or HC cupulolithiasis). Diagnostic interventions to measure vestibular functions were performed such as electronystagmography (ENG), videonystagmography (VNG), and static and dynamic subjective visual vertical (SVV). BPPV was confirmed with nystagmus during positioning/positional test under ENG and VNG. Static SVV was recorded with a light-emitting diode (LED) bar located in front of the patients before eccentric rotation and dynamic SVV was recorded during eccentric rotation with the LED bar. SVV angles were read by the examiner and analyzed. The measured values were compared to those of normal controls and each other. Results Dynamic SVV toward the lesion side in all subtypes of BPPV were significantly different from those of the controls; HC cupulolithiasis showed significantly lower values than those of PC canalolithiasis and HC canalolithiasis. Conclusions HC cupulolithiasis shows a lesser degree of utricular dysfunction compared with other subtypes. It could postulate the difference of pathophysiology between canalolithiasis and cupulolithiasis. Level of Evidence 4. Laryngoscope, 124:984–988, 2014

Summary What is known and Objective: Acarbose, an α-glycosidase inhibitor, is used to treat diabetic patients. Pharmacokinetic evaluation of acarbose is difficult because

To cite this article: Cheong HS, Park S-M, Kim M-O, Park J-S, Lee JY, Byun JY, Park BL, Shin HD, Park C-S. Genome-wide methylation profile of nasal polyps: relation to aspirin hypersensitivity in asthmatics. Allergy 2011; 66: 637–644. Abstract Background: In addition to the dysregulation of arachidonic acid metabolism in aspirin-intolerant asthma (AIA), aspirin acetylsalicylic acid (ASA) exerts effects on inflammation and immunity; however, many of these effects are unknown. Objective: The aim of the study was to evaluate the methylation status of whole genome in blood and polyp tissues with and without aspirin hypersensitivity. Methods: Genome-wide DNA methylation levels in nasal polyps and peripheral blood cells were examined by microarray analysis using five subjects with AIA and four subjects with aspirin-tolerant asthma (ATA). Results: In the nasal polyps of the patients with AIA, hypermethylation was detected at 332 loci in 296 genes, while hypomethylation was detected at 158 loci in 141 genes. Gene ontologic and pathway enrichment analyses revealed that genes involved in lymphocyte proliferation, cell proliferation, leukocyte activation, cytokine biosynthesis, cytokine secretion, immune responses, inflammation, and immunoglobulin binding were hypomethylated, while genes involved in ectoderm development, hemostasis, wound healing, calcium ion binding, and oxidoreductase activity were hypermethylated. In the arachidonate pathway, PGDS, ALOX5AP, and LTB4R were hypomethylated, whereas PTGES was hypermethylated. Conclusion: The nasal polyps of patients with AIA have characteristic methylation patterns affecting 337 genes. The genes and pathways identified in this study may be associated with the presence of aspirin hypersensitivity in asthmatics and are therefore attractive targets for future research.

Lipomatous haemangiopericytoma (a fat-forming solitary fibrous tumour) is a rare soft-tissue tumour histologically characterized by haemangiopericytomatous vasculature and the presence of mature adipocytes. We report the CT and MRI findings of a case of lipomatous haemangiopericytoma involving the perineum. CT showed a well-circumscribed soft-tissue density mass containing a small area of fat density and a punctuate calcification. On MR images, the mass was mostly isointense to the muscle on T(1) weighted images, with heterogeneous signal intensity on T(2) weighted images, and showed strong contrast enhancement except for the fatty and dense collagenous components. This is the first case report of imaging findings of a lipomatous haemangiopericytoma in the radiological literature. Although rare, lipomatous haemangiopericytoma should be considered as a differential diagnosis of fat-containing, hypervascular soft-tissue tumours with variable signal intensity on T(2) weighted images.

Deep drawing and cold forging processes are combined to achieve near net shape forming of automotive part which has not only drum shape but also thickness variation. It is important to find out proper intermediate shape where two totally different forming methods should be joined seamlessly. In the course of development of the combined process, finite element analysis can be utilized effectively to decide optimal position for transferring from the sheet metal work to the bulk forming. Because machining process is eliminated, significant improvement in integrity, reliability, and durability of the part is expected. The developed process combination could be applied in real manufacturing process successfully.

This paper summarizes functions and features of a new latch design, named as pawl latch from herein, for implementation on ramp loading disk drives, where a disk drive with a ramp would allow actuator to stay on the ramp outside the disk when not in use. The new latch system consists of two latch mechanisms: one is inertia latch and the other is magnetic latch. These two latches work together to obtain very reliable non-contact break free latch while maintaining high resistance during rotary shock condition. Simple control method is also presented to alleviate audible noise issue generated using the pawl latch mechanism.

Portal vein complications after liver transplantation (LT) can lead to graft liver failure. In this living donor liver transplantation case a stenosis developed in the right posterior branch of the portal vein of the graft liver from a living donor with type 2 portal vein variation. A 61-year-old woman diagnosed with hepatocellular carcinoma due to hepatitis B received a liver graft revealing a single lumen divided by a septum. The portal vein was anastomosed to the recipient portal vein without venoplasty. Postoperative Doppler sonogram revealed poor flow in the right posterior portal vein with compensatory arterial hyperperfusion. The postoperative computed tomography (CT) scan revealed narrowing of the proximal part of the right posterior portal vein with periportal tracking. Without intervention, the liver enzyme and bilirubin levels decreased to normal and the follow-up CT scan showed decreased periportal tracking. The patient was discharged without major complications. We believe that the posterior portal vein stenosis resulted from the direct anastomosis of the portal vein without a further venoplasty. Although there was no major complication due to the posterior portal vein stenosis in our patient, we suggest a venoplasty to prevent portal vein stenosis when using right lobe grafts with a type 2 portal vein, even if a single lumen is present and there is a margin for a direct anastomosis.

In this paper, we performed the design study of a wide-band digital autocorrelation spectrometer for the observation study of an extra-galaxy's spectral lines and the survey research of the special radio sources in field of the radio astronomy observational research. The autocorrelation spectrometer designed in this paper can be used to their spectrometer of any system because this spectrometer has a wide dynamic power and frequency range properties. In this system we use the aliasing sampling method to minimize the band loss. For the output signal of the correlator we can increase the signal processing speed using by a special DSP chip, the integration and the FFT using hardware, so this spectrometer can support the newest developed technique for the radio astronomy observation so called ``On the fly" method.

To evaluate the helical CT findings of ruptured hepatocellular carcinoma (HCC), 12 patients with ruptured HCC were reviewed with regard to the tumour's location, size and contour protrusion, the appearance of the mass, the enhancement pattern, multiplicity and secondary changes. All ruptured tumours were located at the periphery of the liver and had a protruding contour. The maximum diameter of tumours ranged from 2 cm to 16 cm. Discontinuity of the hepatic surface was seen in 11 cases. In eight cases, CT images during the arterial phase showed a non-enhancing low attenuating lesion with focal discontinuity and peripheral rim enhancement. Seven cases showed separation of tumour content from the peripheral enhancing rim and intraperitoneal rupture of tumour content into the perihepatic space. Because of the similar appearance to an enucleated orbital globe with remaining sclera, this was termed the "enucleation sign". As well as ruptured masses, 10 cases with non-ruptured masses also showed a non-enhancing low attenuating pattern. Seven cases showed a haematoma with high attenuation around the ruptured mass. The peripheral location, protruding contour, discontinuity of the hepatic surface and surrounding haematoma are helpful signs in the diagnosis of ruptured HCC. The "enucleation sign" may be a characteristic finding in ruptured HCC.

The aim of this study was to define the characteristic MR findings of cervical pregnancy. Twelve patients with cervical pregnancy underwent MRI because of difficulty in the diagnosis by ultrasonography, human chorionic gonadotropin assessment, and other clinical evaluations. The assessment of MRI included size and location of the lesion, margin, MR signal intensity, rim of low-signal intensity, enhancement pattern, appearance of enhancing solid component, parametrial change, endometrial change, pelvic fluid collection, and ovarian change. All cases showed ill-marginated mass with very heterogeneous signal intensity on T2-weighted images, irregular internal high-signal intensities on T1-weighted images, a partial or circumferential rim of low-signal intensity, dense irregular peripheral enhancement and enhancing papillary solid components with accompanying tubular signal voids, and variably increased parametrial vascularities. This heterogeneous hemorrhagic mass with densely enhancing papillary solid components may be the typical MR finding for cervical pregnancy. J. Magn. Reson. Imaging 2001;13:918–922. © 2001 Wiley-Liss, Inc.

The purpose was to evaluate angiographic and CT manifestations of vascular Behçet's disease. The medical records of 64 patients with Behçet's disease, treated in our hospital during the last 4 years, were reviewed. 37 patients underwent angiography or CT in the symptomatic regions because of symptoms or clinical signs of vascular involvement by Behçet's disease. 33 (male:female ratio 28:5; mean age 35 years) of the 37 patients demonstrated vascular involvement, which was surgically proven (18 patients) or diagnosed on angiography (15 patients). Angiograms and CT images of these 33 patients were retrospectively analysed for lesion type, location, extent and other characteristic findings of vascular involvement. 12 patients had only venous lesions, 11 had only arterial lesions and 10 had both arterial and venous lesions. The major angiographic findings of vascular Behçet's disease were acute or chronic thrombosis in deep veins of the lower extremities (19 patients), in the inferior vena cava (4 patients) and in the superior vena cava (2 patients), pseudoaneurysms of large or medium sized arteries (11 patients), and occlusions/ stenoses of distal run-off arteries (13 patients). Common CT findings were obliterated deep veins (8 patients) and non-calcified thickened aneurysmal walls (9 patients), with or without contrast enhancement. The combination of these angiographic and CT findings with clinical manifestations are helpful in distinguishing vascular Behçet's disease from other vasculitides.

Vasculitides can cause local or diffuse pathologic changes in the gastrointestinal tract, resulting in nonspecific paralytic ileus, mesenteric ischemia, submucosal edema and hemorrhage, or bowel perforation or stricture. The extent and clinical course of disease depend on the size and location of the affected vessel and the histologic characteristics of the lesion. Vasculitis may primarily involve large vessels (eg, giant cell arteritis, Takayasu arteritis), medium-sized vessels (eg, polyarteritis nodosa, Kawasaki disease, primary granulomatous central nervous system vasculitis), or small vessels (eg, Wegener granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis, Henoch-Schönlein syndrome, systemic lupus erythematosus, rheumatoid vasculitis, Behçet syndrome). Radiologic findings in various types of vasculitis often overlap considerably and therefore have limited value in making a specific diagnosis. Nevertheless, the possibility of vasculitis should be considered whenever mesenteric ischemic changes occur in young patients, are noted at unusual sites (eg, stomach, duodenum, rectum), have a tendency to concomitantly involve the small and large intestine, and are associated with genitourinary involvement. Knowledge of systemic clinical manifestations in affected patients may suggest and even help establish the specific diagnosis.

Haemangioma is an extremely rare tumour of the ovary. We describe the CT and MRI findings of a heavily calcified ovarian haemangioma in a 69-year-old woman presenting with adnexal torsion. CT showed a well-circumscribed mass with extensive punctate calcifications, located posterior to the uterus. MR images showed dark signal intensities of the mass on both T(1) and T(2) weighted images, with poor enhancement of the mass on contrast-enhanced T(1) weighted images. MR images also demonstrated a beak-like protrusion from the adnexal mass, representing the adnexal torsion. This is the first case report of a heavily calcified ovarian haemangioma in the English literature. Although rare, ovarian haemangioma should be included in the differential diagnosis of a heavily calcified adnexal mass.

Purpose: to investigate the utility of the resistive indices (RIs) of the epididymal and intratesticular arteries, and to establish diagnostic criteria for scrotal inflammatory disease on the basis of quantitative color Doppler sonography Material and Methods: We prospectively examined 29 consecutive patients with scrotal pain, and 15 normal control subjects. the RIs of the intratesticular and epididymal arteries were obtained from color Doppler sonographs Results: the RIs of the testicular artery in epididymoorchitis were significantly lower than those in normal control subjects and in epididymitis (p0.5). with a cut-off value of RI=0.5, sensitivity, specificity, accuracy, and positive and negative predictive values were 91%, 94%, 94%, 83%, and 77% respectively. the mean RI of the epididymal arteries in epididymitis and epididymoorchitis was 0.49±0.11. A high level of diagnostic accuracy in scrotal inflammatory disease was achieved when the RIs of the intratesticular and epididymal arteries were less than 0.5 and 0.7 respectively Conclusion: the RI of the intrascrotal artery would give a more objective evaluation than subjective assessment and could provide diagnostic criteria for scrotal inflammatory disease

Large experiments and high-performance computer models generate many petabytes of data. While Cloud Computing systems may meet the needs for analyzing these petabytes by harnessing the computing power of many distributed computers, the key challenge in effectively utilizing such a distributed system is the data management process, including storage, indexing, searching, accessing, and transferring data. Most analysis tasks perform computations on a subset of a large data records satisfying some user specified constraints on attribute (variable) values. This subsetting procedure is extremely important in that it reduces the network traffic to and from the cloud facilities. However, selected data records often span many different data files, and extracting the values out these files can be time-consuming especially if the number of files is large. This work addresses this challenge of working with a large number of files. We use a set of astronomical data set as an example and use an efficient database indexing technique, called FastBit, to significantly speed up the subsetting and thus optimize network usage. Overall, we aim to provide transparent and highly efficient attribute-based data access to scientists through a web-based Astronomy Data Analysis Portal. We will discuss the system design, and options for managing an extremely large number of files while minimizing network usage and latency.

Occupational hand eczema is frequent in hospital workers, especially in nurses. A comprehensive understanding regarding hand eczema is essential for establishing proper prevention and treatment strategies. The purpose of this study was to identify the risk factors for hand eczema in hospital nursing staffs. A self-administered questionnaire study was performed on hospital nursing staffs at a single general hospital in Korea. In addition, 70 patients with hand eczema underwent patch testing. Five hundred and twenty-five of 700 invited nurses completed the study (response rate, 75.0%). The overall frequency of symptom-based hand eczema was 75.6%, and self-reported hand eczema was 31.0%. Risk factors for hand eczema were young age, history of atopic dermatitis, frequent hand washing (>20 times/day) and long duration of glove wearing (>5 min). Hand eczema was less frequent among frequent hand moisturizer users (>3-4 times/day). Positive patch test reactions were observed in 61.4%. Frequent allergens were nickel sulfate (35.7%), cobalt chloride (28.6%) and thiomersal (21.4%). Among various antibiotics, ciprofloxacin (11.4%), trimethoprim/sulfamethoxazole (11.4%) and gentamicin (7.1%) were revealed as common allergens, in order of frequency. Hand eczema is quite common among hospital nursing staffs. Proper preventive programs and educations are demanded.

Uterine Sarcoma Presenting in the Setting of Non-puerperal Uterine Inversion with Uterine Prolapse Puerperal uterine inversion occurs in approximately one out of every 30,000 vaginal deliveries. Non-puerperal uterine inversion is rare with no reliable estimate of frequency in the literature; it is almost always associated with a polypoid uterine tumor. Although the most common cause of non-puerperal uterine inversion is a leiomyoma, a high index of suspicion for a coexisting malignancy must be maintained. Herein, we present a case of a non-puerperal uterine inversion in the setting of a uterine sarcoma that was accompanied by complete prolapse of the uterus into the vagina.

We reviewed CT of four patients with surgically proved bowel infarction secondary to superior mesenteric vein (SMV) thrombosis. Pathologic correlation was available in all patients. Three patients had thrombus in both portal vein and proximal SMV and the remaining patient had thrombus that was seen only in the peripheral branches of the SMV. Contrast-enhanced CT showed a segmental distribution of marked concentric bowel wall thickening in all four patients. Two patients also showed zones of different attenuation in the bowel wall, which were caused by varying degrees of edema and hemorrhage in the submucosa. Dense peripheral enhancement of the bowel wall was present in one patient. Other CT findings included ascites and mesenteric changes such as edema and vascular engorgement. The combination of thrombus in the SMV with bowel wall thickening strongly suggests bowel infarction and, therefore, warrants initiation of appropriate therapy.

We report the imaging findings in a case of Kaposi's sarcoma involving a transplanted kidney, ureter and urinary bladder. Ultrasound and CT demonstrated multiple nodular masses in the pelvis of the transplanted kidney, ureter and bladder. The masses enhanced well on CT following i.v. contrast medium.

Purpose of review Robotic surgery with its numerous advantages over conventional laparoscopy has assumed an ever-expanding role in pelvic and pelvic floor reconstructive surgery. Our goal is to review the literature regarding robotic use in urogynecologic surgery. Recent findings The current literature demonstrates the feasibility and safety of performing robotic urogynecologic procedures in a wide variety of cases. Robotic sacrocolpopexy and hysterectomy are most commonly described, but the use of robotics in the repair of complex pelvic fistulae has also been examined. The available studies mainly consist of case series with short-term follow-up, but early outcomes appear to be comparable to open surgery with decreased patient morbidity. Summary The role of robotics in urogynecologic surgery will continue to grow, as there is an increasing access to the robotic platform, and its use is being incorporated into residency training. More robust studies will be needed to validate the continued use of the robot, as there are concerns regarding cost, training, and credentialing.

This paper presents an improved version of the insect-mimicking flapping-wing mechanism actuated by LIPCA (Lightweight Piezo-Composite Actuator). As the previous version, the actuation displacement of the actuator is converted into flapping-wing motion by a mechanical linkage system that functioned as displacement amplifier as well. In order to provide feathering motion, the wing is attached to the axis through a hinge system that allows the wing rotation at each end of half-stroke, due to air resistance. In this improved version, the total weight has been reduced to the half of the previous one. The device could produce about 90 degree of flapping angle when it operated at around 10 Hz, which was the natural flapping-frequency. Several flapping tests under different parameter configurations were conducted in order to investigate the characteristic of the generated lift. In addition, the smoke-wire test was also conducted, so that the vortices around the wing can be visually observed. Even though the present wing has smaller wing area, it could produce higher lift then before.

The projectile speed of a hypervelocity launcher depends on many parameters. The purpose of this study applies the propriety of optimization method and increases the efficiency of development of experiment facility. In this paper, three gun operating parameters were considered to investigate the performance optimization of the hypervelocity launcher. These parameters were identified as the ratio between piston mass and pump tube volume, pump tube fill pressure, and the number of diaphragms in the contraction section. The test results were used to construct the response surface. The response surface method shows that the isentropic compression with a heavy piston gives a faster exit speed than shock wave compression in the wide operational conditions. First, the test experimented for the preceding study with polyester film in the 1, and 2 diaphragm and then the diaphragm was replaced with stainless steel. The limitation of projectile speed was set under l,000m/s for the safety. * Graduate Research Assistant, Department of Aerospace Engineering ** Professor, Department of Aerospace Engineering, Member AIAA ***Contract Assistant Professor, Department of Aerospace Engineering, Member AIAA Associate Professor, Department of Aerospace Engineering, Member AIAA ^Professor, Department of Aerospace Engineering, Member AIAA Copyright © 2002 by the authors. Published by the American Institute of Aeronautics and Astronautics, Inc., with permission. Introduction The techniques used for aeroballistics were applied, more than 150 years, to aerodynamic experiments. Research for supersonic gas dynamics was revolutionized during World War II with the advent of the supersonic wind tunnel. However, the development of space flight and ballistic missile technology required more testing capabilities at hypersonic speeds. This requirement exceeded the capabilities of the existing facilities and led to the implementation of hypersonic launchers. A high speed launcher is based on the same principles developed for conventional powder gun. The exit velocity of conventional powder gun, 34km/s, are insufficient for use as a hypervelocity launcher. Conventional guns have a mechanical limit of high pressure of the powder explosion. Also the propellant is typically of high molecular weight and therefore has a low acoustic velocity. One of the first hypersonic launchers was a kind of a two-stage gas gun. The first successful twostage gas gun was the Mines gun built at the New Mexico School in 1948. The design was substantially improved upon by Crozier. Crozier used hydrogen gas compressed via a piston in the second stage to propel the projectile. The piston was driven by the conventional guns in the first stage. This design yields an exit velocity around 12km/s. The performance and physical phenomenon of the stage gas gun have been studied numerous times. The studies have thus far focused on interior ballistics, the calculation of the motion of a projectile or piston propelled by an expanding gas, and the classical Lagrange ballistic problem (Poisson, 1832). Table 1 shows two important parameters affecting the performance of two-stage gas gun. The operating parameters denote the operating (c)2002 American Institute of Aeronautics & Astronautics or Published with Permission of Author(s) and/or Author(s)' Sponsoring Organization. conditions of the launcher, and the shape parameters, which are used in the development of the launcher or in numerical analysis, so it is hard to change shape parameters that this study is to find Konkuk University hypervelocity launcher's optimum combination operating parameters using response surface method based on experiment results. Table 1 shows the operating parameters and the shape parameters. Table 2 shows the operating parameters. The shape parameters did not considered in this study. First case, parameters for the polyester film diaphragms that use of the second driver. Second case, parameters for the stainless steel diaphragms that use of the second driver. Fundamental notions and physical phenomenon of hypervelocity launcher Two-stage gas gun consists of the first driver, the second driver (pump tube), and driven part. Figure 1 is a sketch of the general two-stage gas gun configuration and an idealized wave diagram. As the piston is accelerated by the expansion of the first-stage propellant, the piston kinetic energy in the second driver and transforms into high pressure in the chamber. This high pressure in the chamber ruptures the diaphragm. The propellant gas has to have a low acoustic inertia. In case of an ideal gas, the propellant gas has to have a high temperature and a low molecular weight. The method for increasing temperature is ether chemical reaction method or electrical method, Table 1 The parameters of the hypervelocity launcher "" ^^ Components Parameters""^-\^^ Operating Parameters Shape Parameters 1 Driver Powder Powder Mass Powder Burn Rate Length of the 1 Driver 2 Driver Propellant Gas Piston Mass Fill Pressure

In 1922, Thorek described standard free-nipple reduction mammaplasty for gigantomastia. This technique provided a simple and effective way to perform reduction mammaplasty. However, the technique is frequently criticized for producing a breast and nipple with poor projection. Even with the standard modification of the original technique, the resultant breast and nipple may be wide and flat, with unpredictable nipple-areola pigmentation. To create a breast mound and nipple with projection and even pigmentation, the free-nipple-graft breast reduction technique is presented. The Wise pattern skin reduction markings and the superiorly based parenchymal reduction technique are used. After the nipple-areola complex is removed, as a free graft, the inferior pole of the breast is then amputated along the Wise pattern skin markings, leaving lateral and medial pillars of breast tissue, with the apex of the resection corresponding to the new nipple location. The lateral and medial pillars of the superiorly based breast mound are then sutured together. Key interrupted sutures are placed, beginning at the most inferior and posterior point of the pillars, while recruiting tissue centrally to increase the projection. The intersecting point of the inverted T, at 7 cm from the new nipple position, is then sutured to the fasciae of the pectoralis major muscle. If more central projection is desired, the vertical limb design can be lengthened. The tissue inferior to the 7-cm mark is de-epithelialized and tucked under the central breast, if needed, contributing further to the final breast parenchyma projection. The skin of the vertical limb of the Wise pattern is then closed with a dog-ear at the apex to further contribute to nipple projection. The nipple is replaced as a free, thick, split-thickness skin graft. The breast is temporarily closed, and the medial and lateral breast tissue excess is liposuctioned to create a more conical breast. Excessive medial and lateral skin is then resected, keeping the inframammary crease incision under the breast mound. Twenty-five patients underwent free-nipple-graft reduction mammaplasty using this technique between 1992 and 2000. An average of 1600 g of breast tissue per breast was removed. The average follow-up period was 36 months. Patient satisfaction has been very high.

Benign solitary fibrous tumour, a rare mesenchymal tumour of adults, usually arises from the pleura. Only a few cases have been reported in the retroperitoneum and, to our knowledge, there has been no report of its imaging features. We describe the MRI features of benign solitary fibrous tumour arising from the pre-sacral space.