Allogeneic expanded adipose-derived stem cells in the treatment of rectovaginal fistulas in Crohn's disease.

AIM: Crohn's disease (CD)-related rectovaginal fistulas (RVFs) are rare, challenging to treat and associated with a high morbidity. Due to a significant lack of data, we aimed to analyse the safety and feasibility of allogeneic adipose-derived stem cells (ASCs) in the treatment of CD-related RVF. METHOD: Four consecutive patients with CD-related RVF underwent treatment with expanded allogeneic ASCs extracted from a healthy donor in a tertiary referral centre in 2019. None of the patients had an intestinal diversion at the time of the treatment. Follow-up was performed 6 months postoperatively. RESULTS: The median operation time was 45 min with a median hospital stay of 3 days. No intra-operative complications occurred. Three patients (75%) developed recurrent RVF after a median follow-up of 19 days. Two patients required surgical treatment including loose seton drainage due to discharge and pain. One patient developed recurrence of symptoms after 10 days, but refused further surgical therapy. Only one patient (25%) showed healing of the RVF, with re-epithelialization of both the vaginal and rectal opening and absence of clinical symptoms. CONCLUSION: Expanded allogeneic ASC therapy represents a novel safe treatment option for CD-associated RVF. Although efficacy appears limited, further controlled studies are required to draw robust conclusions.

Stereotactical fields applied in proton spot scanning mode with range shifter and collimating aperture.

Some clinical indications require small fields with sharp lateral dose gradients, which is technically challenging in proton beam therapy. This holds especially true for low-range fields applied with the spot scanning technique, where large beam profiles entering from the beam-line or the insertion of range shifting blocks lead to large lateral gradients. We regard the latter case and solve it by shifting the range shifting block far upstream in conjunction with a collimating aperture close to the patient. The experiments of the current work are based on a commercial proton therapy treatment head designed for several delivery modes. In a research environment of the spot-scanning delivery mode a range shifter is inserted downstream of the scanning magnets in a slot which is usually employed only in a scattering delivery mode. This configuration is motivated by equations assuming a simple model of proton transport. In the experiments lateral dose planes are acquired with a scintillation screen and radiochromic films. Dose distributions are calculated with the Monte Carlo dose engine of the RayStation treatment planning system. We demonstrate that proton fields with 80%-20% lateral dose fall-off values between 1.4 mm and 4.0 mm can be achieved for water equivalent depths between 0 cm and 10 cm. The simulated lateral dose profiles agree with the experimental dose profiles. The sharpening of the field edges is set off by a broadening of the proton spots towards the center of the fields. This limits the clinical application mainly to small fields for which the distal and proximal conformality is of minor importance.

Impact of machine log-files uncertainties on the quality assurance of proton pencil beam scanning treatment delivery.

Irradiation log-files store useful information about the plan delivery, and together with independent Monte Carlo dose engine calculations can be used to reduce the time needed for patient-specific quality assurance (PSQA). Nonetheless, machine log-files carry an uncertainty associated to the measurement of the spot position and intensity that can influence the correct evaluation of the quality of the treatment delivery. This work addresses the problem of the inclusion of these uncertainties for the final verification of the treatment delivery. Dedicated measurements performed in an IBA Proteus Plus gantry with a pencil beam scanning (PBS) dedicated nozzle have been carried out to build a 'room-dependent' model of the spot position uncertainties. The model has been obtained through interpolation of the look-up tables describing the systematic and random uncertainties, and it has been tested for a clinical case of a brain cancer patient irradiated in a dry-run. The delivered dose has been compared with the planned dose with the inclusion of the errors obtained applying the model. Our results suggest that the accuracy of the treatment delivery is higher than the spot position uncertainties obtained from the log-file records. The comparison in terms of DVHs shows that the log-reconstructed dose is compatible with the planned dose within the 95% confidence interval obtained applying our model. The initial mean dose difference between the calculated dose to the patient based on the plan and recorded data is around 1%. The difference is essentially due to the log-file uncertainties and it can be removed with a correct treatment of these errors. In conclusion our new PSQA protocol allows for a fast verification of the dose delivered after every treatment fraction through the use of machine log-files and an independent Monte Carlo dose engine. Moreover, the inclusion of log-file uncertainties in the dose calculation allows for a correct evaluation of the quality of the treatment plan delivery.

Rational Design of Low Cost and High Energy Lithium Batteries through Tailored Fluorine-free Electrolyte and Nanostructured S/C Composite.

We report a new Li-S cell concept based on an optimized F-free catholyte solution and a high loading nanostructured C/S composite cathode. The Li2 S8 present in the electrolyte ensures both buffering against active material dissolution and Li+ conduction. The high S loading is obtained by confining elemental S (≈80 %) in the pores of a highly ordered mesopores carbon (CMK3). With this concept we demonstrate stabilization of a high energy density and excellent cycling performance over 500 cycles. This Li-S cell has a specific capacity that reaches over 1000 mA h g-1 , with an overall S loading of 3.6 mg cm-2 and low electrolyte volume (i.e., 10 µL cm-2 ), resulting in a practical energy density of 365 Wh kg-1 . The Li-S system proposed thus meets the requirements for large scale energy storage systems and is expected to be environmentally friendly and have lower cost compared with the commercial Li-ion battery thanks to the removal of both Co and F from the overall formulation.

A high-power and fast charging Li-ion battery with outstanding cycle-life.

Electrochemical energy storage devices based on Li-ion cells currently power almost all electronic devices and power tools. The development of new Li-ion cell configurations by incorporating innovative functional components (electrode materials and electrolyte formulations) will allow to bring this technology beyond mobile electronics and to boost performance largely beyond the state-of-the-art. Here we demonstrate a new full Li-ion cell constituted by a high-potential cathode material, i.e. LiNi0.5Mn1.5O4, a safe nanostructured anode material, i.e. TiO2, and a composite electrolyte made by a mixture of an ionic liquid suitable for high potential applications, i.e. Pyr1,4PF6, a lithium salt, i.e. LiPF6, and standard organic carbonates. The final cell configuration is able to reversibly cycle lithium for thousands of cycles at 1000 mAg-1 and a capacity retention of 65% at cycle 2000.

Liquid 1-propanol studied by neutron scattering, near-infrared, and dielectric spectroscopy.

Liquid monohydroxy alcohols exhibit unusual dynamics related to their hydrogen bonding induced structures. The connection between structure and dynamics is studied for liquid 1-propanol using quasi-elastic neutron scattering, combining time-of-flight and neutron spin-echo techniques, with a focus on the dynamics at length scales corresponding to the main peak and the pre-peak of the structure factor. At the main peak, the structural relaxation times are probed. These correspond well to mechanical relaxation times calculated from literature data. At the pre-peak, corresponding to length scales related to H-bonded structures, the relaxation times are almost an order of magnitude longer. According to previous work [C. Gainaru, R. Meier, S. Schildmann, C. Lederle, W. Hiller, E. Rössler, and R. Böhmer, Phys. Rev. Lett. 105, 258303 (2010)] this time scale difference is connected to the average size of H-bonded clusters. The relation between the relaxation times from neutron scattering and those determined from dielectric spectroscopy is discussed on the basis of broad-band permittivity data of 1-propanol. Moreover, in 1-propanol the dielectric relaxation strength as well as the near-infrared absorbance reveal anomalous behavior below ambient temperature. A corresponding feature could not be found in the polyalcohols propylene glycol and glycerol.

Nuclear deformation and neutron excess as competing effects for dipole strength in the pygmy region.

The electromagnetic dipole strength below the neutron-separation energy has been studied for the xenon isotopes with mass numbers A=124, 128, 132, and 134 in nuclear resonance fluorescence experiments using the γELBE bremsstrahlung facility at Helmholtz-Zentrum Dresden-Rossendorf and the HIγS facility at Triangle Universities Nuclear Laboratory Durham. The systematic study gained new information about the influence of the neutron excess as well as of nuclear deformation on the strength in the region of the pygmy dipole resonance. The results are compared with those obtained for the chain of molybdenum isotopes and with predictions of a random-phase approximation in a deformed basis. It turned out that the effect of nuclear deformation plays a minor role compared with the one caused by neutron excess. A global parametrization of the strength in terms of neutron and proton numbers allowed us to derive a formula capable of predicting the summed E1 strengths in the pygmy region for a wide mass range of nuclides.

Cutis marmorata telangiectatica congenita in a preterm newborn - Case report and literature review.

BACKGROUND: Cutis marmorata telangiectatica congenita (CMTC) is a sporadic congenital skin vascular abnormality. Significant number of patients has other congenital anomalies. CASE REPORT: We report a case of a preterm male newborn with cutis marmorata pattern presented on the skin of the face, right side of front of the trunk, whole back, glutei and both legs. Besides, microretrognatia and asymmetric, bad-formed, low-set ears were notable. Ophthalmologic findings showed visual impairment and pale optic nerve papilla. Monitoring of child showed mental underdevelopment and motor retardation. CONCLUSION: CMTC is a rare finding with good prognosis of skin malformations, with an obligation of dermatologist and paediatrician to investigate other associated congenital anomalies.

Monitoring dressing activity failures through RFID and video.

BACKGROUND: Monitoring and evaluation of Activities of Daily Living in general, and dressing activity in particular, is an important indicator in the evaluation of the overall cognitive state of patients. In addition, the effectiveness of therapy in patients with motor impairments caused by a stroke, for example, can be measured through long-term monitoring of dressing activity. However, automatic monitoring of dressing activity has not received significant attention in the current literature. OBJECTIVES: Considering the importance of monitoring dressing activity, the main goal of this work was to investigate the possibility of recognizing dressing activities and automatically identifying common failures exhibited by patients suffering from motor or cognitive impairments. METHODS: The system developed for this purpose comprised analysis of RFID (radio frequency identification) tracking and computer vision processing. Eleven test subjects, not connected to the research, were recruited and asked to perform the dressing task by choosing any combination of clothes without further assistance. Initially the test subjects performed correct dressing and then they were free to choose from a set of dressing failures identified from the current research literature. RESULTS: The developed system was capable of automatically recognizing common dressing failures. In total, there were four dressing failures observed for upper garments and three failures for lower garments, in addition to recognizing successful dressing. The recognition rate for identified dressing failures was between 80% and 100%. CONCLUSIONS: We developed a robust system to monitor the dressing activity. Given the importance of monitoring the dressing activity as an indicator of both cognitive and motor skills the system allows for the possibility of long term tracking and continuous evaluation of the dressing task. Long term monitoring can be used in rehabilitation and cognitive skills evaluation.

Spread of cochlear excitation during stimulation with pulsed infrared radiation: inferior colliculus measurements.

Infrared neural stimulation (INS) has received considerable attention over the last few years. It provides an alternative method to artificially stimulate neurons without electrical current or the introduction of exogenous chromophores. One of the primary benefits of INS could be the improved spatial selectivity when compared with electrical stimulation. In the present study, we have evaluated the spatial selectivity of INS in the acutely damaged cochlea of guinea pigs and compared it to stimulation with acoustic tone pips in normal-hearing animals. The radiation was delivered via a 200 µm diameter optical fiber, which was inserted through a cochleostomy into the scala tympani of the basal cochlear turn. The stimulated section along the cochlear spiral ganglion was estimated from the neural responses recorded from the central nucleus of the inferior colliculus (ICC). ICC responses were recorded in response to cochlear INS using a multichannel penetrating electrode array. Spatial tuning curves (STCs) were constructed from the responses. For INS, approximately 55% of the activation profiles showed a single maximum, ∼22% had two maxima and ∼13% had multiple maxima. The remaining 10% of the profiles occurred at the limits of the electrode array and could not be classified. The majority of ICC STCs indicated that the spread of activation evoked by optical stimuli is comparable to that produced by acoustic tone pips.

Nature of the pygmy dipole resonance in 140Ce studied in (alpha, alpha' gamma) experiments.

A concentration of electric-dipole excitations below the particle threshold, which is frequently denoted as the pygmy dipole resonance, has been studied in the semimagic nucleus 140Ce in (alpha, alpha' gamma) experiments at E alpha = 136 MeV. The technique of alpha-gamma coincidence experiments allows the separation of E1 excitations from states of other multipolarities in the same energy region and provides an excellent energy resolution to allow a detailed analysis for each state. The experimental results show that the PDR splits into two parts with different nuclear structure: one part which is excited in (alpha, alpha' gamma) as well as (gamma, gamma') experiments and one part which is excited only in (gamma, gamma').

Crystal-like nature of acoustic excitations in glassy ethanol.

We report on inelastic x-ray scattering experiments on crystalline and glassy phases of ethanol in order to directly compare the influence of disorder on high frequency acoustic excitations. We find that both the dispersion and the line-width of the longitudinal acoustic excitations in the glass are the same as in the polycrystal in the reciprocal space portion covering the 1st and 2nd Brillouin zones. The structural disorder is found to play little role apart from an intrinsic angular averaging, and the nature of these excitations must essentially be the same in both glass and poly crystal.

Sound wave scattering in network glasses.

The acoustic branch of two network glasses, (Li2O)xB2O3 ( x = 0.25 and 0.5), is followed over a large momentum transfer range 1-12 nm(-1), using inelastic x-ray scattering. We observe the transition from propagating modes to a region of strong scattering as the Ioffe-Regel limit is reached. A region of Rayleigh scattering of the acoustic modes precedes the strong scattering regime at larger Q, causing a rapid decrease of the mean-free path of the modes.

The effect of selenium on antioxidant system in erythrocytes and liver of the carp (Cyprinus carpio L.)

The effect of selenium-supplemented diet (sodium selenate and selenium yeast) on antioxidant in erythrocytes and liver of the carp (Cyprinus carpio L.) fingerlings was studied. With this goal, the activities of glutathione peroxidase (GSH-Px), catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GR) and glutathione-S-transferase (GST), as well as glutathione (GSH + GSSG) level, were determined. In the group supplemented with sodium selenate, no significant changes in the activity of the above enzymes were recorded in both the erythrocytes and in the liver, with the exception of GST activity that was significantly reduced in the plasma compared with the controls. Glutathione content was at the control level. In the group supplemented with selenium-yeast, the activities of GSH-Px, CAT, and SOD were significantly increased in erythrocytes, whereas GST activity and plasma content of GSH + GSSG were reduced compared with the controls. At the same time, the activities of hepatic SOD and GST were increased compared with the controls. These results demonstrate that organically bound selenium (selenium-yeast) acts more efficiently on antioxidant system of the carp fingerlings than inorganic selenium salts.

Traumatic arteriovenous fistula. Case report and overview.

The difficulties in detecting vascular injuries associated with penetrating limb trauma are greater than generally appreciated. Any delay in diagnosis will compromise management and potentially may lead amputation. Traumatic arteriovenous fistulas (AV fistula) produce several profound pathophysiological and structural changes in the circulatory dynamic of the vessel associated with fistula. Most of the changes are reversible after surgery. However, in longstanding AV fistulas, irreversible degenerative changes occur in the arterial wall and result in dilation and thrombosis. This can make late closure technically difficult. This report presents a case of a femoral AV fistula persisting for three years durations.

Infected late false aneurysm of the superficial femoral artery. Case-report.

A 24-year-old Croatian soldier sustained a comminuted fracture of the femur and after stabilization with AO external fixation an infected late false aneurysm of the superficial femoral artery developed. The aneurysm was extirpated and the artery reconstructed using the saphenous vein.

Knee-ligament injuries associated with leg fractures. Prospective study.

It has been proved in 25-35% of the cases that knee-ligament injuries are associated with fracture of the femoral diaphysis. No such association has been confirmed between leg fractures and knee ligaments. In order to find out if this is a coincidence, a prospective study was conducted on 229 patients who had undergone operations for leg fractures at various locations and of variable intensity. It was established in 41 cases (17.34%) that the leg fracture was associated with knee-ligament injuries, resulting in joint instability. A significantly higher percentage of associated ligament lesions was found in open fractures as opposed to closed leg fractures. The examination was carried out with the patient under general or block anesthesia. On the basis of what was established it is recommended that the knee be examined clinically in all leg osteosynthesis cases.

Clinical and functional evaluation of the Carbomedics Prosthetic Heart Valve in the mitral position. Preliminary results.

The Carbomedics Prosthetic Heart Valve is a new bileaflet pyrolite carbon prosthesis. This paper reports the preliminary results in 40 patients who underwent mitral valve replacement (MVR) using the Carbomedics Valve in 1988. The operative mortality rate was 5% and the early results have been encouraging, with no valve related complications observed in the first post-operative year.

[Use of soft laser in the treatment of oral symptoms]. / Efikasnost mekog lasera u lijecenju oralnih simptoma.

Due to insufficient casual therapy of oral symptoms of dyniae and pyrosis, we applied infrared soft laser in treatment of patients with those oral symptoms. The laser had a wavelength of 904 nm and a radiation strength of 20 W. The tests were performed on 40 persons with stomatopyrosis and stomatodiniae symptoms, under application of laser through 5 days consecutively with radiation of mucosa lasting 3 minutes on 1 cm2. The testing group was represented by persons exclusively under the laser therapy and the control group was represented by 30 persons, who were under a medicamentose therapy with vasodilatator applied with iontophoresis. By persons with stomatopyrosis and stomatodiniae symptoms analgetic effect was attained through the therapy with the laser already after the first application, and the pain and aches intensity was relieved every day during the therapy, by stomatodinae to complete healing. The obtained differences in the intensity of symptoms before and after the therapy were statistically important. The thermoestesiometric determination of laser efficiency by vasodilatation showed differences which were not important, although the temperature during the therapy has slightly increased for 0.1 degrees C. The soft laser can be used as an effective remedy in the treatment of oral symptoms of stomatopyrosis and stomatodinae.