Catheter-Directed Thrombolysis for Acute Limb Ischemia in an Asian Population.

BACKGROUND: The incidence of peripheral arterial occlusions in Asian populations is likely to increase exponentially in the present and future decades due to the adapted Western lifestyle in metropolitan Asian life, extended life expectancies, and high rates of smoking. The literature on thrombolytic treatment of peripheral arterial occlusions in Asian populations is limited. Therefore, we evaluated the thrombolysis results in a real-world contemporary Asian cohort of patients with peripheral arterial occlusions. METHODS: Retrospective review of all electronic patient records of patients who underwent thrombolytic therapy for peripheral arterial occlusions between July 2011 and July 2016 was conducted. Outcomes were angiographic patency, clinical success, bleeding complications, amputation rates, and mortality rates. RESULTS: In total, 82 patients (median age 66 years, range 34-95) underwent catheter-directed thrombolysis. Median treatment duration was 26 hr (3-209). Angiographic patency and clinical success rates were 64% and 66%, respectively. Bleeding complications occurred in 12% of patients of which 6% were major. Amputation-free rates were 81%, 67%, and 63% for 30 days, 6 months, and 1 year, respectively. In-hospital mortality was 6%. CONCLUSIONS: This study demonstrates that thrombolytic treatment of peripheral arterial occlusions in an Asian patient cohort yields comparable treatment success rates to Western cohorts; however, higher rates of bleeding complications are hazardous and remain a detrimental drawback of this treatment.

Cell transfer technique for constructing cytological microarrays for immunocytochemical analysis.

OBJECTIVE: To evaluate the utility of a proposed cell transfer technique for constructing cytological smear microarrays and its potential applications in multiplex immunocytochemical (ICC) staining. METHODS: Ninety-six cytology smears, including two pericardial effusions, 22 ascites and 72 pleural effusions, were transferred to a 33-plex cytological microarray. Paired staining of thyroid transcription factor-1 (TTF-1) and calretinin ICC was performed in duplicate slides. RESULTS: Most of the smeared cells selected for transfer could be removed from the original slides with a minimal loss of cells and with no change in morphological features or immunoreactivity. Comparison of the staining results with immunohistochemical staining results, clinical history and histopathological reports available for each patient revealed that TTF-1 was positive in 32/33 metastatic pulmonary adenocarcinomas (PACs), 1/15 non-pulmonary adenocarcinomas and 0/45 benign effusions. The ICC results for TTF-1 on a transferred cytological microarray revealed high (97%) sensitivity and high (96.7%) specificity for the detection of metastatic PAC. CONCLUSION: Cytology microarrays can be constructed by transferring cells from serous fluid cytological smears, and cells transferred to the microarray retain their morphological integrity and immunoreactivity. Researchers can use the technique for simultaneous immunostaining of multiple specimens in studies of neoplastic or non-neoplastic diseases when available tissue samples are limited.

New Physics Opportunities in the Boosted Di-Higgs-Boson Plus Missing Transverse Energy Signature.

The Higgs field in the standard model may couple to new physics sectors related to dark matter and/or massive neutrinos. In this Letter we propose a novel signature, the boosted di-Higgs-boson plus E_{T} (which is either a dark matter or neutrino), to probe those new physics sectors. In a large class of models, in particular, the supersymmetric standard models and low scale seesaw mechanisms, this signature can play a key role. The signature has a clear background, and at the sqrt[s]=14 TeV high luminosity LHC, we can probe it with a production rate as low as ∼0.1 fb. We apply it to benchmark models, supersymmetry in the bino-Higgsino limit, the canonical seesaw model, and the little Higgs model, finding that the masses of the Higgsino, right-handed neutrino, and heavy vector boson can be probed up to ∼500, 650, and 900 GeV, respectively.

Endovascular Stent Graft Repair is an Effective and Safe Alternative Therapy for Arteriovenous Graft Pseudoaneurysms.

OBJECTIVE/BACKGROUND: Pseudoaneurysm formation occurs in 2-10% of hemodialysis arteriovenous grafts (AVGs). Surgical repair often requires pseudoaneurysm resection, interposition graft placement, and insertion of a catheter as a bridge. Endovascular stent graft repair is a controversial alternative therapy. This study was performed to examine the effectiveness and mid-term outcomes of stent graft repair for AVG pseudoaneurysms. METHODS: All patients who had undergone stent graft repair for AVG pseudoaneurysms between December 2012 and July 2015 were identified from hospital medical records for retrospective analysis. Outcome measures were technical success, early and late complications, and primary and secondary patency rates. RESULTS: A total of 37 stent graft repairs of AVG pseudoaneurysms were performed in 35 patients (42.9% men; mean age 66.9 years). The mean time from AVG creation to pseudoaneurysm repair was 69 months. The indications of treatment (as per the institutional policy) were large pseudoaneurysm (56.7%), impending rupture (27.1%), and bleeding (16.2%). Mean pseudoaneurysm diameter was 23.0 mm. The most common diameter and length of stent graft used were 7 mm (67.6%) and 50 mm (48.6%), respectively. Technical success was 100%. Only one early complication occurred after stent graft repair, which was due to recurrence of the pseudoaneurysm as a result of a short landing zone. Late complications included infection (17.1%) and thrombosis (37.1%). The 1, 6, and 12 month primary patency rates were 89.2%, 55.5%, and 22.0%, respectively. The 1, 6, and 12 month secondary patency rates were 100%, 88.6%, and 78.6%, respectively. The median follow up was 12.3 months. CONCLUSIONS: The study demonstrates that endovascular stent graft repair is an effective and safe alternative therapy for AVG pseudoaneurysms. However, the rate of thrombosis and infection was high and needs to be balanced against open surgery in future studies.

High photosensitivity few-layered MoSe2 back-gated field-effect phototransistors.

In this paper, we report on the fabrication and optoelectronic properties of high sensitive phototransistors based on few-layered MoSe2 back-gated field-effect transistors, with a mobility of 19.7 cm² V⁻¹ s⁻¹ at room temperature. We obtained an ultrahigh photoresponsivity of 97.1 AW⁻¹ and an external quantum efficiency (EQE) of 22 666% using 532 nm laser excitation at room temperature. The photoresponsivity was improved near the threshold gate voltage; however, the selection of the silicon dioxide as a gate oxide represents a limiting factor in the ultimate performance. Thanks to their high photoresponsivity and external quantum efficiency, the few-layered MoSe2-based devices are promising for photoelectronic applications.

[Functional dissociation of parts of the "sensorimotor complex" in the human cortex with the method of magnetoencephalography].

A method of non-invasive human primary motor cortex mapping has been developed. In 18 healthy right-handed subjects magnetic brain responses caused by repeated voluntary left or right index finger movements were studied. Movement onsets were derived from the accelerometer signal. Recordings of magnetic activity throughout whole experimental sessions in all subjects were concatenated into a single sequence, which was separated into independent components using independent component analysis and ranked according to the amount of mutual information with the modified accelerometer signal. Independent components that demonstrated maximum relation to the finger movement were averaged relative to the movement onset. The results of the distributed brain source modeling of the two independent components that manifested maximum amount of mutual information has demonstrated that their sources localize in the cortical areas corresponding to anatomical markers of hand representation in the primary motor and the primary sensory cortices contralateral to the movement. The method developed has demonstrated the fundamental possibility of localizing the M1 area in healthy subjects.

[The use of SPECT-CT in the diagnosis of cancerous lesions of axillary lymph nodes in patients with breast cancer].

The purpose of the study was to explore the possibilities of a new hybrid technology of SPECT-CT in the diagnosis of metastatic regional lymph nodes (LN) in patients with breast cancer (BC). There were examined 57 primary patients. All patients underwent axillary lymph node dissection and /or biopsy of sentinel LN followed by histological examination of the material. Metastases in LN were verified in 20 (35%) of 57 examined patients. Sensitivity, specificity and overall accuracy of SPECT-CT in the combined use of anatomical and functional criteria for assessing the state of LN accounted for 75%, 89% and 84%, respectively. Sensitivity of SPECT-CT in the diagnosis of massive axillary LN lesion (more than two) in breast cancer patients was 95%. Thus, the new hybrid technology of SPECT-CT, combining functional and anatomical techniques for assessing of pathological changes, is highly informative in the diagnosis of metastatic lesions of regional LN in patients with breast cancer.

[Adjuvant chemotherapy for breast cancer: search for new ways of planning].

A decision regarding adjuvant chemotherapy in early (operable) breast cancer in the past was made entirely on the basis of clinical and pathological features. However with the growing awareness of tumor biology and the possibility of the genomic analysis to determine the molecular subtypes of breast cancer it is getting real to identify patients whose tumors are resistant to chemotherapy or vice versa benefit from its addition. Despite the fact that genomic analysis allows some patients avoiding chemotherapy (especially patients with localized breast cancer), such studies do not indicate the most appropriate chemotherapy regimens. Therefore treatment decisions should be based on a combination of biological features of the tumor, its stage and signs that characterize the patient such as age and tolerance to the side effects of therapy.

[Diagnostic accuracy of mammography and mammoscintigraphy in multifocal breast cancer].

The aim of the study was to compare accuracy of conventional mammography and mammoscintigraphy with the 99mTc-Technetril in the detection of multicentric (MC) breast cancer. A total of 135 women (mean age 52 years) with unilateral simple breast lesions at clinical examination underwent preoperative mammography and mammoscintigraphy. Data of diagnostic procedure were compared with histopathologic analysis in all cases. The present of MC breast cancer was proven in 11 of 135 cases (8%). Mammography detected only one of 11 multicentric cases, while mammoscintigraphy-9 of 11 cases. Mammography showed a 9.1% and 93.5% sensitivity and specificity rates for the detection of multicentric breast cancer, respectively. The overall sensitivity and specificity rates for the detection of the form were 81.8% and 91.1% for mammoscintigraphy, respectively. Confirmation of the distinction between two methods has been attained by Bayesian probability calculation. Mammoscintigraphy proved a more highly sensitive diagnostic method than mammography in the detection and preoperative assessment of MC breast cancer and may contribute to changing surgical management in some cases.

[Methodological issues of sentinel lymph nodes biopsy in patients with breast cancer].

Radionuclide imaging of sentinel lymph nodes (SLN) was performed in 122 breast cancer patients, which before the biopsy of lymph nodes it was performed intratumoral injection of colloidal radiopharmaceuticals (RFP): in 89 patients--nanocolloidal (NC) and in 33--colloidal with particle size from 200 to 1000 nm. After the introduction of NC the SLN image was obtained in 83 of 89 women. (93.3%). After the introduction of large colloids (200-1000 nm or more) SLN visualization in this group was achieved in 27 of 33 patients, i.e., in 81.8% of cases (p < 0.05). Along with the axillary SLN, in 55.8% of cases SLN image was obtained in parasternal area and/or lymph nodes of the second and higher orders in axillary as well as under-and supraclavicular regions. On the contrary while using larger colloids, RFP accumulated only in SLN of axillary region in 85.1%. These differences in the topography of the absorption of various diameters radiocolloids were reliable (p = 0.01). Using the NC RFN compared with colloidal RFP of larger diameter can reliably improve SLN visualization till 98.9% however leads to a concomitant accumulation of RFP in lymph nodes of the second order in 55.8% of patients.

[The use of SPECT-CT with 99mTc-labeled phosphates in patients with suspected skeletal metastases in planar bone scintigraphy].

We assessed the diagnostic capabilities of SPECT-CT in patients with unclear and suspicious on the secondary lesion with bone scintigraphy background in planar mode (227 patients (mean age - 57 years) with various primary malignancies). All patients underwent planar scintigraphy with 99mTc-labeled phosphates in the "whole body" mode and then - bizonal single-photon-emission computed tomography combined with X-ray computed tomography (SPECT-CT). In patients with the presence of lesions in the skeleton, suspicious on metastases, there was conducted comparison with the data of SPECT-CT. During planar investigation the suspicion on metastases was detected in 41 patients (18%). The use of SPECT-CT allowed excluding metastases in 29 (71%) and confirmed in 7 (17%) of them. In 5 (12%) cases the nature of the changes remained unclear. Thus, in cancer patients with revealed by planar bone scintigraphy unclear or suspicious for metastatic foci in the skeleton, the use of SPECT-CT allowed in most cases (88%) to clarify the nature of these changes.

[Effectiveness of mammary scintigraphy for determining the results of neoadjuvant polychemotherapy in breast cancer].

Analysis of mammoscintigraphy is presented to assess the effectiveness of neoadjuvant polychemotherapy for locally advanced breast cancer. In 90% of patients there is defined conformity of scintigraphy data on the effectiveness of performed polychemotherapy to the results of histologic examination of the postoperative material. The sensitivity of scintigraphy in assessing the effectiveness of neoadjuvant polychemoterapy was 83.3%, specificity--87.9%, accuracy--86.3%, predictive value of positive and negative results-78.9% and 90.1%, respectively. Mammoscintigraphy is an effective method to control the response of locally advanced breast cancer to neoadjuvant polychemotherapy.

[Combined use of 99mTc-MIBI scintigraphy and ultrasonography (US) in the diagnosis of axillary lymphatic metastasis in patients with breast cancer].

We aimed to evaluate different imaging strategies for diagnosis of axillary LNMs in patients with primary breast cancer (BC). 168 consecutive patients with primary BC were included in the study. Functional imaging by scintigraphy (AxSc) with 99mTc-MIBI was performed in static and tomography modes 15 min after i/v injection. Focal areas of tracer accumulation in axial region were considered as sings of LNMs. Ultrasound (US) examination of axillary region was performed on 7.5 kH scanner. Nodes with diameter more than 1 cm were considered abnormal. All patients were operated with axial LN dissection and subsequent histological evaluation. Scintigraphic signs of LNMs revealed in 65 patients: 48--true positive, 17--false positive. Among 103 women with normal AxSc results 27 had LNMs and 76--uninvolved nodes. Sensitivity (Sen), Specificity (Sp) and Accuracy (Ac) of AxSc were as follows: 64%, 82% and 74%. Sonography diagnosed LNMs in 74 women: 56 were metastatic on histology while other 18--uninvolved. On the contrary, 19 of 94 US normal sized nodes were metastatic on histology. US had following values when used for diagnosis of axillary LNMs: Sen--75%, Sp--81%, Ac--78%. When LNMs were diagnosed as the combination of concordantly abnormal US and AxSc examinations Sp reached 95%, Sen dropped down to 56% and Ac--to 77%. Another model was based on the assumption that LNMs must be diagnosed in all patients with abnormal US or AxSc examinations. According to this strategy Sen reached 83%, Sp--68% and Ac--74%. Thus, we found comparative accuracy of US and AxSc in diagnosis of axillary LNMs in patients with primary BC. Combination of both modalities can significantly improve sensitivity (83%) or specificity (95%) of final conclusion which is determined by established diagnostic strategy and criteria's that are used for BC diagnosis.

[Markers of effectiveness of preoperative taxane-based chemotherapy for locally advanced breast cancer].

The absolute sensitivity signs of breast cancer to the drug have not yet been developed. Data from clinical trials on the study of experimental laboratory predictive markers of chemosensitivity: TOP2alpha (topoisomerase 2-alpha), beta-tubulin (subunit of dimeric protein tubulin), and BRCA1 (breast cancer 1) are contradictory and not numerous. Analysis of the results by the end of the clinical trial will allow examining the correlation between the effectiveness of preoperative taxane-chemotherapy and the level of experimental and standard molecular markets that is important for development of algorithm of treatment tactics for patients with locally advanced breast cancer.

Risk factors and possible mechanisms of intravenous port catheter migration.

OBJECTIVE: To identify the risk factors for catheter migration and demonstrate possible mechanisms of this migration. DESIGN: Retrospective study. SETTING: Chang Gung Memorial Hospital, a tertiary medical centre in Taiwan. PATIENTS: Patients who underwent implantation of intravenous ports via the superior vena cava (SVC). INTERVENTIONS: Procedures involving catheter placement and re-intervention for catheter migration. MAIN OUTCOME MEASURES: The anatomic location of the catheter tip was confirmed by plain chest X-rays (postero-anterior view). From these plain radiographs, the distance (in cm) between the carina and catheter tip and the angle (in degrees) between the locking nut and catheter were measured. METHODS: A total of 1542 procedures related to intravenous port implantation were retrospectively reviewed but only procedures involving implantation via the SVC were included in the analysis. The study group was composed of 31 interventions because of catheter migration, while the control group consisted of 1475 implantation and re-intervention procedures except those involving catheter migrations. RESULTS: Shallow catheter-tip location (p < 0.0001) and the presence of lung cancer (p = 0.006) were risk factors for catheter migration. CONCLUSIONS: Shallow catheter-tip location and the presence of lung cancer are risk factors for catheter migration. Strategies that ensure low catheter-tip location and avoid increased thoracic pressure may be useful preventive measures.

Endoscopic closure of a tracheal access site using bioglue after transtracheal thoracoscopy in a nonsurvival canine model.

OBJECTIVES: An ideal wound closure device would repair the wound with minimal complexity. In this report, we describe a simple wound closure method using BioGlue sealant. METHOD: Eleven canines underwent transtracheal pericardial window creation under endoscopic guidance for natural orifice transluminal endoscopic surgery (NOTES). The tracheal wound was closed using BioGlue sealant. The integrity of the wound was assessed by determining the amount of air leaking under mechanical ventilation. RESULTS: Transtracheal thoracic exploration and pericardial window creation was successful for all of the canines, and adequate wound closure was achieved in 10 of the canines. There was 1 case of NOTES-related death arising from misplacement of the endotracheal tube in the left lower lobar bronchus. This caused a collapse of the left upper lobe and ventilatory failure. Minor lung injuries occurred in 3 canines and minor mediastinal bleeding was encountered in 1 canine during the creation of the access site. CONCLUSION: BioGlue sealant was found to be effective in sealing the tracheal wound in all but 1 of the canines. This study demonstrates that the use of the sealant is a simple and efficient means of endoscopically closing the tracheal access site in NOTES.

[Nuclear medicine in radiotherapy planning for patients with malignant neoplasms of different locations].

The performance of nuclear medicine methods in radiation therapy tactics determination was analyzed in patients receiving therapy for Hodgkin lymphoma (HL, n=556), breast cancer (BC, n=230), treatment-naive patients with non-small cell lung cancer (NSCLC, n=86). In HL patients the nuclear medicine methods were used to determine the irradiation fields for spleen irradiation (67%) and abdominal lymph nodes (27%). The bone marrow scan data had significant influence on radiation therapy tactics in 10-27% of cases. The visualization of primary tumor lymphatic drainage lead to changing the irradiation field topography in 75% cases of external BC and 85% of internal BC localization. Tumorotropic isotope mammal scan data lead to the changes in planned irradiation volume in 16% of BC patietns. In NSLC patients the results of "positive" scintigraphy with lipophilic 99mTc-marked cations lead to the change in irradiation tactics in 16% of cases. Therefore, the results of diagnostic investigations suggest the important role of nuclear medicine diagnostic methods in patients with various tumors of different localizations.

[Methodologic aspects of radionuclide diagnosis of breast cancer with 99mTc-MIBI].

The aim was to study the diagnostic possibilities of breast scintigraphy with help of domestic RFP tehnetril labeled 99mTc. Breast scintigraphy was performed in 132 women at age between 32 and 68 years. Visualization of both breasts in planned mode was performed in the lateral and anterior projections in 10-15 minutes after intravenous injection of 740-860 MBq of 99mTc-tehnetril. After this, a study was conducted in the mode emission computed tomography. Morphological verification of changes in the breast was performed in all cases. Sensitivity, specificity and overall accuracy of planar breast scintigraphy was 96% (105/112), 94% (245/252) and 95% respectively. Upon planar study of 132 breasts suspicious on cancer presence breast scintigraphy showed not high specificity 68% (7/21), sensitivity reached 94% (105/112), overall accuracy--90%. SPECT did not show visible benefits: sensitivity-92% (100/112), specificity--75% (5/21), and overall accuracy--89%. Usage of a semi-quantitative accrual rate of RFP in tumor allowed distinguishing four groups of patients with different, to breast scintigraphy data, likelihood of breast cancer (from 2-10% to 96%). As a result current methods of breast scintigraphy provide high sensitivity (88-96%) and accuracy in breast cancer detecting of any size as far as the use of additional diagnostic criteria, semi-quantitative ratio RFP accumulation in tumor in particular, can significantly increase (up 94%), specificity of diagnostic conclusions.

Scale invariant extension of the standard model with a strongly interacting hidden sector.

We present a scale invariant extension of the standard model with a new QCD-like strong interaction in the hidden sector. A scale Λ(H) is dynamically generated in the hidden sector by dimensional transmutation, and chiral symmetry breaking occurs in the hidden sector. This scale is transmitted to the SM sector by a real singlet scalar messenger S and can trigger electroweak symmetry breaking. Thus all the mass scales in this model arise from the hidden sector scale Λ(H), which has quantum mechanical origin. Furthermore, the lightest hadrons in the hidden sector are stable by the flavor conservation of the hidden sector strong interaction, and could be the cold dark matter (CDM). We study collider phenomenology, relic density, and direct detection rates of the CDM of this model.

Association of primary cutaneous amyloidosis with atopic dermatitis: a nationwide population-based study in Taiwan.

BACKGROUND: Primary cutaneous amyloidosis (PCA) is a pruritic skin disorder most commonly seen in Southeast Asia and South America. Association of PCA with atopic dermatitis (AD) has been reported in the literature. However, no large-scale epidemiological study of PCA and its associations with other diseases has been conducted so far. OBJECTIVES: We aimed to provide overall demographic data and comorbidities of patients with PCA based on a nationwide database in Taiwan. METHODS: Cases of PCA were collected from records of National Health Insurance claims from 2000 to 2007. We analysed patients' gender, age when the diagnosis was first made, and the overall 8-year prevalence. We also investigated comorbidities. RESULTS: The overall 8-year prevalence of PCA was 7·87 per 10,000 persons. Although there was no significant gender difference in the prevalence of PCA, men and women showed a different peak age (men, 71-80 years; women, 41-50 years) and a different age distribution at diagnosis. The mean age at diagnosis of PCA was significantly younger for women than for men. Men sought medical assistance for PCA more frequently than women. There was a higher disease activity from May to September than during other months. PCA was strongly associated with AD (odds ratio 7·18). Patients with PCA had a higher comorbidity of hyperlipidaemia and diabetes mellitus. CONCLUSIONS: This is the first nationwide population-based epidemiological study of PCA. We demonstrate that PCA can be associated with other disorders, especially AD.