Diamond-Like Carbon: A Surface for Extreme, High-Wear Environments.

In this study, we present an in-depth characterization of a diamond-like carbon (DLC) film, using a range of techniques to understand the structure and chemistry of the film both in the interior and particularly at the DLC/air surface and DLC/liquid interface. The DLC film is found to be a combination of sp2 and sp3 carbon, with significant oxygen present at the surface. The oxygen seems to be present as OH groups, making the DLC somewhat hydrophilic. Quartz-Crystal Microbalance (QCM) isotherms and complementary neutron reflectivity data indicate significant adsorption of a model additive, bis(2-ethylhexyl) sulfosuccinate sodium salt (AOT) surfactant, onto the DLC from water solutions and indicate the adsorbed film is a bilayer. This initial study of the structure and composition of a model surfactant is intended to give a clearer insight into how DLC and additives function as antiwear systems.

Living histamine-containing cells from the bronchial lumens of humans. Description and comparison of histamine content with cells of rhesus monkeys.

Cell populations obtained by bronchial lavage from human subjects were examined for the presence of cells related to the mast cell-basophil series. Such bronchial lumen histamine-containing cells (BLHCC) were identified. The BLHCC stained with toluidine blue may be identified by bright field or dark field microscopy. The BLHCC are alive as evidenced by ability to release histamine (H) after exposure to anti-IgE or calcium ionophore. Although H release from peripheral blood leukocytes by these two agents is potentiated by the presence of D2O, H release from BLHCC of the same subjects by anti-IgE or calcium ionophore was not potentiated by D2O. In studies comparing bronchial cell populations of humans and rhesus monkeys with peripheral blood leukocyte populations of the same subjects, the histamine content of the bronchial cell population was much higher in rhesus monkeys. IgE/Alb ratios of respiratory secretions and serum of the same human subjects were of the same order of magnitude in contrast to previous comparisons done on these fluids in rhesus monkeys.

The Importance of Prostate-specific Antigen (PSA) Nadir and Early Identification of PSA Relapse after 10 Years of Prostate Iodine 125 Seed Brachytherapy in Edinburgh.

AIMS: To analyse our 5 and 10 year prostate brachytherapy outcome data and to assess the impact of PSA nadir on relapse free survival and whether an alternative definition of PSA relapse could detect men destined to fail by the Phoenix definition at an earlier time point. MATERIALS AND METHODS: 474 men were treated over a 10 year period between 20012 and 2011 and divided into 2 five year cohorts for the purpose of the analysis. RESULTS: The risk of relapse is strongly predicted by post treat prostate-specific antigen (PSA) nadir. After 3 years post-treatment, PSA nadir plus 0.4 ng/ml identified men at risk of relapse 17 months earlier than the Phoenix definition. CONCLUSION: The Phoenix definition of nadir plus 2.0 ng/ml does not allow the early identification of men destined to relapse. The initiation of salavage therapy at the earliest opportunity could potentially affect subsequent survival and an outline randomised controlled trial proposal is presented.

Carcinoid syndrome caused by an atypical carcinoid of the uterine cervix.

Neuroendocrine tumors of the cervix are rare and are often under- or misdiagnosed. Because these tumors are very aggressive, early diagnosis and subsequent treatment are warranted. We describe a 46-yr-old woman with carcinoid syndrome caused by an atypical carcinoid of the uterine cervix. At age 44, she had dysplasia on Pap smear and underwent total abdominal hysterectomy with the diagnosis of adenocarcinoma. Fourteen months postoperatively, she developed the carcinoid syndrome and was found to have numerous liver metastases. Histological and immunohistochemical investigations of biopsy specimens from the patient's liver lesions and original cervical lesion ("adenocarcinoma") suggested that this woman had a primary atypical carcinoid of the uterine cervix with metastases to the liver. Treatment with octreotide and alkylating agents decreased the episodes of flushing and diarrhea within 8 weeks. If an adenocarcinoma of the uterine cervix is diagnosed, atypical carcinoid should be in the differential diagnosis. Symptoms of the carcinoid syndrome should be pursued and, if present, a urinary 5-hydroxyindolacetic acid level should be obtained. Timely diagnosis of a neuroendocrine tumor of the cervix may improve survival.

From technical quality assurance of radiotherapy to a comprehensive quality of service management system.

BACKGROUND AND PURPOSE: A hierarchy of dosimetry, planning and machine performance checks and evaluations of clinical outcomes have been widely used in radiotherapy for decades. Procedures, codes of practice and guidance are readily available on the 'technical aspects' of radiotherapy treatments, maintenance of which is achieved by quality control checks within a quality assurance approach to radiotherapy. Recently a series of high profile, well-publicised treatment 'accidents' resulting in damage to patients have focused the attention of both professionals and the public. There is now pressure to introduce formal quality management systems. Patients and their relatives/carers are having their expectations raised but their definition of a quality service differs from that generally considered by the oncology professionals. Most departmental managers and staff have wide experience of quality control checks. They understand the philosophy of quality assurance. However the idea of formal quality systems/quality management is alien to them. What is a professional/departmental manager to do? MATERIALS AND METHODS: This paper addresses that question by discussing the underlying principles of quality management covering service provision as well as technical radiotherapy treatment delivery and by providing some guidance based on experience in the practical implementation of quality management through three stages of development: a QA programme incorporating checks on essential parts of the technical treatment delivery, a formal documented certified QA system focusing on technical treatment delivery, a comprehensive quality management system covering all parts of a service. RESULTS AND CONCLUSIONS: One possible action plan is provided indicating progress through the three stages of development based on experience in one large Radiation Oncology Department. With planning, resources and commitment, a comprehensive quality of service management system is achievable in radiotherapy.

Azathioprine-associated pulmonary dysfunction.

We present a case of azathioprine-associated alveolitis diagnosed by gallium-67 scanning and transbronchial biopsy. The patient denied respiratory symptoms, exhibited spiking fevers, and had normal chest roentgenograms. Allopurinol inhibition of azathioprine metabolism may have been a contributing factor.

Foregut carcinoids: a clinical and biochemical analysis.

BACKGROUND: Gastrointestinal foregut carcinoids make up a small percentage (3% to 6%) of all reported carcinoids. Because these tumors are so uncommon, comparisons between the subtypes have been difficult. The goal of this study was to compare the hormonal and clinical characteristics of gastric, duodenal, and pancreatic carcinoids. METHODS: A prospective database of approximately 750 carcinoid patients seen by one author over 25 years was reviewed, and the 104 patients with gastric (33), duodenal (17), or pancreatic (54) carcinoids were selected as the subgroup for analysis. These patients were compared with regard to hormone levels, clinical course, treatment, and survival. RESULTS: Duodenal carcinoids exhibited significantly lower serotoninergic hormone levels than did the gastric and pancreatic carcinoids (urine 5-hydroxyindoleacetic acid [mg/24 h], 5 +/- 1 vs 16 +/- 5 and 47 +/- 12, respectively, P = .03). Pancreatic carcinoids presented with more advanced stage (distant metastases 87% vs 42% and 20% for gastric and duodenal, respectively) and had worse outcomes than patients with gastric and duodenal tumors with 10-year survivals of 10%, 59%, and 58%, respectively (P = .003). CONCLUSIONS: Pancreatic carcinoids produce higher levels of serotoninergic hormones and have a significantly higher stage and worse outcome than other foregut carcinoids. This study demonstrates that the organ of origin is an important determinant of hormonal activity and clinical course for patients with foregut carcinoids.

Accelerated recombinant protein purification process development automated, robotics-based integration of chromatographic purification and analysis.

Recovery of recombinant proteins from endogenous, host molecules can be an experimentally intensive and time-consuming task. Often the time to analyze material during development of recovery procedures is the rate-limiting step. Nowadays, modern techniques and equipment are being specifically engineered to make this effort much more efficient. We present a case study to illustrate how a new, automation tool, designed for easy, systematic methods development, can be used for very rapid process and analytical optimization. This tool uses robotics to integrate process development with rapid LC-based analysis requiring no user intervention. The methods and procedures described can be generalized to any recombinant protein recovery campaign.

Axillary thoracotomy.

The axillary thoracotomy should be the incision of choice for most uncomplicated general thoracic surgical procedures. It can be performed rapidly, avoids major muscle transection, and by employing a double lumen endotracheal tube will permit segmental resection as well as lobectomy without technical problem. One hundred consecutive, elective axillary thoracotomies were performed with minimal morbidity and only one mortality. Twenty-five of the patients were of high surgical risk. The larger posterolateral thoracotomy is reserved for repeat thoracotomy, Pancoast tumors, difficult procedures such as bronchoplasty and/or radical pneumonectomy, and when pleural symphysis is expected. Sometimes called lateral thoracotomy or mini-thoracotomy, the axillary thoracotomy is our most common incision.

Metallic nanoparticles enhanced the spontaneous emission of semiconductor nanocrystals embedded in nanoimprinted photonic crystals.

We report on a method to enhance the light-emission efficiency of printable thin films of a polymer doped with luminescent (CdSe)ZnS nanocrystals via metallic nanoparticles and nanoimprinted photonic crystals. We experimentally show a strong fluorescence enhancement of nanocrystals by coupling exciton-plasmon with the localized surface plasmon of metallic nanoparticles. The emitted light is efficiently diffracted by photonic crystals structures directly imprinted in the nanocomposite polymer. By combining the field susceptibility technique with optical Bloch equations, we examine the interaction of the quantum and plasmonic entities at small distances.

Cryogenic confocal microscopy with rotation in a magnetic field.

Two approaches to conducting magneto-optical confocal spectroscopy are described, in each of which the confocal head is rotatable with respect to the magnetic field. A coudé arrangement has been shown to give adequate performance for scanned imaging, but lower optical throughput than a system based on single-mode optical fiber transport. The design criteria for a cryogenic fiber-coupling objective are described, and the tolerances demanded in lens alignment are shown to be relatively benign, allowing manufacture without special techniques. The practical use of the rotating confocal system with commercial stick-slip positioners has been shown to be rigid enough, and asymmetric weight distribution and diamagnetic forces are small enough to permit single quantum emitters to be studied over a range of angles and field strengths.

Effectiveness of immediate preoperative injection of radiopharmaceutical and blue dye for sentinel node biopsy in patients with breast cancer.

BACKGROUND: Sentinel node biopsy (SNB) in breast cancer conventionally utilises a preoperative radioisotope injection and lymphoscintigraphy, which is time consuming and painful. The aim of this study was to evaluate a potentially more efficient and practical technique of immediate preoperative injection of blue dye and radiopharmaceutical by the surgeon (without involvement of a nuclear medicine department). METHOD: One hundred and sixty three clinically node negative patients with invasive breast cancer undergoing breast-conserving surgery were included. The radiopharmaceutical was delivered to the operating suite and injected by the surgeon in the subareolar region immediately after induction of anaesthesia. Sentinel node biopsy was performed in conjunction with removal of any palpable axillary lymph nodes (axillary node sampling). RESULTS: Sentinel nodes (SNs) were detected in 161 of 163 women. On average, 3.0 sentinel nodes were identified. Twenty nine patients had involved nodes of whom 28 had a positive sentinel node. Of the two patients with failed identification, one had involved axillary lymph nodes on sampling and the other had an involved intramammary lymph node. CONCLUSION: This method produces results identical to those obtained with other techniques. This study shows that sentinel node biopsy can be performed safely without involvement of a nuclear medicine department with the added benefits of no preoperative injection and improved efficiency in the operating suite.

Respiratory effects of live influenza virus vaccine: healthy older subjects and patients with chronic respiratory disease.

Twenty-one healthy, middle-aged volunteers and 8 patients with chronic lung disease were given live, attenuated influenza virus vaccine by nasal spray. Forced vital capacity, 1-sec forced expiratory volume, ratio of 1-sec forced expiratory volume to forced vital capacity, residual volume, ratio of airway conductance to lung volume, maximal expiratory flows after exhalation of 50 and of 75 per cent of the forced vital capacity, closing volume, slope of Phase III, volume of isoflow, single-breath diffusing capacity for CO, and arterial blood gases were measured before and 3, 7, 10, and 21 days after exposure. Vaccination was well tolerated by the healthy volunteers without change in pulmonary function. In contrast, the patients tended to develop increased respiratory symptoms and had a slight decrease in mean forced expiratory volume in 1 sec 3 weeks after vaccination.