An augmented reality and high-speed optical tracking system for laparoscopic surgery.

While minimally invasive laparoscopic surgery can help reduce blood loss, reduce hospital time, and shorten recovery time compared to open surgery, it has the disadvantages of limited field of view and difficulty in locating subsurface targets. Our proposed solution applies an augmented reality (AR) system to overlay pre-operative images, such as those from magnetic resonance imaging (MRI), onto the target organ in the user's real-world environment. Our system can provide critical information regarding the location of subsurface lesions to guide surgical procedures in real time. An infrared motion tracking camera system was employed to obtain real-time position data of the patient and surgical instruments. To perform hologram registration, fiducial markers were used to track and map virtual coordinates to the real world. In this study, phantom models of each organ were constructed to test the reliability and accuracy of the AR-guided laparoscopic system. Root mean square error (RMSE) was used to evaluate the targeting accuracy of the laparoscopic interventional procedure. Our results demonstrated a registration error of 2.42 ± 0.79 mm and a procedural targeting error of 4.17 ± 1.63 mm using our AR-guided laparoscopic system that will be further refined for potential clinical procedures.

Small footprint phase locking system for a large tiled aperture laser array.

A phase sensing system fitted to the control of coherent laser beam array of large cross section is experimented. It is based on the use of a fiber bundle that collects a weak part of the synthetic wavefront, that scales it down (1/40) and that reshapes it in a more compact arrangement (2D to 1D array). Then, the reconfigured beam array can be analyzed by a small footprint system making the large laser beam array easier to phase-lock. The discrete laser array wavefront transmitted by the meter long fiber bundle was stabilized thanks to a multiple arm servo loop. Laser array phase locking was further ensured by random scattering through a diffuser, associated to an alternating projection algorithm. Six fiber laser beams constituting a 110 mm diameter synthetic aperture, were phase-locked with λ/16 accuracy.

Perforation of appendiceal adenocarcinoma ex goblet cell carcinoid: a rare case.

Goblet cell carcinoid tumor is a rare form of carcinoid tumor of the appendix. It behaves more aggressively than classical carcinoid tumor of the appendix. Thus, special attention must be given to its disease course and treatment. Our case presentation is of a 68-year-old female who presented with abdominal pain. Computed tomography of her abdomen and pelvis showed a perforated appendicitis. She underwent an ileocectomy with pathological report showing a goblet cell carcinoid tumor of the appendix with negative lymph nodes. A subsequent colonoscopy done 5 months later showed no synchronous lesions and a healthy anastomosis. Given the limited amount of data available about goblet cell carcinoid tumors of the appendix, it is important to report all findings in an effort to improve our understanding and treatment approaches of this rare disease.

Portomesentric and splenic vein thrombosis (PMSVT) after bariatric surgery: a systematic review of 110 patients.

BACKGROUND: Portomesenteric and splenic vein thrombosis (PMSVT) is a rare but potentially serious complication after bariatric surgery. No study has systematically analyzed its incidence and risk factors. OBJECTIVES: To pool the data regarding PMSVT after bariatric surgery and determine its incidence and risk factors. METHODS: A meta-analysis and systematic review was conducted to retrieve studies on PMSVT after bariatric surgery. RESULTS: A total of 41 eligible studies including 110 patients with postbariatric PMSVT were enrolled; the estimated incidence rate based on 13 studies was .4%. The use of oral contraception was reported in 35.4% of patients, previous surgery in 61.1%, smoking in 37.2%, and history of coagulopathy in 43%. PMSVT mostly occurred after sleeve gastrectomy (78.9%) and within the first postoperative month (88.9%). Pneumoperitoneum pressure was>15 mm Hg in 6% of patients. The portal vein was the most commonly affected vessel (41.5%). Prothrombin 20210 mutation and protein C/S deficiency were the most common thrombophilic conditions. Unfractionated heparin (59.1%), vitamin K antagonists (50.9%), and low molecular weight heparin (39.1%) were the most common treatments for PMSVT. The morbidity and mortality rates for postbariatric PMSVT were 8.2% and 3.6%, respectively. CONCLUSION: PMSVT usually occurs within the first postoperative month and is mostly reported after sleeve gastrectomy. The portal vein is the most commonly involved vessel. A previous hypercoagulable state can be an important risk factor. Most patients can be treated with anticoagulation therapy. Further studies with comprehensive data review of patient information are required.

Enhanced resting-state dynamics of the hemoglobin signal as a novel biomarker for detection of breast cancer.

PURPOSE: The work presented here demonstrates an application of diffuse optical tomography (DOT) to the problem of breast-cancer diagnosis. The potential for using spatial and temporal variability measures of the hemoglobin signal to identify useful biomarkers was studied. METHODS: DOT imaging data were collected using two instrumentation platforms the authors developed, which were suitable for exploring tissue dynamics while performing a simultaneous bilateral exam. For each component of the hemoglobin signal (e.g., total, oxygenated), the image time series was reduced to eight scalar metrics that were affected by one or more dynamic properties of the breast microvasculature (e.g., average amplitude, amplitude heterogeneity, strength of spatial coordination). Receiver-operator characteristic (ROC) analyses, comparing groups of subjects with breast cancer to various control groups (i.e., all noncancer subjects, only those with diagnosed benign breast pathology, and only those with no known breast pathology), were performed to evaluate the effect of cancer on the magnitudes of the metrics and of their interbreast differences and ratios. RESULTS: For women with known breast cancer, simultaneous bilateral DOT breast measures reveal a marked increase in the resting-state amplitude of the vasomotor response in the hemoglobin signal for the affected breast, compared to the contralateral, noncancer breast. Reconstructed 3D spatial maps of observed dynamics also show that this behavior extends well beyond the tumor border. In an effort to identify biomarkers that have the potential to support clinical aims, a group of scalar quantities extracted from the time series measures was systematically examined. This analysis showed that many of the quantities obtained by computing paired responses from the bilateral scans (e.g., interbreast differences, ratios) reveal statistically significant differences between the cancer-positive and -negative subject groups, while the corresponding measures derived from individual breast scans do not. ROC analyses yield area-under-curve values in the 77%-87% range, depending on the metric, with sensitivity and specificity values ranging from 66% to 91%. An interesting result is the initially unexpected finding that the hemodynamic-image metrics are only weakly dependent on the tumor burden, implying that the DOT technique employed is sensitive to tumor-induced changes in the vascular dynamics of the surrounding breast tissue as well. Computational modeling studies serve to identify which properties of the vasomotor response (e.g., average amplitude, amplitude heterogeneity, and phase heterogeneity) principally determine the values of the metrics and their codependences. Findings from the modeling studies also serve to clarify the influence of spatial-response heterogeneity and of system-design limitations, and they reveal the impact that a complex dependence of metric values on the modeled behaviors has on the success in distinguishing between cancer-positive and -negative subjects. CONCLUSIONS: The authors identified promising hemoglobin-based biomarkers for breast cancer from measures of the resting-state dynamics of the vascular bed. A notable feature of these biomarkers is that their spatial extent encompasses a large fraction of the breast volume, which is mainly independent of tumor size. Tumor-induced induction of nitric oxide synthesis, a well-established concomitant of many breast cancers, is offered as a plausible biological causal factor for the reported findings.

Phase I/II trial of everolimus in combination with bortezomib and rituximab (RVR) in relapsed/refractory Waldenstrom macroglobulinemia.

We examined the combination of the mammalian target of rapamycin inhibitor everolimus with bortezomib and rituximab in patients with relapsed/refractory Waldenstrom macroglobulinemia (WM) in a phase I/II study. All patients received six cycles of the combination of everolimus/rituximab or everolimus/bortezomib/rituximab followed by maintenance with everolimus until progression. Forty-six patients were treated; 98% received prior rituximab and 57% received prior bortezomib. No dose-limiting toxicities were observed in the phase I. The most common treatment-related toxicities of all grades were fatigue (63%), anemia (54%), leucopenia (52%), neutropenia (48%) and diarrhea (43%). Thirty-six (78%) of the 46 patients received full dose therapy (FDT) of the three drugs. Of these 36, 2 (6%) had complete response (90% confidence interval (CI): 1-16). In all, 32/36 (89%) of patients experienced at least a minimal response (90% CI: 76-96%). The observed partial response or better response rate was 19/36 (53, 90 CI: 38-67%). For the 36 FDT patients, the median progression-free survival was 21 months (95% CI: 12-not estimable). In summary, this study demonstrates that the combination of everolimus, bortezomib and rituximab is well tolerated and achieved 89% response rate even in patients previously treated, making it a possible model of non-chemotherapeutic-based combination therapy in WM.

Chernobyl and Fukushima nuclear accidents: what has changed in the use of atmospheric dispersion modeling?

The threat of a major accidental or deliberate event that would lead to hazardous materials emission in the atmosphere is a great cause of concern to societies. This is due to the potential large scale of casualties and damages that could result from the release of explosive, flammable or toxic gases from industrial plants or transport accidents, radioactive material from nuclear power plants (NPPs), and chemical, biological, radiological or nuclear (CBRN) terrorist attacks. In order to respond efficiently to such events, emergency services and authorities resort to appropriate planning and organizational patterns. This paper focuses on the use of atmospheric dispersion modeling (ADM) as a support tool for emergency planning and response, to assess the propagation of the hazardous cloud and thereby, take adequate counter measures. This paper intends to illustrate the noticeable evolution in the operational use of ADM tools over 25 y and especially in emergency situations. This study is based on data available in scientific publications and exemplified using the two most severe nuclear accidents: Chernobyl (1986) and Fukushima (2011). It appears that during the Chernobyl accident, ADM were used few days after the beginning of the accident mainly in a diagnosis approach trying to reconstruct what happened, whereas 25 y later, ADM was also used during the first days and weeks of the Fukushima accident to anticipate the potentially threatened areas. We argue that the recent developments in ADM tools play an increasing role in emergencies and crises management, by supporting stakeholders in anticipating, monitoring and assessing post-event damages. However, despite technological evolutions, its prognostic and diagnostic use in emergency situations still arise many issues.

Thermodynamic properties of the α-quartz-type and rutile-type GeO2 from first-principles calculations.

Phonon density-of-states and related thermodynamic properties of the α-quartz-type and rutile-type germanium dioxide (GeO2) are investigated from density functional perturbation theory. The significant density-of-states at the low frequencies in the α-quartz-type GeO2 are at the origin of (i) its lower internal energy below 250 K, (ii) its smaller free energy, (iii) its higher entropy, (iv) its lower Debye temperature and (v) its larger positive linear thermal expansion, with respect to the rutile-type GeO2.

Long-term follow-up of reduced-intensity allogeneic stem cell transplantation for chronic lymphocytic leukemia: prognostic model to predict outcome.

Chronic lymphocytic leukemia (CLL) remains incurable with chemoimmunotherapy, and allogeneic hematopoietic stem cell transplantation (HSCT) offers the potential for cure. We assessed the outcomes of 108 CLL patients undergoing first allogeneic HSCTs, 76 with reduced-intensity (RIC) and 32 with myeloablative conditioning (MAC) between 1998 and 2009 at Dana-Farber Cancer Institute. With median follow-up of 5.9 years in surviving patients, the 5-year overall survival (OS) for the entire cohort is 63% for RIC regimens and 49% for MAC regimens (P=0.18). The risk of death declined significantly starting in 2004, and we found that 5-year OS for HSCT between 2004 and 2009 was 83% for RIC regimens compared with 47% for MAC regimens (P=0.003). For RIC transplantation, we developed a prognostic model based on predictors of progression-free survival (PFS), specifically remission status, lactate dehydrogenase, comorbidity score and lymphocyte count, and found 5-year PFS to be 83% for Score 0, 63% for Score 1, 24% for Score 2 and 6% for Score ≥3 (P<0.0001). We conclude that RIC HSCT for CLL in the current era is associated with excellent long-term PFS and OS, and, as potentially curative therapy, should be considered early in the disease course of relapsed high-risk CLL patients.

Duodenal web associated with malrotation and review of literature.

Intestinal obstruction due to midgut malrotation in neonates is well known. The incidence of malrotation in newborns is around 1:500 and the symptomatic incidence is 1:6000 births. Duodenal web as a cause of intestinal obstruction is less common and is reported to be 1:10 000-1:40 000. Malrotation is known to be associated with other congenital obstructive anomalies including duodenal atresia, stenosis and duodenal web. But, intestinal obstruction due to malrotation associated with duodenal web has been reported only rarely with a few published cases in our literature review. We present a case of intestinal obstruction diagnosed in the prenatal period via sonogram. A plain X-ray of the abdomen after birth showed a distended duodenum with paucity of air distally suggesting duodenal obstruction. An exploratory laparotomy showed a duodenal web proximal to the sphincter of oddi. The patient also had an associated malrotation and underwent Ladd's procedure and appendectomy. The post-operative period was uneventful.

Spatially dispersive scheme for transmission and synthesis of femtosecond pulses through a multicore fiber.

A new scheme is presented for fiber transmission of ultrashort laser pulses. A dispersive device divides the input pulses into spatially separated spectral components which are individually launched in the different channels of a multicore fiber before being recombined at the output by a second dispersive device. The parallel transmission of narrow spectral bands avoids self-phase modulation and could be appropriate to deliver high peak power pulses. Phase management of the spectral bands by an active element offers recovery of the seed pulse duration at the fiber output as well as pulse shaping capabilities. Both are reported in a proof of concept experiment using 190 fs input pulses and a 5 cores polarization maintaining fiber. Extension of the concept to femtosecond pulses amplification is suggested.

Response mechanisms of lactic acid bacteria to alkaline environments: a review.

Regulation of the cytoplasmic or internal pH (pHin) is a fundamental requirement for the survival and viability of bacteria. The optimum pHin for most bacteria is near the neutral point (pH 7.0). Therefore, bacteria may have some strategies to adapt themselves to the acidity or alkalinity of cytoplasm. As other microorganisms, lactic acid bacteria (LAB) are able to maintain a neutral or near neutral cytoplasmic pH even when the pH of the external medium varies. Mechanisms facilitating survival and growth under alkaline conditions of LAB are reviewed. These mechanisms are: (i) the active potassium extrusion and the potassium-proton antiport system, (ii) the sodium-proton antiport system, (iii) the proton-translocating adenosine triphosphatase (ATPase), (iv) the formation of transmembrane proton gradients (ΔpH) in a reversed direction, and (v) the adaptation, cross-protection, and changes in protein synthesis.

Growth of piezoelectric water-free GeO2 and SiO2-substituted GeO2 single-crystals.

Using the slow-cooling method in selected fluxes, we have grown spontaneously nucleated single-crystals of pure GeO(2) and SiO(2)-substituted GeO(2) materials with the α-quartz structure. These piezoelectric materials were obtained in millimeter size as well-faceted, visually colorless, and transparent crystals. Cubic-like or hexagonal prism-like morphology was identified depending on the chemical composition of the single-crystals and on the nature of the flux. Both the silicon substitution rate and the homogeneity of its distribution were estimated by Energy Dispersive X-ray spectroscopy. The cell parameters of the flux-grown GeO(2) and Ge(1-x)Si(x)O(2) (0.038 ≤ x ≤ 0.089) solid-solution were deduced from their X-ray powder diffraction pattern. As expected, the cell volumes decrease as the silicon content substitution increases. A room temperature Infrared spectroscopy study confirms the absence of hydroxyl groups in the as-grown crystals. Unlike what was observed for hydrothermally grown GeO(2) crystals, these flux-grown oxide materials did not present any phase transition before melting as pointed out by a Differential Scanning Calorimetry study. Neither a α-quartz/ß-quartz transition as encountered in SiO(2) near 573 °C nor a α-quartz to rutile transformation were detected for these GeO(2) and Ge(1-x)Si(x)O(2) single-crystals.

A large single-center experience with allogeneic stem-cell transplantation for peripheral T-cell non-Hodgkin lymphoma and advanced mycosis fungoides/Sezary syndrome.

BACKGROUND: The prognosis for patients with most forms of T-cell lymphoma is poor. Allogeneic hematopoietic stem-cell transplantation (HSCT) may improve the outcome. PATIENTS AND METHODS: This study examines the outcome of 52 patients who underwent ablative or nonablative allogeneic HSCT for peripheral T-cell lymphoma (PTCL) or advanced mycosis fungoides/Sezary syndrome over a 12-year period at a single institution. We divided the patients into those with predominantly nodal histologies: peripheral T-cell not otherwise specified (PTCL NOS), angioimmunoblastic (AITL), or anaplastic large cell lymphoma, T/null type (systemic) (ALCL), and predominantly extranodal histologies: natural killer (NK)/T cell, enteropathy type, hepatosplenic, subcutaneous panniculitic, mycosis fungoides, or T cell or NK cell other. RESULTS: Median follow-up of survivors is 49 months. Non-relapse mortality and relapse at 3 years was 27% and 43%, respectively. The incidence of grade II-IV acute graft-versus-host disease (GVHD) was 21%. The incidence of extensive chronic GVHD at 2 years was 27%. The 3-year progression-free survival was 30%: 45% in patients with predominantly nodal histologies (PTCL NOS, AITL, and ALCL) and 6% in patients with predominantly extranodal histologies (P = 0.016). Overall survival at 3 years was 41% for all patients. CONCLUSION: Allogeneic HSCT can produce long-term remissions in relapsed/refractory T-cell lymphoma, especially those with nodal histologies.

Double umbilical cord blood transplantation with reduced intensity conditioning and sirolimus-based GVHD prophylaxis.

The main limitations to umbilical cord blood (UCB) transplantation (UCBT) in adults are delayed engraftment, poor immunological reconstitution and high rates of non-relapse mortality (NRM). Double UCBT (DUCBT) has been used to circumvent the issue of low cell dose, but acute GVHD remains a significant problem. We describe our experience in 32 subjects, who underwent DUCBT after reduced-intensity conditioning with fludarabine/melphalan/antithymocyte globulin and who received sirolimus and tacrolimus to prevent acute GVHD. Engraftment of neutrophils occurred in all patients at a median of 21 days, and platelet engraftment occurred at a median of 42 days. Three subjects had grade II-IV acute GVHD (9.4%) and chronic GVHD occurred in four subjects (cumulative incidence 12.5%). No deaths were caused by GVHD and NRM at 100 days was 12.5%. At 2 years, NRM, PFS and OS were 34.4, 31.2 and 53.1%, respectively. As expected, immunologic reconstitution was slow, but PFS and OS were associated with reconstitution of CD4(+) and CD8(+) lymphocyte subsets, suggesting that recovery of adaptive immunity is required for the prevention of infection and relapse after transplantation. In summary, sirolimus and tacrolimus provide excellent GVHD prophylaxis in DUCBT, and this regimen is associated with low NRM after DUCBT.

Outcome of allo-SCT for women with MDS or AML occurring after breast cancer therapy.

Women with breast cancer who receive adjuvant therapy are at risk for developing therapy-related myelodysplastic syndrome (MDS) or AML (tMDS/AML). Patients with tMDS/AML are often referred for consideration of allogeneic hematopoietic SCT (HSCT). However, the outcomes of HSCT in such patients have not been well described. We report a retrospective study of all women who were treated with HSCT for MDS or AML at our institution between 1991 and 2008. We compared the transplantation outcomes for 24 women with a history of breast cancer with those for 271 women with de novo disease. Three-year OS and disease-free survival (DFS) for patients with a history of breast cancer were 41 and 45%, respectively. The cumulative incidences of tMDS/AML relapse and non-relapse mortality (NRM) were 38 and 17%, respectively. Those outcomes were very similar to those of patients with de novo disease. In multivariable analyses, a history of breast cancer had no impact on OS, DFS, relapse or NRM. A significant proportion of women with tAML/MDS after breast cancer treatment experience DFS after HSCT, similar to that of patients with de novo MDS or AML. This justifies consideration of HSCT for selected patients in this setting.

Multicenter validation study of a transplantation-specific cytogenetics grouping scheme for patients with myelodysplastic syndromes.

Cytogenetics is an important prognostic factor for patients with myelodysplastic syndromes (MDS). However, existing cytogenetics grouping schemes are based on patients treated with supportive care, and may not be optimal for patients undergoing allo-SCT. We proposed earlier an SCT-specific cytogenetics grouping scheme for patients with MDS and AML arising from MDS, based on an analysis of patients transplanted at the Dana-Farber Cancer Institute/Brigham and Women's Hospital. Under this scheme, abnormalities of chromosome 7 and complex karyotype are considered adverse risk, whereas all others are considered standard risk. In this retrospective study, we validated this scheme on an independent multicenter cohort of 546 patients. Adverse cytogenetics was the strongest prognostic factor for outcome in this cohort. The 4-year relapse-free survival and OS were 42 and 46%, respectively, in the standard-risk group, vs 21 and 23% in the adverse group (P<0.0001 for both comparisons). This grouping scheme retained its prognostic significance irrespective of patient age, disease type, earlier leukemogenic therapy and conditioning intensity. Therapy-related disease was not associated with increased mortality in this cohort, after taking cytogenetics into account. We propose that this SCT-specific cytogenetics grouping scheme be used for patients with MDS or AML arising from MDS who are considering or undergoing SCT.

Temperature dependence of single-crystal elastic constants of flux-grown alpha-GaPO(4).

The lattice parameter change with respect to temperature (T) has been measured using high-temperature powder X-ray diffraction techniques for high-temperature flux-grown GaPO(4) single crystals with the alpha-quartz structure. The lattice and the volume linear thermal expansion coefficients in the temperature range 303-1173 K were computed from the X-ray data. The percentage linear thermal expansions along the a and c axes at 1173 K are 1.5 and 0.51, respectively. The temperature dependence of the mass density rho of flux-grown GaPO(4) single crystals was evaluated using the volume thermal expansion coefficient alpha(V)(T) = 3.291 x 10(-5) - 2.786 x 10(-8) [T] + 4.598 x 10(-11)[T](2). Single-crystal high-resolution Brillouin spectroscopy measurements have been carried out at ambient pressure from 303 to 1123 K to determine the elastic constants C(IJ) of high-temperature flux-grown GaPO(4) material. The single-crystal elastic moduli were calculated using the sound velocities via the measured Brillouin frequency shifts Deltanu(B). These are, to our knowledge, the highest temperatures at which single-crystal elastic constants of alpha-GaPO(4) have been measured. Most of the room-temperature elastic constant values measured on flux-grown GaPO(4) material are higher than the ones found for hydrothermally grown GaPO(4) single crystals. The fourth-order temperature coefficients of both the Brillouin frequency shifts T(nuB)((n)) and the single-crystal elastic moduli T(C(IJ))((n)) were obtained. The first-order temperature coefficients of the C(IJ) are in excellent agreement with previous reports on low-temperature hydrothermally grown alpha-GaPO(4) single crystals, while small discrepancies in the higher-order temperature coefficients are observed. This is explained in terms of the OH content in the GaPO(4) network, which is an important parameter in the crystal thermal behavior.