Review article: MRI-targeted biopsies for prostate cancer diagnosis and management.

PURPOSE: Transrectal ultrasound (TRUS)-guided biopsy has been the traditional biopsy route in the detection of prostate cancer. However, due to concern regarding overdetection of low-risk cancer and missed clinically significant cancers as well as risk of sepsis, alternative approaches have been explored. Transperineal template biopsy-sampling the gland every 5 m to 10 mm-reduces error by sampling the whole prostate but increases risk of detecting clinically insignificant cancers as well as conferring risks of side effects such as urinary retention and bleeding. METHODS: There are various targeted biopsy techniques, each with different cancer detection rates, costs and learning curves. Current research focuses on refining biopsy methodology to maximize detection of significant cancers, whilst minimising invasiveness and complications. In this article, the up-to-date research data about MRI-targeted prostate biopsy were reviewed to show its utilization in prostate cancer management and diagnosis. RESULTS AND CONCLUSION: Prostate multiparametric MRI has become an effective tool in the detection of significant cancers and an essential component of the prostate cancer diagnostic pathway incorporating MRI-guided biopsy decisions.

A Multicenter Study of the Clinical Utility of Nontargeted Systematic Transperineal Prostate Biopsies in Patients Undergoing Pre-Biopsy Multiparametric Magnetic Resonance Imaging.

PURPOSE: The added value of nontargeted systematic prostate biopsies when performed alongside magnetic resonance imaging targeted biopsies in men referred with a suspicion of prostate cancer is unclear. We aimed to determine the clinical utility of transperineal nontargeted systematic prostate biopsies, when performed alongside targeted systematic prostate biopsies, using pre-biopsy multiparametric magnetic resonance imaging. MATERIALS AND METHODS: Consecutive patients referred with a suspicion of prostate cancer (April 2017 to October 2019) underwent pre-biopsy multiparametric magnetic resonance imaging. A transperineal biopsy was advised if multiparametric magnetic resonance imaging PI-RADS® (v.2.0) score was 4 or 5, and score 3 required a prostate specific antigen density 0.12 ng/ml or greater. Primary threshold for clinically significant prostate cancer was defined as any Gleason 3+4 or greater. Multivariable logistic regression analysis identified pre-biopsy predictors of clinically significant prostate cancer in nontargeted systematic prostate biopsies, regardless of targeted pathology (p <0.05, R, version 3.5.1). RESULTS: A total of 1,719 men underwent a pre-biopsy multiparametric magnetic resonance imaging, with 679 (39.5%) proceeding to combined targeted systematic prostate biopsies and nontargeted systematic prostate biopsies. In these men clinically significant prostate cancer was detected in 333 (49%) and 139 (20.5%) with targeted systematic prostate biopsies and nontargeted systematic prostate biopsies, respectively. In those men with clinically significant prostate cancer in targeted systematic prostate biopsies, clinically significant prostate cancer was also present in nontargeted systematic prostate biopsies in 117 (17.2%); Gleason 3+3 was present in 50 (7.4%). In 287 men without any cancer in the targeted systematic prostate biopsies, 13 (1.9%) had clinically significant prostate cancer in nontargeted systematic prostate biopsies. In addition 18/679 (2.7%) had Gleason 3+3 disease and no Gleason greater than 4+3 was detected. Predictors associated with clinically significant prostate cancer in nontargeted systematic prostate biopsies were prostate specific antigen 5 ng/ml or greater (OR 2.05, 95% CI 1.13-3.73, p=0.02), PI-RADS score 5 (OR 2.26, 95% CI 1.51-3.38, p <0.001) and prostate volume less than 50 cc (OR 2.47, 95% CI 1.57-3.87, p <0.001). CONCLUSIONS: Detection of clinically significant prostate cancer in exclusively nontargeted transperineal systematic biopsies in a pre-biopsy multiparametric magnetic resonance imaging pathway was low (1.9%).

Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis.

INTRODUCTION: Aim of this study was to biomechanically compare two different acetabular cup fixation constructs in terms of fracture fixation for displaced acetabular fractures involving the anterior column with hemitransverse fracture under partial and full weight-bearing conditions. METHODS: Two different reinforcement rings designed as cages for primary THA were biomechanically tested in terms of managing a complex acetabular fracture. Single-leg stance cyclic loading was performed to assess fracture gap movement and fragment rotation. Twelve hemi pelvis Sawbones were divided into two groups: primary THA with acetabulum roof reinforcement plate (ARRP) (n = 6) and primary THA with Burch-Schneider reinforcement cage (BSRC) (n = 6). RESULTS: During loading under partial weight-bearing (250 N) fracture gap movement tended to be larger in the BSRC group as compared to the ARRP group. Under full weight-bearing conditions, the ARRP showed 60% significantly less motion (p = 0.035) of the os ilium to os ischii gap compared to BSRC. Fracture gap movements between the os ilium and spina iliaca fragments were significantly reduced by 76% (p = 0.048) for ARRP in contrast to BSRC. The ARRP group also demonstrated significantly less movement in the fracture gaps os ischii to quadrilateral plate (62% reduction, p = 0.009) and quadrilateral plate to spina iliaca (87% reduction, p < 0.001). Significantly less rotational movement of the quadrilateral plate to the os ilium was exhibited by the ARRP group (p = 0.015). CONCLUSIONS: The presented acetabulum roof-reinforcement plate (ARRP) provides stable conditions at the acetabular component with adequate stabilization of a displaced acetabular fracture.

Correction to: Comparison of two reinforcement rings for primary total hip arthroplasty addressing displaced acetabular fractures: a biomechanical analysis.

The original version of this article unfortunately contained a mistake.

Towards the Limits of Existence of Nuclear Structure: Observation and First Spectroscopy of the Isotope

The most remote isotope from the proton dripline (by 4 atomic mass units) has been observed: ^{31}K. It is unbound with respect to three-proton (3p) emission, and its decays have been detected in flight by measuring the trajectories of all decay products using microstrip detectors. The 3p emission processes have been studied by the means of angular correlations of ^{28}S+3p and the respective decay vertices. The energies of the previously unknown ground and excited states of ^{31}K have been determined. This provides its 3p separation energy value S_{3p} of -4.6(2) MeV. Upper half-life limits of 10 ps of the observed ^{31}K states have been derived from distributions of the measured decay vertices.

Rational redesign of the ferredoxin-NADP+-oxido-reductase/ferredoxin-interaction for photosynthesis-dependent H2-production.

Utilization of electrons from the photosynthetic water splitting reaction for the generation of biofuels, commodities as well as application in biotransformations requires a partial rerouting of the photosynthetic electron transport chain. Due to its rather negative redox potential and its bifurcational function, ferredoxin at the acceptor side of Photosystem 1 is one of the focal points for such an engineering. With hydrogen production as model system, we show here the impact and potential of redox partner design involving ferredoxin (Fd), ferredoxin-oxido-reductase (FNR) and [FeFe]­hydrogenase HydA1 on electron transport in a future cyanobacterial design cell of Synechocystis PCC 6803. X-ray-structure-based rational design and the allocation of specific interaction residues by NMR-analysis led to the construction of Fd- and FNR-mutants, which in appropriate combination enabled an about 18-fold enhanced electron flow from Fd to HydA1 (in competition with equimolar amounts of FNR) in in vitro assays. The negative impact of these mutations on the Fd-FNR electron transport which indirectly facilitates H2 production (with a contribution of ≤42% by FNR variants and ≤23% by Fd-variants) and the direct positive impact on the Fd-HydA1 electron transport (≤23% by Fd-mutants) provide an excellent basis for the construction of a hydrogen-producing design cell and the study of photosynthetic efficiency-optimization with cyanobacteria.

Comparison of blood pressure monitoring by applanation tonometry and invasively assessed blood pressure in cardiological patients.

The aim of this study was to evaluate the accuracy and precision of non-invasive continuous blood pressure measurement by applanation tonometry (AT) in awake or anaesthetised cardiological intensive care patients. Patients suffering from highly impaired left ventricular function atrial fibrillation or severe aortic valve stenosis were included into the study. Arterial blood pressure was recorded by applanation tonometry (T-Line 400, Tensys Medical®, USA) and an arterial line in awake or anaesthetised patients. Discrepancies in mean (MAP), systolic (SAP), and diastolic (DAP) arterial pressure between the two methods were assessed as bias, limits of agreement and percentage error respectively. In 31 patients a total of 27,900 measurements were analyzed. The concordance correlation coefficient was 0.23, 0.45 and 0.06 for MAP, SAP and DAP, respectively. For all patients bias for MAPAT compared to MAPAL was 14.96 mmHg (SAPAT 4.51 mmHg; DAPAT 19.12 mmHg) with limits of agreement for MAPAT of 46.25 and - 16.33 mm Hg (SAPAT 48.00 and - 38.98 mmHg; DAPAT 50.12 and - 11.89 mmHg). Percentage error for MAPAT was 56.8% (42.7% for SAPAT; 75.2% for DAPAT). We conclude that the AT method is not reliable in ICU patients with severe cardiac comorbidities.

Biological threats from a 'One Health' perspective.

Biological threats are a prime example of an issue that needs the 'One Health' approach. Such an approach would facilitate the prevention and mitigation of these threats. 'One Health' is defined as any added value in terms of the health of humans and animals, financial savings or environmental services achievable through the cooperation of human and veterinary medicines when compared to the two disciplines working separately. This principle also applies to the involvement of other disciplines from the natural sciences and humanities. This paper is not an exhaustive survey of integrated approaches but discusses concepts and methods and provides key examples of the benefits of a 'One Health' approach when applied to biological threats. Zoonoses and vector-borne diseases (i.e. diseases transmitted between animals and humans and by insect or acarian vectors) remain central biological threats in highly dynamic social and environmental conditions. Such diseases are not always directly transmitted. Contaminated food, water, air and soil represent important sources of transmission for foodborne and environmentally related diseases. Therefore, this paper treats environmental sanitation separately because of the importance of the excreta management of humans and animals. Integrated syndromic surveillance and antimicrobial resistance surveillance link the above aspects and are showcases for a 'One Health' approach to biological threat reduction. Biological threats are not only related to natural conditions but may also be exacerbated by large development projects such as dams, mining and infrastructure. Consequently, it is recommended that the health impact assessment (HIA) approach be implemented as early as the planning stage of any large infrastructure project located in a complex socioecological system. This paper extends the HIA approach to an integrated 'One Health' impact assessment approach.

Les menaces biologiques sont un parfait exemple de problématique nécessitant une approche « Une seule santé ¼ en matière de prévention et d'atténuation des risques. « Une seule santé ¼ désigne toute valeur ajoutée en termes de santé humaine et animale, d'économies d'échelle ou de services écologiques obtenue grâce à la collaboration de la médecine humaine et de la médecine vétérinaire (comparativement à ce qu'elles auraient obtenu en travaillant chacune de son côté). Ce principe s'applique également à l'apport d'autres disciplines relevant des sciences naturelles ou sociales. Cet article ne passe pas en revue l'ensemble de ces approches intégrées mais examine les concepts et les méthodes qui les sous-tendent et donne quelques exemples forts des bénéfices apportés par l'approche « Une seule santé ¼ dans le traitement des menaces biologiques. Les maladies zoonotiques (transmissibles entre l'homme et les animaux) et à transmission vectorielle (par un insecte ou un acarien vecteur) représentent une menace biologique particulièrement importante dans les situations fortement dynamiques au plan social et environnemental. La transmission de ces maladies est parfois indirecte. Ainsi les aliments, l'eau, l'air et le sol sont-ils d'importantes sources de transmission pour les maladies d'origine alimentaire ou environnementale. L'hygiène environnementale fait l'objet d'un examen particulier en raison de l'importance de la gestion des déjections humaines et animales. La surveillance intégrée syndromique et la surveillance de la résistance aux agents antimicrobiens relient ces différents aspects et illustrent le recours à une approche « Une seule santé ¼ en matière de réduction des risques biologiques. Les menaces biologiques ne sont pas seulement dues à des évènements naturels ; certains projets de développement peuvent aussi y contribuer, par exemple les barrages, l'exploitation minière et les travaux d'infrastructures. Par conséquent, il est recommandé de procéder à une « évaluation de l'impact sanitaire ¼ dès la phase de planification de tout projet d'infrastructure de grande ampleur situé dans un système socio-écologique complexe. Les auteurs préconisent d'élargir la portée des évaluations de l'impact sanitaire dans une perspective intégrée « Une seule santé ¼.

Las amenazas biológicas son un perfecto ejemplo del tipo de problemas cuya prevención y atenuación exige abordarlos desde los planteamientos de «Una sola salud¼. Se entiende por «Una sola salud¼ todo valor añadido, en términos de salud humana o animal, ahorro económico o servicios ambientales, que pueda deparar la cooperación entre la medicina humana y la veterinaria en comparación con el trabajo de ambas por separado. Este principio se aplica igualmente a la intervención de otras ramas de las ciencias naturales y las humanidades. Los autores no proponen un repaso exhaustivo de las distintas fórmulas de trabajo integrado, sino que examinan conceptos y métodos y ofrecen importantes ejemplos de los beneficios que se obtienen al aplicar la lógica de «Una sola salud¼ a la cuestión de las amenazas biológicas. Las zoonosis y las enfermedades de transmisión vectorial (es decir, respectivamente, las patologías que se transmiten entre animales y personas y las que se transmiten por intervención de un insecto o ácaro como vector) siguen constituyendo amenazas biológicas de primer orden en las condiciones de gran dinamismo social y ambiental que imperan hoy en día. Estas enfermedades no siempre se transmiten directamente. Los alimentos, el agua, el aire y los suelos contaminados son un importante vehículo de enfermedades de transmisión alimentaria o ligadas a factores ambientales. De ahí que los autores examinen por separado el saneamiento ambiental, subrayando la importancia que reviste la gestión de las excreciones humanas y animales. La integración de la vigilancia sindrómica y la vigilancia de las resistencias a antimicrobianos articula entre sí todos estos aspectos y permite abordar la reducción de las amenazas biológicas desde la óptica de «Una sola salud¼. Las amenazas biológicas no solo guardan relación con las condiciones naturales, sino que además pueden verse favorecidas por grandes proyectos de desarrollo como la construcción de represas o infraestructuras o la excavación de minas. Por ello se recomienda aplicar fórmulas de evaluación del impacto sanitario desde la fase misma de planificación de todo gran proyecto de infraestructura que se ubique dentro de un sistema socioecológico complejo. Los autores hacen extensivo el método de evaluación del impacto sanitario a la idea de una evaluación integrada del impacto desde la perspectiva de «Una sola salud¼.

[Outcome of intensive medical care for inflammatory rheumatic diseases]. / Outcome intensivmedizinischer Betreuung bei rheumatischen Erkrankungen.

BACKGROUND AND OBJECTIVE: Very little is known about the outcome of patients with inflammatory rheumatic diseases in intensive care units (ICU). This retrospective study investigated the results of intensive medical treatment in these patients and the reliability of scoring systems used for the prediction of survival. MATERIAL AND METHODS: A case group consisting of 50 patients suffering from inflammatory rheumatic diseases was generated by analysis of patient records from the ICU at the University Hospital for Internal Medicine in Halle (Saale) in the years 2001-2010. The APACHE II score and SAPS II were used to estimate the probable mortality rate. The data were compared to those of a control group consisting of 72 patients treated on the ICU and suffering from non-inflammatory joint diseases. RESULTS: In the case group a higher mortality rate (38 % vs. 20.8 %) and a higher frequency of respiratory, nephrogenic and cardiovascular complications were observed. In addition, these patients more often underwent artificial ventilation (66 % vs. 35 %) and had a higher rate of infections (74 % vs. 40.3 %) compared to the control group. In patients with inflammatory rheumatic diseases the SAPS II was not useful for correctly predicting mortality, whereas the APACHE II score showed sufficient agreement with the actual mortality rate. CONCLUSION: Patients with inflammatory rheumatic diseases displayed a poorer outcome compared with the control group in the course of the intensive care treatment. Universally applied scoring systems used to predict mortality are of limited value in this patient population.

The prognostic effect of tumour-infiltrating lymphocytic subpopulations in bladder cancer.

BACKGROUND: Intratumoural lymphocytic infiltration is strongly associated with the outcome of many human epithelial cancers. The current paper investigated whether subpopulations of tumour-infiltrating T lymphocytes are associated with certain clinicopathological parameters and the prognosis of patients with invasive bladder cancer (BCa). PATIENTS AND METHODS: The infiltration densities of the adaptive immune markers CD3 (the whole T cell population), FOXP3 (regulatory T cells; Tregs), CD8 (T effector cells) and CD45R0 (T effector memory cells) were analysed by immunohistochemistry and image analysis with tissue microarrays of tumour tissues from 149 patients with invasive BCa treated with radical cystectomy. The findings were correlated with certain clinicopathological parameters. RESULTS: Higher FOXP3/CD3 [OS: p = 0.016, HR 1.29, 95% confidence intervals (95% CIs 1.05-1.59)] and FOXP3/CD8 (OS: p = 0.013, HR 1.32, 95% CIs 1.06-1.65) ratios were significantly associated with briefer overall survival and time to cancer-specific death; the latter ratio represented an independent prognostic factor according to a multivariate analysis adjusted for pathological T and N stages (HR 1.32, 95% CIs 1.05-1.67, p = 0.018). The infiltration densities of individual markers (CD3, CD8, FOXP3 and CD45R0) were not significantly associated with clinicopathological parameters or survival; however, a trend towards a better outcome was observed for higher log-transformed CD8 (p = 0.070, HR 0.80, 95% CIs 0.63-1.02) and CD3 (p = 0.113, HR 0.84, 95% CIs 0.68-1.04) infiltration values. CONCLUSIONS: A high fraction of Tregs amongst CD3- and CD8-positive lymphocytes indicated a poor prognosis, thereby emphasising the important role that Tregs play in the suppression of the anti-tumour immune response. No single lymphocytic marker was significantly correlated with clinical outcomes, but high CD3 and CD8 infiltration showed trends towards better prognosis.

Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open-label, randomized controlled trial.

OBJECTIVE: To determine whether the amniotic fluid index (AFI) or the single deepest vertical pocket (SDP) technique for estimating amniotic fluid volume is superior for predicting adverse pregnancy outcome. METHODS: This was a multicenter randomized controlled trial including 1052 pregnant women with a term singleton pregnancy across four hospitals in Germany. Women were assigned randomly, according to a computer-generated allocation sequence, to AFI or SDP measurement for estimation of amniotic fluid volume. Oligohydramnios was defined as AFI ≤ 5 cm or the absence of a pocket measuring at least 2 × 1 cm. The diagnosis of oligohydramnios was followed by labor induction. The primary outcome measure was postpartum admission to a neonatal intensive care unit. Further outcome parameters were the rates of diagnosis of oligohydramnios and induction of labor (for oligohydramnios or without specific indication), and mode of delivery. RESULTS: Postpartum admission to a neonatal intensive care unit was similar between groups (4.2% (n = 21) vs 5.0% (n = 25); relative risk (RR), 0.85 (95% CI, 0.48-1.50); P = 0.57). In the AFI group, there were more cases of oligohydramnios (9.8% (n = 49) vs 2.2% (n = 11); RR, 4.51 (95% CI, 2.2-8.57); P < 0.01) and more cases of labor induction for oligohydramnios (12.7% (n = 33) vs 3.6% (n = 10); RR, 3.50 (95% CI, 1.76-6.96); P < 0.01) than in the SDP group. Moreover, an abnormal cardiotocography was seen more often in the AFI group than in the SDP group (32.3% (n = 161) vs 26.2% (n = 132); RR, 1.23 (95% CI, 1.02-1.50); P = 0.03). The other outcome measures were not significantly different between the two groups. CONCLUSIONS: Use of the AFI method increased the rate of diagnosis of oligohydramnios and labor induction for oligohydramnios without improving perinatal outcome. The SDP method is therefore the favorable method to estimate amniotic fluid volume, especially in a population with many low-risk pregnancies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Observation and Spectroscopy of New Proton-Unbound Isotopes ³°Ar and ²9Cl: An Interplay of Prompt Two-Proton and Sequential Decay.

Previously unknown isotopes (30)Ar and (29)Cl have been identified by measurement of the trajectories of their in-flight decay products (28)S+p+p and (28)S+p, respectively. The analysis of angular correlations of the fragments provided information on decay energies and the structure of the parent states. The ground states of (30)Ar and (29)Cl were found at 2.25(-0.10)(+0.15) and 1.8±0.1 MeV above the two- and one-proton thresholds, respectively. The lowest states in (30)Ar and (29)Cl point to a violation of isobaric symmetry in the structure of these unbound nuclei. The two-proton decay has been identified in a transition region between simultaneous two-proton and sequential proton emissions from the (30)Ar ground state, which is characterized by an interplay of three-body and two-body decay mechanisms. The first hint of a fine structure of the two-proton decay of (30)Ar*(2(+)) has been obtained by detecting two decay branches into the ground and first-excited states of the (28)S fragment.

Electron attenuation in free, neutral ethane clusters.

The electron effective attenuation length (EAL) in free, neutral ethane clusters has been determined at 40 eV kinetic energy by combining carbon 1s x-ray photoelectron spectroscopy and theoretical lineshape modeling. More specifically, theory is employed to form model spectra on a grid in cluster size (N) and EAL (λ), allowing N and λ to be determined by optimizing the goodness-of-fit χ(2)(N, λ) between model and observed spectra. Experimentally, the clusters were produced in an adiabatic-expansion setup using helium as the driving gas, spanning a range of 100-600 molecules in mean cluster size. The effective attenuation length was determined to be 8.4 ± 1.9 Å, in good agreement with an independent estimate of 10 Å formed on the basis of molecular electron-scattering data and Monte Carlo simulations. The aggregation state of the clusters as well as the cluster temperature and its importance to the derived EAL value are discussed in some depth.

Competitive exclusion in a two-species chemotaxis model.

We consider a mathematical model for the spatio-temporal evolution of two biological species in a competitive situation. Besides diffusing, both species move toward higher concentrations of a chemical substance which is produced by themselves. The resulting system consists of two parabolic equations with Lotka-Volterra-type kinetic terms and chemotactic cross-diffusion, along with an elliptic equation describing the behavior of the chemical. We study the question in how far the phenomenon of competitive exclusion occurs in such a context. We identify parameter regimes for which indeed one of the species dies out asymptotically, whereas the other reaches its carrying capacity in the large time limit.

Exponentially fast thinning of nanoscale films by turbulent mixing.

Films are nanoscopic elements of foams, emulsions, and suspensions that form a paradigm for nanochannel transport that eventually tests the limits of hydrodynamic descriptions. Here, we study the collapse of a freestanding film to its equilibrium. The generation of nanoscale films usually is a slow linear process; using thermal forcing we find unprecedented dynamics with exponentially fast thinning. The complex interplay of thermal convection, interface, and gravitational forces yields optimal turbulent mixing and transport. Domains of collapsed film are generated, elongated, and convected in a beautiful display of chaotic mixing. With a time scale analysis, we identify mixing as the dominant dynamical process responsible for exponential thinning.

Direct observation of long-lived isomers in 212Bi.

Long-lived isomers in (212)Bi have been studied following (238)U projectile fragmentation at 670 MeV per nucleon. The fragmentation products were injected as highly charged ions into a storage ring, giving access to masses and half-lives. While the excitation energy of the first isomer of (212)Bi was confirmed, the second isomer was observed at 1478(30) keV, in contrast to the previously accepted value of >1910 keV. It was also found to have an extended Lorentz-corrected in-ring half-life >30 min, compared to 7.0(3) min for the neutral atom. Both the energy and half-life differences can be understood as being due a substantial, though previously unrecognized, internal decay branch for neutral atoms. Earlier shell-model calculations are now found to give good agreement with the isomer excitation energy. Furthermore, these and new calculations predict the existence of states at slightly higher energy that could facilitate isomer deexcitation studies.

Measurement of the dipole polarizability of the unstable neutron-rich nucleus 68Ni.

The E1 strength distribution in 68Ni has been investigated using Coulomb excitation in inverse kinematics at the R3B-LAND setup and by measuring the invariant mass in the one- and two-neutron decay channels. The giant dipole resonance and a low-lying peak (pygmy dipole resonance) have been observed at 17.1(2) and 9.55(17) MeV, respectively. The measured dipole polarizability is compared to relativistic random phase approximation calculations yielding a neutron-skin thickness of 0.17(2) fm. A method and analysis applicable to neutron-rich nuclei has been developed, allowing for a precise determination of neutron skins in nuclei as a function of neutron excess.

Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis.

BACKGROUND AND STUDY AIM: Placement of covered self-expanding metal or plastic stents (SEMS or SEPS) is an established method for managing intrathoracic leaks. Recently, endoscopic vacuum-assisted closure (EVAC) has been described as a new effective treatment option. Our aim was to compare stent placement with EVAC for nonsurgical closure of intrathoracic anastomotic leaks. PATIENTS AND METHODS: In a retrospective analysis we were able to identify 39 patients who were treated with SEMS or SEPS and 32 patients who were treated with EVAC for intrathoracic leakage. In addition to successful fistula closure, we analyzed hospital mortality, number of endoscopic interventions, incidence of stenoses, and duration of hospitalization. RESULTS: In a multivariate analysis, successful wound closure was independently associated with EVAC therapy (hazard ratio 2.997, 95 % confidence interval [95 %CI] 1.568 - 5.729; P = 0.001). The overall closure rate was significantly higher in the EVAC group (84.4 %) compared with the SEMS/SEPS group (53.8 %). No difference was found for hospitalization and hospital mortality. We found significantly more strictures in the stent group (28.2 % vs. 9.4 % with EVAC, P < 0,05). CONCLUSIONS: EVAC is an effective endoscopic treatment option for intrathoracic leaks and showed higher effectiveness than stent placement in our cohort.

Comparison of direct and indirect alcohol markers with PEth in blood and urine in alcohol dependent inpatients during detoxication.

The importance of direct and indirect alcohol markers to evaluate alcohol consumption in clinical and forensic settings is increasingly recognized. While some markers are used to prove abstinence from ethanol, other markers are suitable for detection of alcohol misuse. Phosphatidyl ethanol (PEth) is ranked among the latter. There is only little information about the correlation between PEth and other currently used markers (ethyl glucuronide, ethyl sulfate, carbohydrate deficient transferrin, gamma-glutamyl transpeptidase, and methanol) and about their decline during detoxification. To get more information, 18 alcohol-dependent patients in withdrawal therapy were monitored for these parameters in blood and urine for up to 19 days. There was no correlation between the different markers. PEth showed a rapid decrease at the beginning of the intervention, a slow decline after the first few days, and could still be detected after 19 days of abstinence from ethanol.

Structure of self-assembled free methanol/tetrachloromethane clusters.

The structure of molecular clusters of diameters at or below a nanometer is important both in nucleation phenomena and potentially for the preparation and application of nanoparticles. Little is known about the relationship between the structure and composition of the cluster and about the interplay between cluster composition, size, and temperature. The present project explores how the structure of mixed CH3OH/CCl4 clusters vary with composition and size; implicitly by changing the amount of noncondensing backing gas and thus the capacity to remove heat during cluster condensation, and explicitly through theoretical models. Experimentally, molecular clusters were produced by coexpansion of helium and a vapor of azeotropic methanol/tetrachloromethane composition in a supersonic nozzle flow. The clusters were subsequently characterized by means of carbon 1s photoelectron spectroscopy. Additional information was obtained by molecular-dynamics simulations of clusters at 3 different sizes, 4 different compositions and several temperatures, and using polarizable force fields. Mixed clusters were indeed obtained in the coexpansion experiments. The clusters show an increasing degree of surface coverage by methanol as the backing pressure is lowered, and at the lowest helium pressure the cluster signal from tetrachloromethane has almost vanished. The MD simulations show a gradual change in cluster structure with increasing methanol contents, from that of isolated rings of methanol at the surface of a tetrachloromethane core, to a contiguous methanol cap covering more than half of the cluster surface, to that of subclusters of tetrachloromethane submerged in a methanol environment. Both experimental and computational results support a thermodynamical driving force for methanol to dominate the surface structure of the mixed clusters. At high helium pressure, the growing clusters may cool efficiently, possibly impeding the diffusion of methanol to the surface. At low helium pressure, methanol is completely dominating the outermost few layers of the clusters, possibly in parts caused by preferential loss of tetrachloromethane through evaporative cooling.