Irreversible Electroporation versus Radiofrequency Ablation: A Comparison of Local and Systemic Effects in a Small-Animal Model.

Purpose To compare both periablational and systemic effects of two mechanistically different types of ablation: thermal radiofrequency (RF) ablation and electroporative ablation with irreversible electroporation (IRE) in appropriately selected animal models. Materials and Methods Animal experiments were performed according to a protocol approved by the Animal Care Committee of Hebrew University. Female C57BL/6 mice (n = 165) were randomized to undergo either RF or IRE ablation of noncancerous normal liver. The inflammatory response, cell proliferation, interleukin 6 (IL-6) levels, and intactness of vessels in the liver were assessed at 6, 12, and 24 hours and at 3, 7, and 14 days after ablation (n = 122 for mechanistic experiments). Systemic effects were then assessed by comparing tumor formation in an Mdr2-knockout (KO) mouse model (n = 15) and tumor growth in a remote BNL 1ME hepatoma xenograft tumor (n = 28). Results were averaged and evaluated by using two-tailed t tests. Results Although RF ablation was associated with a well-defined periablational inflammatory rim, for IRE, the infiltrate penetrated the ablation zone, largely along persistently patent vessels. Peak IL-6 levels (6 hours after ablation) were 10 and three times higher than at baseline for IRE and RF, respectively (P < .03). Mdr2-KO mice that were treated with IRE ablation had more tumors that were 3 mm or larger than mice treated with RF ablation or sham operation (mean, 3.6 ± 1.3 [standard deviation] vs 2.4 ± 1.1 and 2.2 ± 0.8, respectively; P < .05 for IRE vs both RF ablation and sham operation). For BNL 1ME tumors, both RF and IRE liver ablation reduced tumor growth, with a greater effect noted for IRE (1329 mm(3) ± 586 and 819 mm(3) ± 327 vs 2241 mm(3) ± 548 for sham operation; P < .05) that was accompanied by more infiltrating lymphocytes compared with sham operation (7.6 cells per frame ± 1.9 vs 11.2 ± 2.1 vs 0.3 ± 0.1; P < .05). Conclusion Persistent patency of vasculature within the coagulated zone from IRE increases the area and accumulation of infiltrative cells that is associated with a higher serum IL-6 level than RF ablation. These local changes of IRE induce more robust systemic effects, including both tumorigenic and immunogenic effects. (©) RSNA, 2016 Online supplemental material is available for this article.

Nitrous oxide abuse leading to extreme homocysteine levels and thrombosis in young adults: a case series.

BACKGROUND: Neurologic complications from recreational use of nitrous oxide (N2O), which are attributed to vitamin B12 deficiency, have been well documented. With increasing dosages and frequency of N2O use, an additional association with thromboembolisms is becoming apparent. OBJECTIVES: To assess thrombotic complications of recreational N2O use. METHODS: All medical charts at the largest hospital in Amsterdam were searched for N2O use and subsequent neurologic and/or thrombotic events. For patients with thrombotic events, we extracted data on the risk factors for arterial and venous thrombosis as well as serum vitamin B12 and homocysteine concentrations. RESULTS: Between January 2015 and May 2021, 326 patients who reported recreational use of N2O were identified; of these, 17 (5%) patients presented with severe thrombotic events associated with N2O (71% men; median age, 26 years [range, 18-53 years]), 5 patients presented with arterial thrombosis (3 with acute coronary syndrome, 1 with femoral artery thrombosis, and 1 with middle cerebral artery thrombus), and 12 patients presented with venous thromboembolisms (10 with pulmonary embolisms, 1 with portal vein thrombosis and 1 with cerebral vein thrombosis). Additionally, homocysteine were concentrations severely increased (median, 125 µmol/L [range, 22-253 µmol/L]; reference, <15 µmol/L). Patients reported use of 400 to 6000 g (ie, 50-750 balloons) of N2O in 1 day. Fifty percent of these patients had experienced neurologic symptoms before the thrombotic event. CONCLUSION: We describe an alarming incidence of serious thrombotic events among young adults after excessive recreational use of N2O, accompanied by extremely high homocysteine concentrations. The upward trend in the recreational use of N2O warrants more awareness of its dangers among both users and medical professionals. Furthermore, these findings could reopen the discussion on possible associations between hyperhomocysteinemia and thrombosis mediated through N2O.

Development of a 25-plex SNP assay for traceability in cattle.

Single nucleotide polymorphisms (SNPs) are amenable to automation and therefore have become the marker of choice for DNA profiling. SNaPshot, a primer extension-based method, was used to multiplex 25 SNPs that have been previously validated as useful for identity control. Detection of extended products was based on four different fluorochromes and extension primers with oligonucleotide tails of differing lengths, thus controlling the concise length of the entire chromatogram to 81 bases. Allele frequencies for Holstein, Simmental, Limousin, Angus, Charolais and Tux Cattle were estimated and significant positive Pearson-correlation coefficients were obtained among the analysed breeds. The probability that two randomly unrelated individuals would share identical genotypes for all 25 loci varied from 10(-8) to 10(-10) for these breeds. For parentage control, the exclusion power was found to be 99.9% when the genotypes of both putative parents are known. A traceability test of duplicated samples indicated a high genotyping precision of >0.998. This was further corroborated by analysis of 60 cases of parent-sib pairs and trio families. The 25-plex SNaPshot assay is adapted for low- and high-throughput capacity and thus presents an alternative for DNA-based traceability in the major commercial cattle breeds.

Estimation of the number of SNP genetic markers required for parentage verification.

Formulae were developed to compute exclusion probabilities for parentage confirmation for any number of diallelic markers under the assumption that the minor allele frequency (MAF) varied among markers, but has a uniform distribution. Three scenarios were analysed: a progeny with (1) a single putative parent; (2) two putative parents; and (3) one actual parent and one putative parent. Exclusion probabilities were computed for minimum values for the MAFs of 0.1, 0.2 and 0.3, and required either one or at least two conflicts for exclusion. The numbers of markers required to obtain 99% exclusion probabilities based on a single conflict for the three minimum MAFs were 54, 45 and 39 for scenario 1; 17, 16 and 15 for scenario 2; and 28, 25 and 24 for scenario 3. The requirement of at least two conflicts for exclusion increased the number of markers required by approximately 45% for all three scenarios and all three minimum MAFs. The results obtained by the analytical formulae were very close to results obtained by simulation and to values in the literature for specific marker sets.

Incorporation of discrete genotype effects for multiple genes into animal model evaluations when only a small fraction of the population has been genotyped.

An efficient algorithm is described for marker-assisted selection appropriate for large populations, even though only a small fraction of the population is genotyped. Genotype probabilities for specific loci are computed for all animals without genotypes. Effects of the quantitative trait loci (QTL) are then estimated by a "cow model" and the appropriate effects are subtracted from the cows' records. Selection is based on genetic evaluations computed from the adjusted records after addition of each animal's QTL genotype effect. The proposed scheme was applied to 10 simulated populations of 37,000 cows generated over 30 yr and compared with a selection scheme based on a standard animal model. Two diallelic QTL with substitution effects of 0.5 and 0.32 phenotypic standard deviations were simulated with initial frequencies of 0.5 for both alleles. Means and standard errors of estimates of the QTL effects at yr 30 were 0.498 +/- 0.011 and 0.347 +/- 0.008. Thus, estimation of the larger QTL was nearly exact, whereas the smaller QTL was slightly overestimated. At yr 9 through 12 after the beginning of the breeding program, genetic gain in the marker-assisted selection scheme was 0.17 standard deviations greater than the standard scheme. This corresponds to nearly 2 yr of genetic progress relative to the standard scheme, or more than 40% of the total genetic gain obtained by the standard scheme at yr 9. Although genetic gain of the 2 schemes was nearly equal by yr 30, the Gibson effect of eventual greater progress by trait-based selection was not observed. Extension of the methods proposed in the current study could be applied to rank sires accurately including both marker and pedigree information for the large number of segregating QTL that will be detected by whole-genome single nucleotide polymorphism scans.

Psychiatric combat reactions during the Yom Kippur War.

The authors explore the stress of war by reporting some selected epidemiological aspects of the psychiatric combat reactions among Israeli troops during a period of intensive hostilities in the Yom Kippur War of 1973. They examined the distribution of these casualties according to intensity of fire, age, rank, sociopsychological grading, and military assignment and measured treatment outcome at the end of the war and 18 months later.

Calcium binding to bile salts.

Calcium binding to bile salt monomers and micelles is an important issue with respect to the possible (but rare) precipitation of calcium bile salts in the gallbladder. In the present work the binding of Ca2+ to six bile salts was measured in solutions containing 2 to 100 mM bile salts by means of a calcium-sensitive dye, murexide, which determines the ionic calcium concentration. In solutions containing bile salt at concentration higher than 20 mM most, if not all, of the bound Ca2+ is associated with micellar surfaces. The results were analyzed by employing a model which combines specific binding with electrostatic equations and accounts for the system being a closed one. The analysis of Ca2+ binding data considered explicitly the presence of Na+ ions and yielded intrinsic binding coefficients for Ca2+ and Na+ which were utilized to explain and predict binding results for various concentrations of Ca2+, Na+ and bile salts. The calculations indicate that in saline solutions most of the surface sites were bound by Na+, whereas less than 10% were bound by Ca2+ even in the presence of 8 mM Ca2+. The binding of Ca2+ to bile salt micelles increases with pH. An increase in temperature results in reduced binding affinity of Ca2+ to the bile salt micelles.

Alkali halide-assisted penetration of neostigmine across excised human skin: a combination of structured water disruption and a Donnan-like effect.

The penetration of neostigmine across excised human skin mounted in flow-through diffusion cells, delivered from a 0.28 M aqueous solution, was below detection limits. The presence of either NaCl or LiCl in the donor solution caused significant fluxes of neostigmine, with permeability coefficients (Kp's) in the range of 10(-6) cm min-1. Paradoxically, low concentrations of NaCl or LiCl (0.25 and 0.5 M) were more effective in this respect than the 1 M solution, which was the least effective concentration in the range of 0.25-3 M. Thus, the dependence of the experimental Kp values on inorganic ion concentration followed a biphasic course, suggesting the participation of two distinctive mechanisms in the penetration-enhancement process. The early phase corresponding to 0.25 and 0.5 M NaCl or LiCl is being partly ascribed to a decrease in the viscosity of lamellar water caused by the influx of the respective hydrated ions, hydration of LiCl or NaCl being more extensive at low alkali halide concentration that at higher ones (reference cited). The late phase corresponding to 2 and 3 M LiCl and NaCl is partly ascribed to a Donnan-like effect whereby the presence of a large excess of poorly diffusible common ion (Na+ or Li+) enhances the partitioning into the skin of the more diffusible ion, in this case neostigmine cation. The presence of inorganic ions at different concentrations had no effect on the partial molal volume of neostigmine bromide (Vi infinity = 223.5 cm3 mol-1), which was practically the same for all concentrations of either LiCl and NaCl.(ABSTRACT TRUNCATED AT 250 WORDS)

Pitfall of acquired ocular torticollis.

Following a posttraumatic concussion syndrome, a 24-year-old female presented at left clavicular fracture and dislocation with a compensatory head posture thought to be due to her sternocleidomastoid muscle involvement. Further investigation disclosed the existence of a concomitant superior oblique muscle palsy seemingly also of traumatic origin. The clinical course and the constellation of her symptoms are described.

Benign palsy of superior oblique muscle.

Thirteen patients with nontraumatic superior oblique muscle palsy were examined during a four to seven year follow-up period. Extensive investigations disclosed no underlying systemic or neurologic diseases. In all patients a quick improvement and recovery of the motility imbalance occurred spontaneously in about 10 weeks, suggesting a benign prognosis in the condition.

Mental health work with Gulf War evacuees: the use of a transitional therapeutic space.

This paper describes the intervention of a mental health team formed during the Persian Gulf War to provide assistance to people evacuated from their homes after they were seriously damaged or destroyed by Iraqi Scud missiles. The intervention was based on the view that a crisis upsets the person's emotional equilibrium, resulting in a new and alien emotional state, which is frightening to the person involved by virtue of its strangeness. The disturbance may result in the development of a frozen, rigid unadaptive internal state, i.e. trauma. The mental health team used the interaction between external and internal realities, within a transitional space which enabled the development of a potential space.

Cardiac protection by preconditioning is generated via an iron-signal created by proteasomal degradation of iron proteins.

Ischemia associated injury of the myocardium is caused by oxidative damage during reperfusion. Myocardial protection by ischemic preconditioning (IPC) was shown to be mediated by a transient 'iron-signal' that leads to the accumulation of apoferritin and sequestration of reactive iron released during the ischemia. Here we identified the source of this 'iron signal' and evaluated its role in the mechanisms of cardiac protection by hypoxic preconditioning. Rat hearts were retrogradely perfused and the effect of proteasomal and lysosomal protease inhibitors on ferritin levels were measured. The iron-signal was abolished, ferritin levels were not increased and cardiac protection was diminished by inhibition of the proteasome prior to IPC. Similarly, double amounts of ferritin and better recovery after ex vivo ischemia-and-reperfusion (I/R) were found in hearts from in vivo hypoxia pre-conditioned animals. IPC followed by normoxic perfusion for 30 min ('delay') prior to I/R caused a reduced ferritin accumulation at the end of the ischemia phase and reduced protection. Full restoration of the IPC-mediated cardiac protection was achieved by employing lysosomal inhibitors during the 'delay'. In conclusion, proteasomal protein degradation of iron-proteins causes the generation of the 'iron-signal' by IPC, ensuing de-novo apoferritin synthesis and thus, sequestering reactive iron. Lysosomal proteases are involved in subsequent ferritin breakdown as revealed by the use of specific pathway inhibitors during the 'delay'. We suggest that proteasomal iron-protein degradation is a stress response causing an expeditious cytosolic iron release thus, altering iron homeostasis to protect the myocardium during I/R, while lysosomal ferritin degradation is part of housekeeping iron homeostasis.

Aging is an organ-specific process: changes in homeostasis of iron and redox proteins in the rat.

Organ-specific changes of iron- and redox-related proteins occur with age in the rat. Ferritin, the major iron storage and detoxifying protein, as well as the proteins of the methionine-centered redox cycle (MCRC) were examined in old and young animals, and showed organ-dependent changes. In spleens and livers of aged rats, ferritin (protein) levels were greater than in young ones, and their iron saturation increased, rendering higher ferritin-bound iron (FtBI). Iron saturation of the ferritin molecule in the tongues and sternohyoids of old rats was lower but ferritin level was higher than in young rats, resulting in increased FtBI with age. Ferritin level in the esophagus of older rats was lower than in young rats but its molecular iron content higher thus the total FtBI remained the same. In the larynx, both ferritin and its iron content were the same in young and old animals. MCRC proteins were measured in livers and spleens only. With aging, methionine sulfoxide reductase A and B (MsrA and MsrB) levels in livers and spleens decreased. Thioredoxin1 (Trx) and Trx-reductase1 were elevated in old spleens, but reduced in livers. Aged spleens showed reduced Msr isozyme activity; but in the liver, its activity increased. mRNA changes with age were monitored and found to be organ specific. These organ-specific changes could reflect the different challenges and the selective pathways of each organ and its resultant capacity to cope with aging.

Incorporation of genotype effects into animal model evaluations when only a small fraction of the population has been genotyped.

The method of Israel and Weller (Estimation of candidate gene effects in dairy cattle populations. Journal of Dairy Science 1998, 81, 1653-1662) to estimate quantitative trait locus (QTL) effects when only a small fraction of the population was genotyped was investigated by simulation. The QTL effect was underestimated in all cases, but bias was greater for extreme allelic frequencies, and increased with the number of generations included in the simulations. Apparently, as the fraction of animals with inferred genotypes increases, the genotype probabilities tend to 'mimic' the effect of relationships. Unbiased estimates of QTL effects were derived by a modified 'cow model' without the inclusion of the relationship matrix on simulated data, even though only a small fraction of the population was genotyped. This method yielded empirically unbiased estimates for the effects of the genes DGAT1 and ABCG2 on milk production traits in the Israeli Holstein population. Based on these results, an efficient algorithm for marker-assisted selection in dairy cattle was proposed. Quantitative trait loci effects are estimated and subtracted from the cows' records. Genetic evaluations are then computed for the adjusted records. Animals are then selected based on the sum of their polygenic genetic evaluations and QTL effects. This scheme differs from a traditional dairy cattle breeding scheme in that all bull calves were considered candidates for selection. At year 10, total genetic gain was 20% greater by the proposed algorithm as compared to the selection based on a standard animal model for a locus with a substitution effect of 0.5 phenotypic standard deviations. The proposed method is easy to apply, and all required software are 'on the shelf.' It is only necessary to genotype breeding males, which are a very small fraction of the entire population. The method is flexible with respect to the model used for routine genetic evaluation. Any number of genetic markers can be easily incorporated into the algorithm, and the reduction in genetic gain due to incorrect QTL determination is minimal.

Risk factors for severity and relapse of pseudomembranous colitis in an elderly population.

OBJECTIVE: Pseudomembranous colitis (PMC) is well recognized as an important cause of diarrhoea in patients receiving antibiotics, with significant consequences of morbidity and mortality. Mortality among elderly patients is high, and even with successful treatment, a significant number of patients relapse. To evaluate the outcome of elderly patients with PMC, and to try to identify risk factors that might influence mortality or relapse. METHOD: We studied 72 consecutive hospitalized patients with endoscopically proven PMC. The medical records of all patients with their clinical history and laboratory data were reviewed in detail. These data included: pre-hospitalization residence and physical status, background medical history, presenting symptoms, antibiotic history, haematological and biochemical parameters, treatment, duration of hospitalization, complications, mortality within 30 days of hospitalization and relapse. RESULTS: Of the 72 patients (M/F=34/38, mean age=77 years), 47% were nursing home residents. Prior to hospitalization, 91.6% of patients had received antibiotic treatment (cephalosporins - 64%, penicillins - 42% and quinolones - 28%), 26% of patients received antacid therapy and 36% had been fed with a nasogastric tube (NGT). Thirty-seven (51%) patients recovered without complications, 21 (29%) patients died within 30 days of hospitalization and 14 (19%) patients were re-hospitalized because of relapse of PMC. Multivariate analysis revealed that white blood cell count above 20 x 10(3)/mm3 (P=0.009), serum albumin level of less than 2.5 g/dl (P=0.02), and pre-hospitalization NGT feeding (P=0.01) were associated with high mortality. Treatment with acid-reducing drugs (P=0.01) and living at a nursing home (P=0.06) were associated with high relapse rates. CONCLUSION: Pseudomembranous colitis is an important complication of antibiotic therapy and is associated with high mortality and recurrence rate, especially in old and debilitated persons. Pre-admission NGT feeding, severe leucocytosis and hypoalbuminaemia on admission are associated with increased mortality. Pre-hospitalization acid reducing treatment and nursing home residency are associated with increased risk of recurrence.

A womb of his own.

Although some feminists formerly saw utopian possibilities in reproductive technology, many now fear that the new technologies are turning women's bodies into test tubes. They feel that these technologies are designed less to help infertile women than to appease men's envy of women's reproductive power. The consequences of the new technologies for the psychology of women and children and the future creation of culture are open questions. Should the technologies succeed in taking reproduction out of the body altogether, it remains to be seen whether women will gain in freedom, or whether this will simply fulfill the age-old misogynistic fantasy of depriving women of their central place in procreation.

Late development of chorioretinal lesions in birdshot retinochoroidopathy.

The clinical manifestations of diffuse retinochoroidopathy after recurrent episodes of vitriitis led to the diagnosis of birdshot retinochoroidopathy in two patients in whom the initial lesions were cystoid macular edema and papillophlebitis. Although the onset and clinical characteristics of the early lesions varied, both patients had manifestations of chronic retinal vasculitis. We observed the late appearance and evolution of the characteristic cream-colored depigmented spots which were not present in the early stages of the disease. In addition the second case also developed choroidal neovascularization. Serial electroretinographic examinations showed that this disorder has a progressive course from focal lesions to widespread diffuse changes.