Preoperative radiotherapy in the management of retroperitoneal liposarcoma.

BACKGROUND: Histological subtype influences both prognosis and patterns of treatment failure in retroperitoneal sarcoma. Previous studies on the efficacy of neoadjuvant radiotherapy (NRT) have incorporated multiple histological types with heterogeneous tumour biology. The survival impact of NRT specifically for patients with retroperitoneal liposarcoma is poorly defined. METHODS: Patients who underwent resection with curative intent for retroperitoneal liposarcoma and who received NRT or surgery alone were identified in the US National Cancer Data Base (2004-2013). Cox regression was used to identify co-variables associated with overall survival. NRT and surgery-alone cohorts were matched 1 : 1 by propensity scores based on the survival hazard on Cox modelling. Overall survival was compared by Kaplan-Meier estimates. RESULTS: A total of 2082 patients with retroperitoneal liposarcoma were identified; 1908 underwent surgery alone and 174 received NRT before surgical resection. Median tumour size was 22·0 cm and 34·9 per cent of tumours were high grade. In the unmatched cohort, NRT was not associated with improved overall survival (χ2 = 3·49, P = 0·062). In the propensity score-matched cohort, NRT was associated with an improvement in survival (median overall survival 129·2 versus 84·3 months; P = 0·046; hazard ratio (HR) 1·54, 95 per cent c.i. 1·01 to 2·36). This effect appeared most pronounced for tumours with adjacent organ invasion (median overall survival not reached versus 63·8 months; P = 0·044; HR 1·79, 1·01 to 3·19). CONCLUSION: NRT improved survival in patients undergoing surgery for retroperitoneal liposarcoma, particularly those with high-risk pathological features.

Gain lifetime measurement of a Ni-like Ag soft X-ray laser.

Experimental results of a two-stage Ni-like Ag soft X-ray laser operated in a seed-amplifier configuration are presented. Both targets were pumped applying the double-pulse grazing incidence technique with intrinsic travelling wave excitation. The injection of the seed X-ray laser into the amplifier target was realized by a spherical mirror. The results show amplification of the seed X-ray laser and allow for a direct measurement of the gain lifetime. The experimental configuration is suitable for providing valuable input for computational simulations.

[Development of the Austrian Society for Child and Adolescent Psychiatry and Psychotherapeutic Medicine: results of a member survey]. / Entwicklungen der Österreichische Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie ­ Ergebnisse einer Mitgliederbefragung.

BACKGROUND: Due to legal changes in 2015, the medical specialist society ÖGKJP is in a dynamic development process. In recent years, the Executive Board has gone through an organisational development process and developed new structures and strategies. The aim of this study was to ask about the importance of the various offers and objectives and the satisfaction with the events and measures via a member survey. Respondents were also invited to identify future topics and to evaluate their importance. METHODS: 249 members could be reached by email and had been provided with a self-developed questionnaire to be answered by an online-application (Lime-Survey). The questionnaire consisted of twelve closed questions for five topics (see result section). The question could be answered by a Likert-like-scale (1 very content to 5 not at all content). Statistical analysis was performed by descriptive tests. RESULTS: 101 members (nearly 35%) have replied to the questionnaire. 65% of the responders were regular members, 15% were regular members in training and 8% were extraordinary members. 12% do not give any information about their membership status With regard to the topic research and science, importance was rated on average between 1.53 and 2.55 and satisfaction with the implementation between 1.50 and 2.16. With regard to the topic events and cooperation partnerships, the importance was rated between 1.63 and 2.10, the satisfaction with the implementation between 1.55 and 2.22. The representation of the organisation in the public was considered to be highly important (1.23), the satisfaction of the members is 2.24 points. The innovations in the service of the company were assessed in terms of their importance as follows: homepage 1.82, learning platform Moodle 2.28 and the new secretariat with 1.83. The satisfaction of the members with these innovations is given the grades 2.22, 2.50 and 1.84. DISCUSSION: Participation was good, members rated satisfaction on a good, but improvable level. Importance of selected topics was confirmed and two future topics were pointed out especially, events and cooperation partnerships as well as the representation of the ÖGKJP at the political level.

Pancreatic Head Resection Following Roux-en-Y Gastric Bypass: Operative Considerations and Outcomes.

PURPOSE: This study aimed to identify optimal management decisions for surgeons preforming pancreatic head resection on patients with altered anatomy due to a previous Roux-en-Y gastric bypass (RYGB). METHODS: A multi-national (4), multi-center (28) collaborative of 55 pancreatic surgeons who have performed pancreatoduodenectomy or total pancreatectomy following RYGB for obesity (2005-2018) was created. Demographics, operative details, and perioperative outcomes from this cohort were analyzed and compared in a propensity-score matched analysis with a multi-center cohort of 5533 pancreatoduodenectomies without prior RYGB. RESULTS: Ninety-six patients with a previous RYGB undergoing pancreatic head resection were assembled. Pathologic indications between the RYGB and normal anatomy cohorts did not differ. Propensity score matching of RYGB vs. patients with unaltered anatomy demonstrated no differences in major postoperative outcomes. In total 20 distinct reconstructions were employed (of 37 potential options); the three most frequent reconstructions accounted for 52.1%, and none demonstrated superior outcomes. There were no differences in outcomes observed between original biliopancreatic limb use (66.7%) and those where a secondary Roux limb was created for biliopancreatic reconstruction. Remnant stomachs were removed in 54.7% of cases, with no outcome differences between resected and retained stomachs. Venting gastrostomy tubes were used in 36.2% of retained stomachs without obvious outcome benefits. Jejunostomy tubes were used infrequently (11.7%). CONCLUSIONS: Pancreatic head resection after RYGB is an infrequently encountered, unique and challenging scenario for any given surgeon. These patients do not appear to suffer higher morbidity than those with unaltered anatomy. Various technical reconstructive options do not appear to confer distinct benefits.

Lymph node evaluation and survival after curative-intent resection of duodenal adenocarcinoma: A matched cohort study.

BACKGROUND: Lymph node (LN) metastasis in patients with duodenal adenocarcinoma is associated with poor prognosis; however, the optimal extent of LN assessment and the interaction between LN assessment and adjuvant systemic therapy is poorly understood. METHODS: Resected non-metastatic duodenal adenocarcinoma patients (n = 1743) were identified in the National Cancer Database (1998-2011). Logistic regression analysis identified covariates associated with LN metastasis. The influence of increasing LN cut-off points on overall survival (OS) was analysed using the log-rank test and Cox proportional hazards modelling. Adjuvant chemotherapy (AC) and surgery alone cohorts were matched (1:1) by propensity scores based on the likelihood of nodal metastasis or survival hazard on Cox modelling. OS in the matched cohort was compared by Kaplan-Meier estimates. RESULTS: LN metastases were present in 865 (49.6%) patients. Increasing LN assessment was associated with an increased likelihood of nodal involvement (P = 0.008). In node-negative patients, increasing LN assessment was associated with a decreased risk of death, with the largest actuarial survival differences observed for ≥15 LN (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.48-0.82, P = 0.001). In the propensity score-matched cohort of node-negative patients, AC was associated with non-significant improvements in 5-year actuarial (66.1% versus 58.7%, HR 0.79, 95% CI 0.53-1.18, P = 0.249), and did not vary by adequacy of LN counts (<15 LNs: HR 0.79, 95% CI 0.51-1.24, P = 0.305; ≥15 LNs: HR 0.90, 95% CI 0.35-2.30, P = 0.900). CONCLUSIONS: The extent of LN identification has prognostic significance in resected node-negative duodenal adenocarcinoma, but cannot be implicated in the selection of node-negative patients for AC.

Overexpression and purification of a recombinant chimeric HIV type 2/HIV type 1 envelope peptide and application in an accelerated immunobased HIV type 1/2 antibody detection system (AIBS): a new rapid serological screening assay.

A chimeric HIV-2/HIV-1 envelope sequence containing an immunodominant region of HIV-2 gp36 and the corresponding region of HIV-1 gp41 was constructed and overexpressed in Escherichia coli. The recombinant product (rp21/18) was purified and applied in a novel antibody-screening assay. Characteristics in the design of this new principle are as follows: (1) the overall assay time is about 30 min; (2) the assay procedure includes three manipulation steps; and (3) the test shows a reliable performance with respect to sensitivity and specificity. The diluted serum sample and the protein G-horseradish peroxidase conjugate are added simultaneously into a coated (hybrid antigen HIV-1/2) and blocked microtiter plate well. The in-batch incubation of serum sample with protein G-horseradish peroxidase saves two manipulation steps that are normally necessary in the five-step procedure of a classical ELISA. AIBS was evaluated with commercially available seroconversion panels and with random negative serum samples from a blood bank. Seroconversion results demonstrated that AIBS has equivalent sensitivity to ELISAs and the third generation assays. The specificity was determined on a total blood donor population of 5012 (Red Cross Vienna, Austria). The repeat reactive rates for donor population were 0.02%. AIBS represents a general immunometric system (not only HIV antibodies). The entire assay procedure of AIBS evaluated for HIV-1/2 screening, including result reporting, can be performed automatically by several commercially available systems. Depending on these systems AIBS is potentially useful in laboratories or blood banks that have both high- and low-volume testing.

Aggression and counteraggression during child psychiatric hospitalization.

The article reports on a 1-year descriptive study of aggressive incidents and staff counteraggressive strategies within a child psychiatry inpatient unit. Ninety-nine child/adolescent patients produced a total of 887 reportable aggressive incidents during the 12-month study period. Seclusion, activity restriction, physical restraint, and administration of p.r.n. medication were studied in relation to patient aggression. Results of the study confirm the hypotheses that (1) much patient aggression within defined clinical contexts conforms to patterns of prediction directly related to person and environmental variables, and (2) the primary value of counteraggression strategies such as seclusion and restraint resides in the acute management of aggressive children and not in long-term therapeutic functions. The article offers some recommendations for new research in this general area as well as suggestions for clinical applications of these methods.

Self- and other-directed aggression in child and adolescent psychiatric inpatients.

OBJECTIVE: To examine self- and other-directed aggression in 89 children and adolescents on a psychiatric inpatient unit to determine ways in which aggressive and nonaggressive patients differ and to discover those factors associated with self-directed versus other-directed aggression. METHOD: Three types of data were collected: ongoing observations of aggressive behavior during hospitalization, Child Behavior Checklists completed by a parent or guardian at admission, and patient and family history data gathered from a retrospective chart review. RESULTS: Compared with nonaggressive patients, aggressive patients were more likely to have a history of antisocial behavior, to be victims of abuse or neglect, to have lived in a foster home, and to have had several primary caretakers. Both groups of aggressive patients engaged in three types of aggressive behavior with equal frequency and were strikingly similar on a host of other variables. Only the number of primary caretakers with whom a patient had lived discriminated self- from other-directed aggressive patients; patients who experienced frequent disruptions in caretaking were likely to engage in acts of self-injury during hospitalization. CONCLUSIONS: Whether a particular patient will engage in aggressive behavior during hospitalization can be accurately predicted from preadmission characteristics; however, the manner in which a patient is likely to aggress, i.e., toward others or self, is difficult to predict because of striking similarities between types of aggressive patients. Further investigations are needed to determine how self- and other-directed aggressive patients differ and to elucidate relationships between disrupted, unstable, or inadequate caretaking and aggression, particularly self-injury, in children and adolescents.

High-harmonic generation and parametric amplification in the soft X-rays from extended electron trajectories.

We report, for the first time, the generation of high-order harmonics in a spectral range between 200 eV and 1 keV with an unusual spectral property: only every 4(th) (4i + 1, i∈ℵ) harmonic line appears, whereas the usual high-harmonic spectra consist of every odd (2i + 1) harmonic. We attribute this unique property to the quantum path interference of two extended electron trajectories that experience multiple re-scattering. In the well-established theory, electrons emitted via tunnel ionisation are accelerated by a laser field, return to the ion and recombine. The acceleration typically lasts for less than one optical cycle, and the electrons radiate in the extreme ultraviolet range at recombination. In contrast, for extended trajectories, electrons are accelerated over two or more optical cycles. Here, we demonstrate that two sets of trajectories dominate and provide substantial contributions to the generated soft X-ray radiation because they fulfil the resonance condition for X-ray parametric amplification.

Parametric amplification of attosecond pulse trains at 11†nm.

We report the first experimental demonstration of the parametric amplification of attosecond pulse trains at around 11 nm. The helium amplifier is driven by intense laser pulses and seeded by high-order harmonics pulses generated in a neon gas jet. Our measurements suggest that amplification takes place only if the seed pulse-trains are perfectly synchronized in time with the driving laser field in the amplifier. Varying the delay, we estimate the durations of the individual extreme ultraviolet pulses within the train to be on the order of 0.2 fs. Our results demonstrate that strong-field parametric amplification can be a suitable tool to amplify weak attosecond pulses from non-destructive pump-probe experiments and it is an important step towards designing amplifiers for realization of energetic XUV pulses with sub-femtosecond duration using compact lasers fitting in university laboratories.

Acyltransferase-catalyzed cleavage of arachidonic acid from phospholipids and transfer to lysophosphatides in macrophages derived from bone marrow. Comparison of different donor- and acceptor substrate combinations.

In a previous paper it was shown that in prelabeled murine thymocytes a direct CoA-mediated transfer of arachidonic acid from phosphatidylcholine to lysophosphatidylethanolamine occurs which does not involve the intermediate formation of free fatty acid. The transfer is ATP-independent and is catalyzed by the acyl-CoA: lysophosphatide acyltransferase operating in reverse. In prelabeled thymocytes phosphatidylcholine was the only arachidonoyl donor and lysophosphatidylethanolamine the only lysoacceptor. In murine bone-marrow-derived macrophages a series of CoA-mediated transfer reactions were detected leading to a redistribution of arachidonic acid between phospholipids. Using exogenous substrates a bidirectional transfer from 1-acyl-2-arachidonoylglycerophosphocholine to lysophosphatidylethanolamine occurs. An unidirectional transfer from 1-acyl-2-arachidonoylglycerophosphoinositol to lysophosphatidylcholine and from 1-acyl-2-arachidonoylglycerophosphoinositol to lysophosphatidylethanolamine was observed. Plasmalogenic lysoacceptors generally have a weaker acceptor capacity than the correspondent acyllysophospholipid. In macrophages the CoA-mediated transfer of arachidonoyl moieties is independent of ATP and Mg2+ and is totally inhibited by sodium cholate, indicating that it is catalyzed by the acyl-CoA: lysophosphatide acyltransferase.

Interactions between parents and pediatric primary care physicians about children's mental health.

Interaction patterns between parents and pediatricians were examined during 1,378 well-child visits to four public and private pediatric clinics. During 327 visits, parents listed at least one psychosocial concern related to their child's mental health. At 37 percent of these visits, parents said they did not wish to discuss the concern with the physician. Physicians failed to address concerns during approximately 35 percent of visits at which parents were willing to discuss them. Successful parent-physician interactions were three times more frequent in private practices than in a public clinic; they were more likely when fewer concerns were stated and less likely when behavior problems were the concern. Parents concerned about the parent-infant relationship were four times more likely to be referred to outside mental health services, although these cases were relatively rare. Older children and families receiving Medicaid were also more likely to be referred to such services.

Photostructurized electrochemical biosensors for bioreactor control and measurement in body fluids.

This article details a new type of biosensor for the simultaneous analysis of glucose, glutamate and glutamine in complex biological fluids like fermentation broths and blood. Simultaneous analysis was made possible by the application of different enzyme layers onto different electrodes of one photostructurized sensor. Photostructuring was done by means of a new developed photopolymer. Preparation of the photopolymer and the enzyme layers as well as the characterization of the sensors thus constructed with respect to linearity, response time and sensitivity are described.