Determination and benchmarking of 27Al(d,α) and 27Al(d,p) reaction cross sections for energies and angles relevant to NRA.

The cross-sections of deuteron-induced nuclear reactions suitable for ion beam analysis, measured in different laboratories, are often significantly different. In the present work, differential cross-sections of 27Al(d,p) and 27Al(d,α) reactions were measured, and the cross sections benchmarked with thick target spectra obtained from pure aluminium for the first time in two independent laboratories. The 27Al(d,p) and (d,α) differential cross-sections were measured between 1.4 and 2 MeV at scattering angles of 165°, 150°, and 135° in the VDGT laboratory in Tehran (Iran), and the same measurements for detector angle of 150° were repeated from scratch, including target making, with independent equipment on the SAFIR platform at INSP in Paris (France). The results of these two measurements at 150° are in good agreement, and for the first time a fitted function is proposed to describe the Al-cross sections for which no suitable theoretical expression exists. The obtained differential cross-sections were validated through benchmarking, by fitting with SIMNRA deuteron-induced particle spectra obtained from a high purity bulk Al target at both labs for deuteron incident energies between 1.6 and 2 MeV. The thick target spectra are well-reproduced. The evaluated and benchmarked cross sections have been uploaded to the ion beam analysis nuclear data library database (www-nds.iaea.org/ibandl/).

Delineation of lung cancer with FDG PET/CT during radiation therapy.

OBJECTIVES: To propose an easily applicable segmentation method (perPET-RT) for delineation of tumour volume during radiotherapy on interim fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Sixty-seven patients (51 primary tumours, 60 lymph nodes), from 4 prospective studies, underwent an FDG PET/CT scan during the fifth week of radiation therapy, using different generations of PET/CT. Per-therapeutic PET/CT scans were delineated in consensus by two experienced physicians leading to the gold standard threshold to be applied. The mathematical expression of Thopt, the optimal threshold to be applied as a function of the maximum standard uptake value (SUVmax), was determined. The performance of this method (perPET-RT) was assessed by computing the DICE similarity coefficient (DSC) and was compared with 8 fixed threshold values and 3 adaptive thresholding methods. RESULTS: Thopt verified the following expression: Thopt = A.ln(1/SUVmax) + B where A and B were 2 constants. A and B were independent from the generation of PET/CT, but depended on the type of lesions (primary lung tumours vs. lymph nodes). PerPET-RT showed good to very good agreement in comparison to the gold standard. The mean and standard deviation of DSC value was 0.81 ± 0.13 for lung lesions and 0.78 ± 0.15 for lymph nodes. PerPET-RT showed a significant better agreement than the other segmentation methods (p < 0.001), except for one of the adaptive thresholding method ADT (p = 0.11). CONCLUSION: On the database used, perPET-RT has proven its reliability and accuracy for tumour delineation on per-therapeutic FDG PET/CT using only SUVmax measurement. This method may be used to delineate tumour volume for dose-escalation planning. TRIAL REGISTRATION: NCT01261598 , NCT01261585 , NCT01576796 .

Emergency medicine providers' opioid prescribing practices stratified by gender, age, and years in practice / 世界急诊医学杂志（英文）

@#BACKGROUND: Emergency medicine providers (EMPs) prescribe about 25％ of opioids, but the effect of EMP risk perception on decisions to prescribe opioids is unknown. This study was undertaken to identify factors that influence EMP risk and opioid prescribing practices. METHODS: We distributed an anonymous questionnaire to EMPs at a military trauma and referral center. Response frequencies and distributions were assessed for independence using the Chi-square test. RESULTS: Eighty-nine EMPs completed the questionnaire (100％ response). Respondents were primarily younger male physicians (80％) in practice under five years (55％). Male EMPs were more likely to prescribe more opioid tablets than female ones both when and when not concerned for opioid misuse (P<0.001, P<0.007, respectively). Of the providers, 70％ stated that patient age would influence their prescribing decisions. Hydrocodone and oxycodone were the opioids prescribed most frequently. About 60％ of the providers reported changing their prescribing behavior would not prevent opioid misuse. Additionally, 40％ of the providers believed at least 10％ of patients seen at this military ED misused opioids. CONCLUSION: Female EM providers reported prescribing fewer opioid tablets. Patient age influenced prescribing behavior, but the effect is unknown. Finally, EM providers reported that altering their prescribing behavior would not prevent prescription opioid misuse.

Contrast-enhanced ultrasonography evaluation after autologous fat grafting in scar revision.

AIM: Fat transfer is commonly used to fill loss of volume in depressed scars caused by trauma, deep burns or surgery. The aim of the study is to investigate the degree of fat graft take through evaluation of the microcirculation of grafted autologous adipose tissue using contrast-enhanced ultrasonography. PATIENTS AND METHOD: From 2010 to 2012 at the Department of Plastic and Reconstructive Surgery of the Traumatological Center in Turin, a study population was selected from patients with surgical indications for autologous fat transfer for scar correction. For each surgical procedure patients underwent a clinical and sonographic evaluation before and after intervention (at 1 month and 3 months). RESULTS: Out of a total of 28 interventions, 24 showed a good result; defined as improvement of the scar, and confirmed by the presence of vascularization in the transplanted tissue. In 4 cases, there was a lack of blood supply at the first evaluation but an initial good clinical scar correction. The absence of blood vessels was confirmed at 3 months accompanied by complete resorption of the transferred fat with a failure of good clinical outcome. CONCLUSION: Contrast-enhanced ultrasonography was able to evaluate the microvasculature of adipose tissue after fat transfer. Due to this characteristic, it allows to monitor and predict the take of adipose tissue and provide realistic and early information on the clinical outcome of fat transfer.

Limiting step involved in the thermal growth of silicon oxide films on silicon carbide.

Thermal growth of silicon oxide films on silicon carbide in O2 was investigated using oxygen isotopic substitution and narrow resonance nuclear reaction profiling. This investigation was carried out in parallel with the thermal growth of silicon oxide films on Si. Results demonstrate that the limiting steps of the thermal oxide growth are different in these two semiconductors, being diffusion limited in the case of Si and reaction limited in the case of SiC. This fact renders the growth kinetics of SiO2 on SiC very sensitive to the reactivity of the interface region, whose compositional and structural changes can affect the electrical properties of the structure.

Testicular microlithiasis.

Testicular microlithiasis is an uncommon condition that is characterized by calcifications within the lumina of seminiferous tubules. It is usually an incidental finding on high frequency scrotal sonography. Testicular microlithiasis is a benign condition but is associated with testicular malignancies. Recent reports support this association and suggest regular follow-up in these patients.

Frère Jacques Beaulieu: from rogue lithotomist to nursery rhyme character.

PURPOSE: We discuss the history of Frère Jacques Beaulieu, a celebrated 17th century French lithotomist, and question the relationship of his name to a well-known nursery rhyme character. MATERIALS AND METHODS: We reviewed historical reports about Beaulieu and his career as a lithotomist. Nursery rhyme interpretations were also reviewed. RESULTS: Beaulieu was born in 1651 to a peasant family and learned the practice of lithotomy by apprenticeship. He was never formally ordained yet donned a monk habit and called himself Frère Jacques. He was the first person to use the lateral approach to perineal lithotomy and openly shared his surgical technique. His lithotomy procedure was observed by the high court in Paris on 3 separate occasions between 1697 and 1704. Unfortunately his patients had significant morbidity and mortality, and he was denied operating privileges. He performed approximately 5,000 lithotomies in 30 years and died in 1719 at age 68 years. The nursery rhyme "Frère Jacques" probably refers to a playful group of Jacobinic monks who often overslept. We found no direct association between Frere Jacques Beaulieu and the nursery rhyme character. CONCLUSIONS: Beaulieu was an early urologist who was the first to describe the lateral approach to perineal lithotomy. Unlike other lithotomists of the 17th century, he openly shared his surgical techniques and stimulated others to refine the procedure. Regardless of the exact derivation of the nursery rhyme, the name Frere Jacques will always be remembered in song.

Testicular microlithiasis is associated with testicular pathology.

OBJECTIVES: To evaluate the impact of testicular microlithiasis (TM) on male health by describing our experience. TM is an uncommon condition characterized by calcium deposits in the lumina of seminiferous tubules. These intratesticular calcifications appear as bright, 2- to 3-mm echogenic foci on testicular ultrasound (US). METHODS: Patients diagnosed with TM by high-frequency testicular US over a 4-year period from two separate institutions were included in this study. Approximately 1100 testicular USs were performed (both hospitals combined) over the 4-year period. Patients were clinically identified by the characteristic appearance of TM on testicular US. Pathologic specimens were obtained in 14 (64%) of 22 patients. RESULTS: Thirty-eight testicles (16 bilateral cases) in 22 patients were found to have TM. The incidence of TM was approximately 2%. Mean age at presentation was 29 years (range 8 to 63). Eight (36%) of 22 patients had testicular malignancies. Five (23%) of 22 patients were infertile. Three (14%) of 22 patients presented with unilateral necrosis of the testes due to spermatic cord torsion. Two patients had varicoceles, 1 patient had epididymitis, and another patient had torsion of an appendix testis. Previously unreported associations of TM and neurofibromatosis (1 patient) and acquired immunodeficiency syndrome (AIDS) (1 patient) were noted. No patient with TM later developed a testicular malignancy, yet the mean follow-up was only 31 months (range 1 to 108). One patient with unilateral TM developed bilateral TM, and 1 patient with bilateral TM subsequently developed unilateral TM. One patient developed spermatic cord torsion and testicular infarction 4 years after previously documented TM. CONCLUSIONS: TM is usually diagnosed by testicular US performed for various indications. TM is an uncommon condition that is found in testes with both malignant and nonmalignant conditions. The association of TM and testicular malignancy suggests regular follow-up with testicular US examinations.

Intra-abdominal pulmonary sequestration: a benign suprarenal mass.

A 34-year-old white woman presented with an 8.5-cm left suprarenal mass. Evaluation revealed normal adrenal hormone function. Pathologic examination after surgical removal revealed a rare benign condition, intra-abdominal extralobar pulmonary sequestration (accessory lung).

Primary adenocarcinoma of the epididymis: case report and review of the literature.

Primary epididymal malignancies are uncommon, and epididymal adenocarcinomas are exceedingly rare. We report a case of primary adenocarcinoma of the epididymis in a 62-year-old man and review the world literature on epididymal adenocarcinoma.

Review of US medical school finances, 1996-1997.

Based on data from the Annual Medical School Questionnaire of the Liaison Committee on Medical Education, to which 100% of schools responded, the revenues that supported the programs and activities of the 125 accredited medical schools in the United States totaled $34897 million in 1996-1997. A large proportion (78.9%) of these revenues was derived from 3 sources: practice plans, grants and contracts, and hospital support. Both public and private medical schools, in aggregate, have continued to experience growth throughout the last decade but at a progressively slower rate, primarily because of a slowing in the growth of practice plan revenues. Federal revenues supporting research in public and private medical schools since 1992-1993 have grown at annualized, constant-dollar rates of 5.6% and 4%, respectively. Growth in state and local appropriations to public medical schools has tended to lag behind inflation. Growth in reported revenues from endowments that are used to support programs at private medical schools is on the rise. The aggregate numbers mask considerable variation among schools with regard to changes in financing. A small, but appreciable, number of schools have witnessed a constant-dollar decline in their total practice plan revenues since 1992-1993. The financial data reviewed in this report demonstrate the continued dependence of medical schools on faculty-generated sources of revenue and confirm the perception that medical schools, as a group, are experiencing constraints on the growth of their enterprises.

Schistosomiasis of the urinary bladder in an African immigrant to North Carolina.

A 30-year-old black man came to the emergency department with gross hematuria, prostatitis, and urethritis 4 months after immigrating to this country from the Sudan in Africa. Urinalysis revealed hematuria and no ova or parasites. An intravenous urogram showed normal kidneys and ureters. The patient had cystoscopy with biopsies of an inflamed and ulcerated bladder mucosa. The nematode Schistosoma haematobium and schistosome eggs were identified without evidence of urothelial malignancy. The patient was treated with praziquantel and is currently asymptomatic. Over 200 million people are infected with schistosomiasis worldwide, yet this disease is rarely encountered in this country. The differential diagnosis and assessment of patients must include exposure to uncommon diseases that are endemic to other geographic regions.

Cardiac arrhythmias with external fixed-rate signal generators in shock wave lithotripsy with the Medstone lithotripter.

OBJECTIVES: To evaluate the incidence and outcome of cardiac arrhythmias associated with an external fixed-rate generator and the Medstone lithotripter with regard to stone location, anesthesia type, patient age, and gender. METHODS: Data were obtained on 933 patients who underwent shock wave lithotripsy (SWL) with the Medstone lithotripter. Patients were randomly divided into two study groups, including those with pre-existing cardiac disease, hypertension, and cardiac medications. Group 1 (576 patients) were treated with the external fixed-rate signal generator (cardiac simulator). Group 2 (357 patients) underwent electrocardiogram-gated SWL (no simulator). All patients were monitored for arrhythmias during SWL. Patients who developed arrhythmias on the simulator were converted to gated SWL. RESULTS: In group 1, 463 patients (80%) had no arrhythmias during treatment, whereas 113 patients (20%) developed cardiac arrhythmias (primarily premature ventricular contractions [PVCs]) and were successfully converted to gated SWL. Only 1 patient in group 2 (0.3%) had a documented arrhythmia (PVC). Group 1 patients who developed arrhythmias with a cardiac simulator were more likely to have renal rather than ureteral stones. Chi-square analysis showed a significant correlation between patients with and without arrhythmias in group 1 with regard to stone location (P <0.0001). In group 1, regional anesthesia, intravenous anesthesia, and general anesthesia had an arrhythmia rate of 14%, 27%, and 38%, respectively. The only patient in group 2 who developed arrhythmias was under general anesthesia. The differences between groups 1 and 2, with regard to anesthesia type and arrhythmia, were statistically significant (P <0.001). No patients required additional medical therapy or hospitalization for cardiac events, and all patients safely completed the SWL treatment. CONCLUSIONS: With careful monitoring and adequate precautions, external fixed-rate signal generators are safe, effective methods for pacing the Medstone shock wave lithotripter and probably other extracorporeal shock wave lithotripters.

Unusual complications of the vacuum erection device.

OBJECTIVES: The vacuum erection device (VED) is usually well tolerated and very effective for patients with erectile dysfunction. When used correctly, VEDs carry low morbidity and few recognized complications. We report on 5 patients who developed unusual complications associated with VED use, including two previously unreported complications of urethral bleeding and capture of scrotal tunica within the penile shaft. METHODS: Patient 1: a 38-year-old diabetic man with significant peripheral neuropathy and an 8-year history of erectile dysfunction developed penile skin necrosis at the ring site after leaving the penile ring on for an excessive length of time (6 hours). Patient 2: a 76-year-old diabetic man who used a VED correctly for 3 months developed severe urethral bleeding. Patient 3: a 75-year-old diabetic man who enjoyed satisfactory erections with a VED for 14 months developed a 3 x 3-cm penile cystic mass located on the proximal right side of the penile shaft. This mass was not present in the flaccid state and was seen only with VED use. Patient 4: a 65-year-old man developed Peyronie's disease after 4 years of correct VED use. Patient 5: a 62-year-old man with neurogenic impotence following a radical prostatectomy developed penile ecchymoses acutely following placement of a smaller constriction ring. He subsequently developed a dorsal penile plaque with mild dorsal curvature. RESULTS: Patient 1 did well with local skin care and no longer uses a VED. Patient 2 underwent cystoscopy and was found to have prominent urethral vessels (varicosities) in the midurethra, compared with a normal cystoscopy 9 months previously. This patient no longer uses a VED and now denies any urethral bleeding at 15-month follow-up. Patient 3 underwent corpora cavernosography and contrast injection of the cystic mass. These radiographic studies showed that the mass did not communicate with either corpora cavernosa or the corpus spongiosum. A retrograde urethrogram failed to show a urethral diverticulum. The patient was surgically explored, and the penile cystic mass was found to be scrotal tunica vaginalis. Subsequently, a hydrocele repair was performed, yet postoperatively the patient developed testicular migration into the ipsilateral penile shaft. Testicular fixation was not feasible secondary to a childhood herniorrhaphy, and an orchiectomy was performed. Patient 4 underwent implantation of a penile prosthesis and is doing well at 3-year follow-up. Patient 5 experiences mild dorsal penile curvature with erections induced by transurethral prostaglandin E1. The penile curvature does not interfere with intercourse and will be managed conservatively. CONCLUSIONS: We describe unusual side effects associated with VEDs. Although thousands of men use VEDs successfully and without morbidity, the urologist must be aware of unusual complications associated with VED use.

Review of US medical school finances, 1995-1996.

For the 1995-1996 fiscal year, all 125 accredited US medical schools responded to the annual medical school questionnaire of the Liaison Committee on Medical Education, part I-A. Using data from the financial portion of the questionnaire, we identify patterns of financing medical education during the past 3 years and the practice plan arrangements adopted by medical schools, including their organizational and legal structures. This financial review details differences in how public and private medical schools are being funded and funding changes during the past 3 years. The reported data show that revenues supporting medical school programs and activities totaled more than $31 billion in 1995-1996, an increase of 5.4% in inflation-adjusted dollars during the previous year. Compared with the previous year, revenues, in current and constant dollars, increased in almost every category in 1995-1996.

Mid-infrared spectroscopy of erbium doped chloride laser crystals.

We report on a spectroscopic analysis of ErCl3 and 1% Er 3+:YCl3 to determine their potential as possible laser sources at 3.5 and 4.5 mm. Concentration quenching of the low lying excited states is reported to be surprisingly very weak in this system. Although some shortening of the lifetimes is measured in the fully concentrated system, they retain lifetimes that are of order several milliseconds or more. A Judd-Ofelt analysis is performed and the projected gains for the 3.5 and 4.5 mm transitions are calculated. Successful growth techniques of erbium doped chlorides are also described.