Gynecological brachytherapy for postoperative endometrial cancer: dosimetric analysis (Ir-192 vs Co-60)

Introduction. Endovaginal brachytherapy treatment dosimetry differences were studied using Ir-192 or Co-60 sources for postoperative endometrial cancer. Materials and methods. A prospective descriptive study was conducted. Thirty-six dosimetry plans of different patients were studied (15 by Ir-192 and 21 by Co-60). Variables studied included D2cc Rectum, D2cc Bladder, D2cc Sigmoid, dose percentage at point 0 (applicator surface on the top of the cylinder) and dose percentage at point 1 (5 mm deep on the top of the cylinder). A comparative analysis was performed of the values obtained from each variable between Ir-192 and Co-60 treatments. We compared average of each variables between Iridium and Cobalt by T Student for independent samples (SPSS 22). Results. here were no significant differences on using Ir-192 or Co-60 by variables, except for dose percentage at point 1 in which we detected significant differences (Table 1). Discussion. Brachytherapy treatment dosimetry plans are similar using Ir-192 or Co-60, except dose percentage at point 1. In the scientific literature, some differences exist and there are some advantages in using cobalt (AU)

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Gynecological brachytherapy for postoperative endometrial cancer: dosimetric analysis (Ir-192 vs Co-60).

INTRODUCTION: Endovaginal brachytherapy treatment dosimetry differences were studied using Ir-192 or Co-60 sources for postoperative endometrial cancer. MATERIALS AND METHODS: A prospective descriptive study was conducted. Thirty-six dosimetry plans of different patients were studied (15 by Ir-192 and 21 by Co-60). Variables studied included D2cc Rectum, D2cc Bladder, D2cc Sigmoid, dose percentage at point 0 (applicator surface on the top of the cylinder) and dose percentage at point 1 (5 mm deep on the top of the cylinder). A comparative analysis was performed of the values obtained from each variable between Ir-192 and Co-60 treatments. We compared average of each variables between Iridium and Cobalt by T Student for independent samples (SPSS 22). RESULTS: There were no significant differences on using Ir-192 or Co-60 by variables, except for dose percentage at point 1 in which we detected significant differences (Table 1). Table 1 The results Variables Sources Iridium 192 Cobalt 60 D2cc Rectum (mean dose) [rank] 6.01 Gy [3.99-7.90] 5.28 Gy [3.87-6,34] D2cc Bladder (mean dose) [rank] 5.82 Gy [4.20-8.38] 5.05 Gy [2.23-6.95] D2cc Sigmoid (mean dose) [rank] 4.43 Gy [1.66-6.67] 2.33 Gy [0.60-4.28] Dose percentage at point 0a (mean) [rank] 210.74% [120.90-234.90] 204.75% [177.10-223] Dose percentage at point 1b (mean) [rank] 93.49% [87.30-100.60] 100.11% [96.70-102] aPoint 0: point to the applicator surface bPoint 1: point to 5 mm applicator surface DISCUSSION: Brachytherapy treatment dosimetry plans are similar using Ir-192 or Co-60, except dose percentage at point 1. In the scientific literature, some differences exist and there are some advantages in using cobalt.

Histological Evolution of BK Virus-Associated Nephropathy: Importance of Integrating Clinical and Pathological Findings.

Long-term clinicopathological studies of BK-associated nephropathy (PyVAN) are not available. We studied 206 biopsies (71 patients), followed 3.09 ± 1.46 years after immunosuppression reduction. The biopsy features (% immunostain for PyV large T ag + staining and inflammation ± acute rejection) were correlated with viral load dynamics and serum creatinine to define the clinicopathological status (PyVCPS). Incidence of acute rejection was 28% in the second biopsy and 50% subsequently (25% mixed T cell-mediated allograft rejection (TCMR) + antibody-mediated allograft rejection (AMR); rejection overall affected 38% of patients (>50% AMR). Graft loss was 15.4% (0.8-5.3 years after PyVAN); 76% had complete viral clearance (mean 28 weeks). The only predictors of graft loss were acute rejection (TCMR p = 0.008, any type p = 0.07), and increased "t" and "ci" in the second biopsy (p = 0.006 and 0.048). Higher peak viremia correlated with poorer viral clearance (p = 0.002). Presumptive and proven PyVAN had similar presentation, evolution, and outcome. Late PyVAN (>2 years, 9.8%) justifies BK viremia evaluation at any point with graft dysfunction and/or biopsy evaluation. This study describes the histological evolution of PyVAN and corresponding clinicopathological correlations. Although the pathological features overall reflect the viral and immunological interactions, the PyVAN course remains difficult to predict based on any single feature. Appropriate clinical management requires repeat biopsies and determination of the PyVCPS at relevant time points, for corresponding personalized immunosuppression adjustment.

Mast cell quantitation in renal transplant biopsy specimens as a potential marker for the cumulative burden of tissue injury.

Although mast cells (MC) play an ambiguous role in acute rejection, they have been implicated in chronic fibrotic processes overall and also in the kidney. Their morphological assessment in the context of comprehensive renal allograft pathology has not been sufficiently addressed, however. Using the CD117 immunostain in 461 consecutive kidney allograft biopsy specimens we counted the number of MC in the most inflamed biopsy area. The number of MC was correlated with the presence of the Banff defined features of T-cell-mediated and antibody-mediated rejection. No correlation was found between the number of MC and the presence or degree of T-cell-mediated rejection or with most parameters defining acute or chronic antibody-mediated rejection. Significant correlation was found, however, with the degree of interstitial fibrosis (IF; P = .000), and time post- transplantation (P = .000). Peritubular C4d staining correlated negatively with the number of MC (P = .000). Correlation of MC infiltration and peritubular capillary multilamellation (P = .000) indicated an association between general interstitial and microvascular chronic pathology. We conclude that MC represent a somewhat unique cellular component that correlates poorly with parameters of active T-cell or antibody-mediated allograft rejection. In contrast, because MC correlate strongly with IF and time post-transplantation, they could potentially be valuable as a surrogate marker for the cumulative burden of tissue injury.

Stem cell factor, interleukin-16, and interleukin-2 receptor alpha are predictive biomarkers for delayed and slow graft function.

INTRODUCTION: Delayed graft function (DGF) and slow graft function (SGF) due to ischemic and reperfusion injury (IRI) are common complications of deceased donor kidney transplantation. We tested whether a panel of serum and urine cytokines represent early biomarkers for DGF and SGF. METHODS: We collected serum and urine samples from 61 patients 48 hours posttransplantation and used a multiplex enzyme-linked immunosorbent assay (ELISA) technique to measure levels of 23 cytokines. Fourteen patients developed poor graft function (PGF), with 6 having DGF and 8 with SGF. RESULTS: Area under receiver operation characteristics curve (AUC) demonstrated the following: serum levels of SCF (0.88) and interleukin (IL) 16 (0.74). CONCLUSIONS: This study showed that a select panel of cytokines measured early post kidney transplantation may predict poor graft function.

Listing for expanded criteria donor kidneys in older adults and those with predicted benefit.

Certain patient groups are predicted to derive significant survival benefit from transplantation with expanded criteria donor (ECD) kidneys. An algorithm published in 2005 by Merion and colleagues characterizes this group: older adults, diabetics and registrants at centers with long waiting times. Our goal was to evaluate ECD listing practice patterns in the United States in terms of these characteristics. We reviewed 142 907 first-time deceased donor kidney registrants reported to United Network for Organ Sharing (UNOS) between 2003 and 2008. Of registrants predicted to benefit from ECD transplantation according to the Merion algorithm ('ECD-benefit'), 49.8% were listed for ECD offers ('ECD-willing'), with proportions ranging from 0% to 100% by transplant center. In contrast, 67.6% of adults over the age of 65 years were ECD-willing, also ranging from 0% to 100% by center. In multivariate models, neither diabetes nor center waiting time was significantly associated with ECD-willingness in any subgroup. From the time of initial registration, irrespective of eventual transplantation, ECD-willingness was associated with a significant adjusted survival advantage in the ECD-benefit group (HR for death 0.88, p < 0.001) and in older adults (HR 0.89, p < 0.001), but an increased mortality in non-ECD-benefit registrants (HR 1.11, p < 0.001). In conclusion, ECD listing practices are widely varied and not consistent with published recommendations, a pattern that may disenfranchise certain transplant registrants.

Quantitative detection of promoter hypermethylation as a biomarker of acute kidney injury during transplantation.

Aberrant promoter hypermethylation, also known as epigenetics, is thought to be a promising biomarker approach to diagnose malignancies. Kidney repair after injury is a recapitulation of normal morphogenesis, with similarities to malignant transformation. We hypothesized that changes in urine epigenetics could be a biomarker approach during early kidney transplant injury and repair. We examined urine DNA for aberrant methylation of two gene promoters (DAPK and CALCA) by quantitative methylation-specific polymerase chain reaction from 13 deceased and 10 living donor kidney transplant recipients on postoperative day 2 and 65 healthy controls. Results were compared with clinical outcomes and to results of the kidney biopsy. Transplant recipients were significantly more likely to have aberrant hypermethylation of the CALCA gene promoter in urine than healthy controls (100% vs 31%; P < .0001). There was increased CALCA hypermethylation in the urine of deceased versus living donor transplants (21.60 +/- 12.5 vs 12.19 +/- 4.7; P = .04). Furthermore, there was a trend toward increased aberrant hypermethylation of urine CALCA in patients with biopsy-proven acute tubular necrosis versus acute rejection and slow or prompt graft function (mean: 20.40 +/- 6.9, 13.87 +/- 6.49, 17.17 +/- 13.4; P = .67). However, there was no difference of CALCA hypermethylation in urine of patients with delayed graft function versus those with slow or prompt graft function (16.9 +/- 6.2 vs 18.5 +/- 13.7, respectively; P = .5). There was no aberrant hypermethylation of DAPK in the urine of transplant patients. Urine epigenetics is a promising biomarker approach for acute ischemic injury in transplantation that merits future study.

Strategy for the control of foot-and-mouth disease in Uruguay.

FMD was diagnosed in Uruguay and in most of the South American countries in 1870. In 1961 the first law was issued to enforce the control of the disease. In 1990 a new regulation was approved which determined the process to eradicate FMD. The last clinical case was on June 18th 1990, and in 1996 the OIE declared Uruguay a free country without vaccination. In 2001 FMD was re-introduced, with an outbreak of 2057 animals which were controlled throughout four months of strong activity which ended with two vaccinations of all livestock. On May 22nd 2003, the OIE recognized Uruguay as a country 'free with vaccination'.

Radiation awareness program for extracorporeal shockwave lithotripsy using Medstone lithotripters.

To determine the effectiveness of a radiation awareness program in reducing the radiation exposure to patients treated by a Medstone lithotripter, the exposure was calculated at the end of each extracorporeal shockwave (SWL) treatment using a table of measurements of the estimated entrance exposure rates 70 cm from the X-ray tube port. The results, related to stone size and patient weight, were distributed every month to each radiologic technologist, and a summary was sent regularly to the treating urologists. The doses before and after the introduction of the radiation awareness program were compared to determine the effectiveness of the program, and the chi-square test was used to determine statistical significance. The average calculated radiation exposure before and after introduction of the radiation awareness program was 16.39 rad and 8.26 rad, respectively, for patients with single renal stones; 17.31 rad and 9.02 rad, respectively, with single ureteral stones; 18.45 rad and 9.39 rad, respectively, with multiple renal stones; and 20.59 rad and 11.28 rad, respectively with multiple ureteral stones. These reductions in calculated radiation exposure were statistically significant only with multiple ureteral stones (P = 0.03). The only statistically significant differences in the stone-free rates, retreatment rates, and post-SWL secondary procedure rates before and after the introduction of the radiation awareness program were seen in the stone-free rates with single renal stones: 70% v 65%, respectively (P = 0.02); in the retreatment rates with single ureteral stones: 10% v 6%, respectively ( P < .01); and in the post-SWL secondary procedure rates with single renal stones: 4% v 2%, respectively (P = 0.01), and single ureteral stones: 7% v 4%, respectively (P = 0.05). The radiation awareness program resulted in a 51% reduction in the estimated radiation exposure to patients during SWL using Medstone lithotripters.

A high-efficiency microwave thermoablation system for the treatment of benign prostatic hyperplasia: results of a randomized, sham-controlled, prospective, double-blind, multicenter clinical trial.

OBJECTIVES: To determine the effectiveness, safety, and impact on patient quality of life (QOL) of a novel transurethral microwave thermoablation system for the treatment of benign prostatic hyperplasia (BPH). METHODS: A total of 169 patients with BPH were randomized to undergo a 1-hour microwave (n = 125) or sham (n = 44) procedure using the Urologix Targis thermoablation system on an outpatient basis, without general or regional anesthesia. Symptoms, flow rates, and QOL scores were determined before the study procedure and periodically thereafter up to 6 months. RESULTS: Mean American Urological Association (AUA) score in the microwave group diminished 50% (P <0.0005) by the 6-month evaluation (10.5, 95% confidence interval [CI] 9.2 to 11.8) compared with baseline values (20.8, 95% CI 19.8 to 21.9). The sham group also exhibited lower postprocedural AUA scores; however, the magnitude of the postprocedural decline in AUA score in the microwave group was significantly greater (P <0.01) than that in the sham group. Half the microwave group had an AUA score of less than 9 by 6 months, and the decrease in symptoms was similar among patients with initially moderate versus initially severe symptoms. Mean peak urinary flow rate (Qmax) in the microwave group increased 51% (P <0.0005) by 6 months to 11.8 mL/s (95% CI 10.7 to 13.0) versus a pretreatment value of 7.8 mL/s (95% CI 7.4 to 8.2). The magnitude of the postprocedural increase in Qmax was significantly greater in the microwave than the sham group (P <0.05). In nearly half the microwave group (47%), Qmax increased 50% or more by 6 months compared with 24% of the sham group. Microwave treatment resulted in a significantly greater (P <0.05) positive impact on patient QOL than did the sham procedure. By 6 months, the QOL score in microwave-treated patients (2.2, 95% CI 1.9 to 2.4) averaged 48% lower (P <0.0005) than that at baseline (4.2, 95% CI 4.0 to 4.4). Significantly greater durability of treatment effects was also evident with microwave than with sham treatment, as judged by the higher proportion of microwave-treated patients (98.4%) requiring no further treatment during the 6-month study period versus 83.3% of sham control patients (P <0.0005). Microwave treatment was well tolerated, and complications were generally minor, readily manageable, and transitory. CONCLUSIONS: The microwave thermoablation system proved to be an effective and safe treatment modality for BPH, with a positive impact on patient QOL.

Signos clínicos de neumonía infantil en niños con otra patología respiratoria. Segunda parte / Clinical signs of pneumonia in children with other respiratory pathology. Part II

Los signos clínicos de neumonía, retracciones y polípnea, han ganado franca aceptación como reconocedores de este problema pero pudiera ser que en algunos lugares de alta densidad poblacional su uso deba ser vigilado en vista de los recientes cambios en el reconocimiento de la fisiología de la enfermedad obstructiva respiratoria y de las modificaciones del medio ambiente.

Signos clínicos de neumonía infantil en niños con otra patología respiratoria / Clinicals signs of pneumonia in children with other respiratory pathology

Los signos de neumonía infantil pueden confundirse, en ciertos casos, con otra enfermedad respiratoria, entre las que predomina la enfermedad obstructiva pulmonar. En este trabajo presentamos los principales lineamientos del programa, y esbozamos algunas sugerencias para mejorar las aplicaciones que tienen las normas del Programa de Control de Infección Respiratoria Aguda.

Riboflavin-sensitized photoprocesses of tryptophan.

The photodegradation of tryptophan in oxygen saturated aqueous solution sensitized by riboflavin is accompanied by the generation of the following reactive oxygen species: 1O2, OH., H2O2 and O2.-. When parallel photodegradation experiments are run with 14C-riboflavin in one case and 14C-tryptophan in the other and the irradiation products are separated by Sephadex G-15 and C18-HPLC, the generation of the following species is detected: aggregate forms of riboflavin, indolic products associated to flavins, indolic products of molecular weight higher than tryptophan, formylkynurenine, and other tryptophan photodecomposition products. The significance of the riboflavin anion radical and tryptophan cation radical as intermediates in the photoproduct formation is discussed.

Extracorporeal shock wave lithotripsy induced stimulation of the obturator nerve.

Extracorporeal shock wave lithotripsy to a left lower third ureteral calculus, 1.4 x 0.9 cm. large, using an unmodified Dornier HM3* lithotriptor with the patient in the sitting position produced thigh adductor movement with each shock. The procedure was terminated. Extracorporeal shock wave lithotripsy was performed uneventfully 1 week later using a Medstone STS lithotriptor with the patient in the supine position. We believe that the sitting position caused increased intra-abdominal pressure in the pelvis resulting in apposition of the ureteral segment containing the calculus to the obturator nerve, which was included either in the second focal point or in the extended shock path of the Dornier HM3 unit.

Riboflavin-photosensitized anaerobic modification of rat lens proteins. A correlation with age-related changes.

When rat lens homogenate or its soluble protein fractions are irradiated in the presence of riboflavin, a photo-adduct is obtained between this vitamin and the lens proteins. Irradiation of these proteins in the presence of riboflavin also leads to a modification in the chromatographic elution pattern with an increase in the high-molecular-weight fraction. In an aging study with rats, it was shown that the proportion of the high-molecular-weight protein fraction significantly increased with age, whereas the proportion of the low-molecular-weight protein fraction concomitantly decreased. It is postulated that aging produces an increase in the accessibility of the tryptophan residues of the lens proteins, as established by iodide fluorescence quenching experiments.

Advantages of handsewn over stapled bowel anastomosis.

Bowel anastomoses are conventionally performed using a handsewn technique or a stapling device. Each has potential benefits and disadvantages. The most clinically significant complications of the bowel anastomosis are anastomotic leakage and stricture formation. The indices of healing and tissue cohesion were compared dynamically over time in 24 dogs randomized to undergo either a standard two-layer handsewn anastomosis or a stapled anastomosis with the Premium CEEA (United States Surgical Corporation, Norwalk, CT). Animals were sacrificed at 1, 4, 7, and 28 days postoperatively. Each anastomosis was evaluated for anastomotic index, burst pressure, collagen content, and histologic appearance. The anastomotic index was similar on postoperative day (POD) 1, 4, and 7; but on day 28 all handsewn anastomoses had larger diameters than the widest CEEA anastomosis. Burst pressure was higher in handsewn anastomoses at all intervals. Collagen content tended to be higher on POD 7 in the CEEA anastomoses. Histological evaluation showed more complete epithelialization and less inflammation in handsewn anastomoses on POD 28. The higher level of collagen in the CEEA anastomoses on POD 7 may be implicated in the tendency toward stricture formation found with this type of anastomosis. This study demonstrates that the greater speed and ease of the stapled anastomosis is offset by the greater strength, reduced tendency to stricture, and more complete healing of the handsewn anastomosis.

Glycolytic component of rat spermatid energy and acid-base metabolism.

The impact of glycolysis on rat spermatid energy metabolism is made apparent by the simultaneous occurrence of the following three events upon glucose addition to the extracellular medium of a rat spermatid cell suspension: decrease in ATP content, exit of acid equivalents, and increased lactate production and efflux. In this work, we have studied the interrelations between these three phenomena. By measuring ATP content, net acid transport, lactate exit, oxygen consumption, intracellular pH, CO2 production, and glycolytic intermediates in the presence of glucose and glucose analogues, we conclude that 1) lactate production, decrease in ATP content, and acid equivalent exit are dependent on the metabolism of glucose up to different stages in glycolysis. 2) The decrease in ATP content is not directly related to the exit of acid equivalents from rat spermatids. 3) Glucose metabolism is a net ATP-consuming process at high intracellular ATP content but is a net ATP-producing process at low intracellular ATP concentration in rat spermatids. 4) Acid equivalent production arises from the metabolism of glucose beyond glyceraldehyde 3-phosphate dehydrogenase. 5) Lactic acid diffusion and/or lactate transport and CO2 production and exit could account for the glucose-dependent acid equivalent efflux in rat spermatids.

Accuracy of ultrasound in diagnosis of rupture after blunt testicular trauma.

In 6 patients who underwent ultrasound scanning and operation after blunt testicular trauma, the scan suggested the correct diagnosis in only 2 patients. There was one false-positive and three false-negative diagnoses of rupture. Absence of firm diagnostic criteria for rupture and high error rates with various criteria now in use make reliance on ultrasound in the diagnosis of testicular rupture inappropriate at this time.