Intraoperative fluorescence perfusion assessment should be corrected by a measured subject-specific arterial input function.

SIGNIFICANCE: The effects of varying the indocyanine green injection dose, injection rate, physiologic dispersion of dye, and intravenous tubing volume propagate into the shape and magnitude of the arterial input function (AIF) during intraoperative fluorescence perfusion assessment, thereby altering the observed kinetics of the fluorescence images in vivo. AIM: Numerical simulations are used to demonstrate the effect of AIF on metrics derived from tissue concentration curves such as peak fluorescence, time-to-peak (TTP), and egress slope. APPROACH: Forward models of tissue concentration were produced by convolving simulated AIFs with the adiabatic approximation to the tissue homogeneity model using input parameters representing six different tissue examples (normal brain, glioma, normal skin, ischemic skin, normal bone, and osteonecrosis). RESULTS: The results show that AIF perturbations result in variations in estimates of total intensity of up to 80% and TTP error of up to 200%, with the errors more dominant in brain, less in skin, and less in bone. Interestingly, error in ingress slope was as high as 60% across all tissue types. These are key observable parameters used in fluorescence imaging either implicitly by viewing the image or explicitly through intensity fitting algorithms. Correcting by deconvolving the image with a measured subject-specific AIF provides an intuitive means of visualizing the data while also removing the source of variance and allowing intra- and intersubject comparisons. CONCLUSIONS: These results suggest that intraoperative fluorescence perfusion assessment should be corrected by patient-specific AIFs measured by pulse dye densitometry.

Risk factors and seroprevalence of hepatitis E evaluated in frozen-serum samples (2002-2003) of pregnant women compared with female blood donors in a Southern region of Brazil.

Hepatitis E has always been related to morbidity in pregnant women. Its epidemiology is not well understood in Brazil. Therefore, we tested sera from 209 pregnant women and 199 female blood donors, collected at a single center in Curitiba, Brazil. The Wantai assay was used for testing the anti-hepatitis E virus (anti-HEV), immunoglobulin G (IgG), and an in-house polymerase chain reaction process for testing HEV RNA. Anti-HEV was detected in 22.5% of the total group, 19% in the pregnant women group, and 26% in the blood donor group (P = 0.11), a much higher prevalence when compared with other studies in Brazil. Demographical analysis showed that 92.4% were born in the South Region of Brazil, 4.9% in the Southeast, and 2.7% were distributed over other regions of the country. With respect to their origin, 99% were from the South, 0.7% from the Southeast, and 0.2% from the Central-West regions. Income, education, race, number of pregnancies, and abortion did differ significantly when comparing both the groups (P < 0.001). Age >30 (P = 0.012) and the number (>3) of pregnancies (P = 0.008) were related to anti-HEV positivity. All anti-HEV IgG-positive females were HEV RNA negative. In conclusion, HEV positivity was found in one out of five young women, which showed an urgent need for further epidemiological studies in Brazil.

Central xanthoma of the jaw in association with Noonan syndrome.

Xanthomas are histiocytic lesions of the skin, soft tissue, and bone and are generally considered to be reactive in nature. When they arise in the bones of the jaw, they are referred to as central xanthomas. New evidence supports the hypothesis that central xanthomas are a separate and distinct entity from their extragnathic counterparts. Noonan syndrome (NS) is an autosomal dominant disorder that has been associated with giant cell lesions, which also commonly occur in the jaw. We present a case of a 15-year-old boy with NS who presented with a radiolucent lesion of the mandible that on excision was found to be a central xanthoma. Although giant cell lesions have been well described in NS, xanthomas of the jaw have not been reported. We will also discuss the entities that must be excluded before making a diagnosis of central xanthoma, as this can affect both treatment and follow-up.

Migratory-stage sea lamprey Petromyzon marinus stop responding to conspecific damage-released alarm cues after 4 h of continuous exposure in laboratory conditions.

This study investigated the length of avoidance response of migratory-stage sea lamprey Petromyzon marinus exposed continuously to conspecific damage-released alarm cues for varying lengths of time in laboratory stream channels. Ten replicate groups of P. marinus, separated by sex, were exposed to either deionized water control or to P. marinus extract for 0, 2 or 4 h continuously. Petromyzon marinus maintained their avoidance response to the conspecific damage-released alarm cue after continuous exposure to the alarm cue for 0 and 2 h but not 4 h. Beyond being one of the first studies in regards to sensory-olfactory adaptation-acclimation of fishes to alarm cues of any kind, these results have important implications for use of conspecific alarm cues in P. marinus control. For example, continuous application of conspecific alarm cue during the day, when P. marinus are inactive and hiding, may result in sensory adaptation to the odour by nightfall when they migrate upstream.

Time of Dropout From the Liver Transplant List in Patients With Hepatocellular Carcinoma: Clinical Behavior According to Tumor Characteristics and Severity of Liver Disease.

BACKGROUND: Prolonged time on the waiting list affects post-transplant survival of patients with hepatocellular carcinoma (HCC). However, it is not yet known which patients will be at higher risk for early dropout from the list. We investigate specific risk factors for early waiting list dropout in patients with HCC. METHODS: This was a single-center, intention-to-treat analysis of adults with HCC, within the Milan criteria, from July 2006 through September 2013. Patients were divided into groups according to waiting list time. The main end point was dropout from the list. RESULTS: The dropout rates of the study cohort at 3, 6, and 12-months were 6.4%, 12.4%, and 17.7%, respectively. Patients who dropped out from the list tended to be older, with blood types A and O, and with higher Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. They also had larger nodules, responded poorly to trans-arterial chemo-embolization (TACE), and had a higher alpha-fetoprotein. Those with blood types B and AB appeared to be protected for dropout (odds ratio [OR] = 0.21, P = .02). Patients who responded to TACE were also protected (OR = 0.22, P < .001). When we looked into time to dropout, the only baseline characteristic that stood out was a higher MELD score (13 for those dropping out up to 90 days vs 10 for those dropping out after 180 days, P = .0025). CONCLUSIONS: We conclude that patients who drop out early from the list are primarily driven by the severity of liver disease. Patients who had progressive HCC had a high tumor load and poor response to loco-regional therapies, dropping out from the list after 180 days of inclusion.

Assessment of biophysical therapy in the management of pain in current medical practice compared with ibuprofen and placebo: a pilot study.

Pain management is a daily part of current medical practice. The aim of this pilot study was to assess the efficacy of a biophysical procedure (Med Select 729) compared to a usual pain killer drug (Ibuprofen), and to placebo in order to disclose some effective procedures to be employed especially in elderly people with multiple comorbidities, in patients with allergy to chemical drugs or previous side effects, in non-responders to usual medications, and in chronic diseases to reduce overload. A total of 66 patients were divided in 3 groups. After one week of biophysical therapy they showed similar effect to ibuprofen and after one month the statistical significance was achieved with p less than 0.02 in comparison to placebo. We conclude that biophysical therapy was shown to be an effective and safe procedure for the management of pain in current medical practice.

The behavioural response of adult Petromyzon marinus to damage-released alarm and predator cues.

Using semi-natural enclosures, this study investigated (1) whether adult sea lamprey Petromyzon marinus show avoidance of damage-released conspecific cues, damage-released heterospecific cues and predator cues and (2) whether this is a general response to injured heterospecific fishes or a specific response to injured P. marinus. Ten replicate groups of 10 adult P. marinus, separated by sex, were exposed to one of the following nine stimuli: deionized water (control), extracts prepared from adult P. marinus, decayed adult P. marinus (conspecific stimuli), sympatric white sucker Catostomus commersonii, Amazon sailfin catfish Pterygoplichthys pardalis (heterospecific stimuli), 2-phenylethylamine (PEA HCl) solution, northern water snake Nerodia sipedon washing, human saliva (predator cues) and an adult P. marinus extract and human saliva combination (a damage-released conspecific cue and a predator cue). Adult P. marinus showed a significant avoidance response to the adult P. marinus extract as well as to C. commersonii, human saliva, PEA and the adult P. marinus extract and human saliva combination. For mobile P. marinus, the N. sipedon washing induced behaviour consistent with predator inspection. Exposure to the P. pardalis extract did not induce a significant avoidance response during the stimulus release period. Mobile adult female P. marinus showed a stronger avoidance behaviour than mobile adult male P. marinus in response to the adult P. marinus extract and the adult P. marinus extract and human saliva combination. The findings support the continued investigation of natural damage-released alarm cue and predator-based repellents for the behavioural manipulation of P. marinus populations in the Laurentian Great Lakes.

Akaline, saline and mixed saline-alkaline stresses induce physiological and morpho-anatomical changes in Lotus tenuis shoots.

Saline, alkaline and mixed saline-alkaline conditions frequently co-occur in soil. In this work, we compared these plant stress sources on the legume Lotus tenuis, regarding their effects on shoot growth and leaf and stem anatomy. In addition, we aimed to gain insight on the plant physiological status of stressed plants. We performed pot experiments with four treatments: control without salt (pH = 5.8; EC = 1.2 dS·m(-1)) and three stress conditions, saline (100 mM NaCl, pH = 5.8; EC = 11.0 dS·m(-1)), alkaline (10 mM NaHCO3, pH = 8.0, EC = 1.9 dS·m(-1)) and mixed salt-alkaline (10 mM NaHCO3 + 100 mM NaCl, pH = 8.0, EC = 11.0 dS·m(-1)). Neutral and alkaline salts produced a similar level of growth inhibition on L. tenuis shoots, whereas their mixture exacerbated their detrimental effects. Our results showed that none of the analysed morpho-anatomical parameters categorically differentiated one stress from the other. However, NaCl- and NaHCO3 -derived stress could be discriminated to different extents and/or directions of changes in some of the anatomical traits. For example, alkalinity led to increased stomatal opening, unlike NaCl-treated plants, where a reduction in stomatal aperture was observed. Similarly, plants from the mixed saline-alkaline treatment characteristically lacked palisade mesophyll in their leaves. The stem cross-section and vessel areas, as well as the number of vascular bundles in the sectioned stem were reduced in all treatments. A rise in the number of vessel elements in the xylem was recorded in NaCl-treated plants, but not in those treated exclusively with NaHCO3.

The role of secondary surgery in recurrent ovarian cancer.

Despite optimal treatment (complete cytoreduction and adjuvant chemotherapy), 5-year survival for advanced ovarian cancer is approximately 30% and most patients succumb to their disease. Cytoreductive surgery is accepted as a major treatment of primary ovarian cancer but its role in recurrent disease is controversial and remains a field of discussion mainly owing to missing data from prospective randomized trials. A critical review of literature evidence on secondary surgery in recurrent ovarian cancer will be described.

Fiebre periódica, estomatitis aftosa, faringitis y adenitis: síndrome PFAPA en Argentina / Periodic fever, aphthous stomatitis, pharyngitis and adenitis: PFAPA syndrome in Argentina

Introducción: El síndrome PFAPA es una patología benigna, no hereditaria, de etiología y patogenia desconocidas. Hay pocas publicaciones sobre esta fiebre periódica en Sudamérica. El propósito es comunicar la experiencia en un gran hospital pediátrico de Argentina. Pacientes y métodos: Se diagnosticó PFAPA a 18 pacientes atendidos entre enero de 2002 y junio de 2009, en los Consultorios de Mediano Riesgo del Hospital de Pediatría Prof. Dr. Juan P. Garrahan, de la Ciudad de Buenos Aires. Se utilizaron los criterios de Thomas et al modificados. El seguimiento continuó con la evaluación en los nuevos episodios febriles, citaciones y comunicaciones telefónicas. Resultados: La edad promedio al inicio fue de 2,5 años (rango: 0,4-7,5) y transcurrieron en promedio 3,2 años (rango: 0,4-10,9) hasta el diagnóstico. Los episodios febriles duraban en promedio 4,5 días (rango: 2-8) y el intervalo medio entre el comienzo de las crisis fue de 23 días (rango: 15-30). Los ataques febriles cedieron con metilprednisona a 1mg/kg o betametasona a 0,15mg/kg en dosis única. Con una media de seguimiento de 2,6 años (rango: 0,5–5,9), 13 pacientes continúan con episodios febriles a intervalos promedio de 4,6 meses (rango: 1-12). Se consideran curados a 5 pacientes que no tuvieron crisis febriles por más de un año durante el período del estudio; en ellos, la enfermedad tuvo un promedio de duración de 4,7 años (rango: 1-9,7). Conclusiones: El síndrome PFAPA es una patología esporádica, cuyo reconocimiento suele ser dificultoso. La metilprednisona y la betametasona han mostrado ser efectivas para controlar los síntomas de las crisis febriles. La remisión definitiva del síndrome puede ocurrir en los primeros años de evolución; aunque en la mayoría de los pacientes los episodios febriles continúan con aumento de los intervalos libres y atenuación de los síntomas, y la curación sin secuelas en edades prepuberales o en la adolescencia (AU)

Introduction: PFAPA syndrome is a benign, non-hereditary condition, of unknown etiology and pathogenesis. There are few reports of it in South America. The purpose of this article is to communicate the experience in a large pediatric hospital in Argentina. Patients and methods: A total of 18 patients were diagnosed with PFAPA between 2002 and 2009 at the Medium Risk Clinic, Prof. Dr. Juan P. Garrahan Pediatrics Hospital, Buenos Aires City. The modified criteria reported by Thomas et al were used for diagnosis. The follow up continued with evaluations during new febrile episodes, clinic check ups and telephone calls. Results: The mean age at onset of symptoms was 2.5 years (range: 0.4–7.5) and the mean lag time from onset of symptoms and diagnosis was 3.2 years (range: 0.4-10.9). Fever episodes lasted for a mean of 4.5 days (range: 2-8), with a mean interval of 23 days (range: 15-30) between the beginning of the attacks. Febrile episodes were treated with methyl prednisone at a dose of 1mg/kg or betamethasone at a dose of 0.15mg/kg in a single dose. With a mean follow up of 2.6 years (range: 0.5–5.9) 13 patients remain with febrile episodes at a mean interval of 4.6 months (range: 1-12). Five patients did not have febrile crisis for more than a year during the study period and they are considered cured; in this group the disease lasted a mean of 4.7 years (1-9.7). Conclusions: PFAPA syndrome is a sporadic, difficult to diagnose, condition. Both methyl-prednisone and betamethasone have shown to be effective in controlling the symptoms during the febrile crisis. The definitive remission of the syndrome may occur in the first years of onset, although in most patients the febrile episodes continue with an increase of free intervals and attenuated symptoms, and full recovery in prepuberty or adolescence with no sequelae (AU)

[Periodic fever, aphthous stomatitis, pharyngitis and adenitis: PFAPA syndrome in Argentina]. / Fiebre periódica, estomatitis aftosa, faringitis y adenitis: síndrome PFAPA en Argentina.

INTRODUCTION: PFAPA syndrome is a benign, non-hereditary condition, of unknown etiology and pathogenesis. There are few reports of it in South America. The purpose of this article is to communicate the experience in a large pediatric hospital in Argentina. PATIENTS AND METHODS: A total of 18 patients were diagnosed with PFAPA between 2002 and 2009 at the Medium Risk Clinic, Prof. Dr. Juan P. Garrahan Pediatrics Hospital, Buenos Aires City. The modified criteria reported by Thomas et al were used for diagnosis. The follow up continued with evaluations during new febrile episodes, clinic check ups and telephone calls. RESULTS: The mean age at onset of symptoms was 2.5 years (range: 0.4-7.5) and the mean lag time from onset of symptoms and diagnosis was 3.2 years (range: 0.4-10.9). Fever episodes lasted for a mean of 4.5 days (range: 2-8), with a mean interval of 23 days (range: 15-30) between the beginning of the attacks. Febrile episodes were treated with methyl prednisone at a dose of 1mg/kg or betamethasone at a dose of 0.15mg/kg in a single dose. With a mean follow up of 2.6 years (range: 0.5-5.9) 13 patients remain with febrile episodes at a mean interval of 4.6 months (range: 1-12). Five patients did not have febrile crisis for more than a year during the study period and they are considered cured; in this group the disease lasted a mean of 4.7 years (1-9.7). CONCLUSIONS: PFAPA syndrome is a sporadic, difficult to diagnose, condition. Both methyl-prednisone and betamethasone have shown to be effective in controlling the symptoms during the febrile crisis. The definitive remission of the syndrome may occur in the first years of onset, although in most patients the febrile episodes continue with an increase of free intervals and attenuated symptoms, and full recovery in prepuberty or adolescence with no sequelae.

Quantitative and mid-infrared changes of humic substances from burned soils.

The humic substances are an abundant and important part of soil organic matter which plays many roles in ecosystems. On the other hand, forest fires are known to have a potential impact on the soil organic matter. Consequently, we chose to study the impact of forest fires on humic substances and the three relevant fractions, e.g. humic acids (HA), fulvic acids (FA) and non-humified fraction (NHF), NHF being the fulvic acids not adsorbed on XAD-8 resins. The studied site is a Mediterranean forest called "Maures Mountains", in France, where 30 sites were sampled in two layers: 0-5 and -5 to 15 cm. In order to validate the method, the 2 horizons from 5 sites randomly chosen were analyzed in triplicates. The extraction and fractionation procedures were achieved using alkali- and acid-solutions. The measurement of total organic carbon (TOC) using the TOC-meter and the use of Fourier transform infra-red (FTIR) spectroscopy gave us quantitative and qualitative results to evaluate the impact of forest fires and the role of their repetition. The results show that the fires led to significant decreases (Student test, P=0.05) of humic substances (HS), HA and of the fulvic fractions (FF=FA+NHF) in surface layers, corresponding to 40%, 34% and 35%, respectively. Moreover, the significant HA/FF ratio increases (Student test, P=0.05), as a result of the fire, indicate that NHF was probably transformed in FA-like compounds. About the qualitative impact, the results showed a significant decrease of alkyl and hydroxyl groups (OH), carboxylic acids and carbohydrates in HA after a wildfire, whereas the decrease was significant only for alkyl groups and carboxylic acids in FA. Lastly, the design of this work (control and burned sites, number of samples, time elapsed after fires, etc.) enables one to show the recovery of the Mediterranean forest ecosystem. FA quality and OH groups in HA are recovered between 3 and 16 years after the fire whereas alkyl groups, carboxylic acids and carbohydrates in HA as well as HS contents are not returned to the control state 16 years after the last fire.

Intraosseous ameloblastoma.

Ameloblastomas are benign slow-growing aggressive neoplasms with a poorly understood potential for rare metastasis. They are capable of reaching large sizes with extensive local bone erosion and destruction. They are composed of a mixture of ameloblastic epithelium and mesenchyme and arise from rests of outer and inner enamel epithelium and dental lamina. Microscopically, ameloblastomas are recognizable from their recapitulation of embryologic ameloblasts and stellate reticulum. There are 3 subtypes: the conventional or solid-multicystic variant, the unicystic variant, and the desmoplastic variant. Treatment planning for a given tumor includes consideration of location, primary versus recurrent, size, presence of cortical perforation, and age and health of the patient. Complete excision is recommended for conventional and desmoplastic variants. The unicystic variant requires additional subtyping to determine the best treatment approach.

Early experience with laparoscopic major liver resections: a case-comparison study.

Laparoscopic major liver resections are regarded as demanding operations whose convenience is still under evaluation. The aim of the present study was to report our early experience and to describe surgical technique of laparoscopic major liver resections. Study group consisted of 6 female patients with benign disease and a mean age of 40.5 years, who underwent right hepatectomy in 4 cases and left hepatectomy in 2 cases. No mortality was observed. Morbidity consists in 1 biliary fistula that requires rehospitalization and a new laparoscopic operation. The mean operative time was of 201.7 minutes, with a mean hospital stay of 5.5 days. The authors conclude that laparoscopic major liver resections could be performed, at least for benign disease and by surgeons experienced in laparoscopy, with good results. Nevertheless, further studies are required before to draw definitive conclusions, especially for neoplastic patients who represent the most relevant group.

Prevalencia de trastornos del desarrollo en consultorios de mediano riesgo del Hospital Garrahan / Prevalence of developmental disorders in patients seen at the aoutpatient clinic of the Garrahan Hospital

Los trastornos del desarrollo son problemas relevantes y de gran impacto para la familia y la sociedad. Según Glascoe aproximadamente el 15-18 por ciento de los niños en Estados Unidos tienen alteración del desarrollo o de la conducta. Los datos en países en vías de desarrollo son muy escasos. Objetivos. Determinar la prevalencia de trastornos del desarollo (TD) en niños de 1 año a 5 años, 11 meses y 29 días que asisten al consultorio de Mediano Riesgo (MR) del hospital de Pediatría Juan P. Garrahan. diferenciar y caracterizar a los niños con trastorno del desarrollo evidente o sospechoso. Materiales y métodos: Estudio de corte transversal, prospectivo y descriptivo realizado entre 07/2007 y 03/2008. Se incluyeron pacientes de 1 año a 5 años 11 meses y 29 días que consultaron al sector de Mediano Riesgo con trastornos del desarrollo evidente o sospechoso por evaluación clínica asistemática o presencia de factores de riesgo. Los evidentes fueron derivados para evaluación especifica del desarrollo. A los sospechosos se les realizó un interrogatorio del desarrollo y se les administró la prueba de pesquisa PRUNAPE. Resultados: Sobre un total de 922 pacientes elegidos al azar, el 45.5 por ciento (N=420) fueron incluidos por presentar alteraciones evidentes o sospechosas de trastornos del desarrollo para la población elegida en ese período fue del 20 por ciento (N=186) para los evidentes y 17.5 por ciento (N=161) para los sospechosos. Del grupo de pacientes sospechosos (N=161), el 62.2 por ciento (N=100) no pasó la prueba de pesquisa o presentó algún tipo de trastorno de conducta o disfluencia, que requirió intervención terapéutica orientada por el pediatra. Cuando la sospecha fue de los padres (N=20): un 75 por ciento falló en la PRUNAPE (N=15), un niño presentó trastorno de la conducta que requirió intervención terapéutica (N=1) y un niño disfluencia o trartamudez (N=1).

Experience with railroad injuries at a major urban trauma center serving the United States-Mexico border.

BACKGROUND: In the United States (US), railroads are commonly used to transport humans and commerce, especially along the US-Mexico border. Some people will use freight trains to travel within the US. Some of these people will suffer a train-related injury with extensive soft tissue and bone trauma. There is little information about the demographics, injuries, or outcomes of these patients, and the financial expense of providing care for these individuals. We attempt to provide insight into some of these issues. METHODS: We performed a retrospective chart review of patients from the University of Texas Health Science Center at San Antonio from January 1996 to September 2003. Various demographic, total hospital costs, operative procedures, and outcomes were examined. RESULTS: Men were well represented (61 of 67 patients), and the overall mean age was 28.8 years. Hispanics (58 of 67 patients) were the main ethnic group and 61% were undocumented aliens (41 of 67 patients). Bony and soft tissue injuries were common, necessitating an amputation in 38 patients. The mean operative procedures per patient were 2.97. Follow-up was poor. Total hospital cost for all the patients was $2,468,004.47 with a mean of $36,835.89 ($1,305.00-$331, 452.74) per patient. CONCLUSION: Victims of train-related injuries were predominantly young and male. Many patients required an amputation. Multistaged and complex reconstructive procedures may not be realistic in a group of patients in whom follow-up is poor.

Inferior vena cava filter ensnarement by central line guide wires--a report of 4 cases and brief review.

Ensnarement of inferior vena cava filters with central line guide wires is an infrequent complication that has been sporadically reported. The authors present 4 patients who experienced this complication. They review the literature, make recommendations to avoid this preventable complication, and recommend what to do once the complication occurs.