Radiation exposure during TACE procedures using additional cone-beam CT (CBCT) for guidance: safety and precautions.

Background During transarterial chemoembolization (TACE), cone-beam computed tomography (CBCT) can be used for tumor and feeding vessel detection as well as postembolization CT imaging. However, there will be additional radiation exposure from CBCT. Purpose To evaluate the additional dose raised through CBCT-assisted guidance in comparison to TACE procedures guided with pulsed digital subtraction angiography (DSA) alone. Material and Methods In 70 of 140 consecutive patients undergoing TACE for liver cancer, CBCT was used to facilitate the TACE. Cumulative dose area product (DAP), cumulative kerma(air), DAP values of DSA, total and cine specific fluoroscopy times (FT) of 1375 DSA runs, and DAP of 91 CBCTs were recorded and analyzed using Spearman's correlation, Mann-Whitney U-test, and Kruskal-Wallis test. P values < 0.05 were considered significant. Results Additional CBCT increased DAP by 2% ( P = 0.737), kerma(air) by 24.6% ( P = 0.206), and FT by 0.02% ( P = 0.453). Subgroup analysis revealed that postembolization CBCT for detection of ethiodized oil deposits added more DAP to the procedure. Performing CBCT-assisted TACE, DSA until first CBCT contributed about 38% to the total DAP. Guidance CBCT acquisitions conduced to 6% of the procedure's DAP. Additional DSA for guidance after CBCT acquisition required approximately 46% of the mean DAP. The last DSA run for documentation purposes contributed about 10% of the DAP. Conclusion CBCT adds radiation exposure in TACE. However, the capability of CBCT to detect vessels and overlay in real-time during fluoroscopy facilitates TACE with resultant reduction of DAPs up to 46%.

Global analysis of gene expression in maize leaves treated with low temperature. II. Combined effect of severe cold (8 °C) and circadian rhythm.

KEY MESSAGE: In maize seedlings, severe cold results in dysregulation of circadian pattern of gene expression causing profound modulation of transcription of genes related to photosynthesis and other key biological processes. Plants live highly cyclic life and their response to environmental stresses must allow for underlying biological rhythms. To study the interplay of a stress and a rhythmic cue we investigated transcriptomic response of maize seedlings to low temperature in the context of diurnal gene expression. Severe cold stress had pronounced effect on the circadian rhythm of a substantial proportion of genes. Their response was strikingly dual, comprising either flattening (partial or complete) of the diel amplitude or delay of expression maximum/minimum by several hours. Genes encoding central oscillator components behaved in the same dual manner, unlike their Arabidopsis counterparts reported earlier to cease cycling altogether upon cold treatment. Also numerous genes lacking circadian rhythm responded to the cold by undergoing up- or down-regulation. Notably, the transcriptome changes preceded major physiological manifestations of cold stress. In silico analysis of metabolic processes likely affected by observed gene expression changes indicated major down-regulation of photosynthesis, profound and multifarious modulation of plant hormone levels, and of chromatin structure, transcription, and translation. A role of trehalose and stachyose in cold stress signaling was also suggested. Meta-analysis of published transcriptomic data allowed discrimination between general stress response of maize and that unique to severe cold. Several cis- and trans-factors likely involved in the latter were predicted, albeit none of them seemed to have a major role. These results underscore a key role of modulation of diel gene expression in maize response to severe cold and the unique character of the cold-response of the maize circadian clock.

[Teleradiological report turnaround times: An internal efficiency and quality control analysis]. / Teleradiologische Prozess- und Untersuchungszeiten: Eine institutsinterne Effizienz- und Qualitätsanalyse.

AIMS: The teleradiological examinations performed at the Charité were analyzed for the purpose of internal quality and efficiency control. Data included the type and number of examinations performed, the time of day and week the examination was performed and the differences in teleradiologist report turnaround times. MATERIAL AND METHODS: A retrospective analysis of the radiology information system (RIS) database of all teleradiological computed tomography examinations performed at the Charité from 2011 through 2013 was carried out. The search retrieved 10,200 teleradiological examinations which were included in the analysis. The records were analyzed for the time of the day and week the examination was performed, the interval between examination and time of reporting, the type of teleradiological examination and the campus in which they were performed. RESULTS: The number of teleradiological examinations performed increased continuously during the observation period. Computed tomography of the head was the most frequently performed type of examination with 86%. Taking all forms of examination into consideration it took an average of 34 min until a report was written. Over the 3-year observation period the times remained virtually unaltered. CONCLUSION: During the 3-year observation period nearly constant report times could be observed in spite of the increased numbers of examinations. This indicates an efficiency enhancement and rational integration of teleradiology into the radiological workflow.

Percutaneous Large-Bore Pulmonary Thrombectomy with the FlowTriever Device: Initial Experience in Intermediate-High and High-Risk Patients.

OBJECTIVES: This retrospective cohort study investigates outcomes of patients with intermediate-high and high-risk pulmonary embolism (PE) who were treated with transfemoral mechanical thrombectomy (MT) using the large-bore Inari FlowTriever aspiration catheter system. MATERIAL AND METHODS: Twenty-seven patients (mean age 56.1 ± 15.3 years) treated with MT for PE between 04/2021 and 11/2021 were reviewed. Risk stratification was performed according to European Society of Cardiology (ESC) guidelines. Clinical and hemodynamic characteristics before and after the procedure were compared with the paired Student's t test, and duration of hospital stay was analyzed with the Kaplan-Meier estimator. Procedure-related adverse advents were assessed. RESULTS: Of 27 patients treated, 18 were classified as high risk. Mean right-to-left ventricular ratio on baseline CT was 1.7 ± 0.6. After MT, a statistically significant reduction in mean pulmonary artery pressures from 35.9 ± 9.6 to 26.1 ± 9.0 mmHg (p = 0.002) and heart rates from 109.4 ± 22.5 to 82.8 ± 13.8 beats per minute (p < 0.001) was achieved. Two patients died of prolonged cardiogenic shock. Three patients died of post-interventional complications of which a paradoxical embolism can be considered related to MT. One patient needed short cardiopulmonary resuscitation during the procedure due to clot displacement. Patients with PE as primary driver of clinical instability had a median intensive care unit (ICU) stay of 2 days (0.5-3.5 days). Patients who developed PE as a complication of an underlying medical condition spent 11 days (9.5-12.5 days) in the ICU. CONCLUSION: In this small study population of predominantly high-risk PE patients, large-bore MT without adjunctive thrombolysis was feasible with an acceptable procedure-related complication rate.

Switching off for future-Cost estimate and a simple approach to improving the ecological footprint of radiological departments.

PURPOSE: Besides diagnostic imaging devices, in particular computed tomography (CT) and magnetic resonance imaging (MRI), numerous reading workstations contribute to the high energy consumption of radiological departments. It was investigated whether switching off workstations after core working hours can relevantly lower energy consumption considering both ecological and economical aspects. METHODS: Besides calculating different theoretical energy consumption scenarios, we measured power consumption of 3 workstations in our department over a 6-month period under routine working conditions and another 6-month period during which users were asked to switch off workstations after work. Staff costs arising from restarting workstations manually were calculated. RESULTS: Our approach to switching off workstations after core working hours reduced energy consumption by about 5.6 %, corresponding to an extrapolated saving of 3.2 tons in carbon dioxide (CO2) emissions and 2100.70 USD/year in electricity costs for 227 workstations. Theoretical calculations indicate that consistent automatic shutdown after core working hours could result in a potential total reduction of energy consumption of 38.6 %, equaling 22.2 tons of CO2 and 14,388.28 USD/year. However, staff costs resulting from waiting times after manually restarting workstations would amount to 36,280.02 USD/year. CONCLUSIONS: Switching off workstations after core working hours can considerably reduce energy consumption and costs, but varies with user adherence. Staff costs caused by waiting time after manually starting up workstations outweigh energy savings by far. Therefore, an energy-saving plan with automated shutdown/restart besides enabling an energy-saving mode would be the most effective way of saving both energy and costs.

Hepatocellular carcinoma tumor thrombus entering the right atrium treated with combining percutaneous and intravenous high-dose-rate brachytherapy: a case report.

The presented report describes a case of a Hepatocellular carcinoma (HCC) tumor thrombus (TT) infiltrating the inferior vena cava (IVC) and the right atrium (RA) in a 66-year old male patient who initially presented with TT related symptoms. CT-guided high-dose-rate brachytherapy (HDRBT) was performed for both, the intraparenchymal primary and the TT. A marked improvement of the tumor-related symptoms and shrinkage of the tumor mass were achieved six months after treatment initiation. The combination of intravascular and percutaneous HDRBT demonstrating a promising approach to palliate tumor-related symptoms in advanced HCC with macrovascular invasion.

[Hepatitis A in 1998]. / Wirusowe zapalenie watroby typu A w 1998 roku.

2011 cases of hepatitis A were reported in 1998. The incidence rate was estimated to be 5.2 per 100,000; that represents almost 50% decrease compared to the preceding year. The incidence rates within rural and urban populations were similar. The highest incidence rates were reported in the NW and Central parts of the country. 19.6% of all reported cases occurred among children 10-14 years old. Evaluation of the efficacy of vaccination against HAV showed an incidence rate substantially lower in flooded area compared to the neighbouring one during the 1997 deluge. After the deluge epidemic of hepatitis A was not reported.

[Etiology of chronic hepatitis as evaluated by liver biopsy and serum samples submitted to the Department of Immunopathology of the National Institute of Hygiene in 1993-1995]. / Etiologia przewleklych zapalen watroby na podstawie badan biopsji watroby i surowic nadeslanych do Zakladu Immunopatologii Panstwowego Zakladu Higieny w Latach 1993-1995.

The purpose of this study was to assess the relative incidence of chronic hepatitis in a population of patients with chronic liver disease and to determine the etiological spectrum of this syndrome with special reference to its defined histopathological forms. Histopathology aided by immunohistochemistry, and serology aided by the PCR method were employed in studies of liver biopsy specimens and serum samples, respectively. Out of 1150 patients with chronic liver disease examined, chronic hepatitis was diagnosed in 685 (60% of all cases examined). In this group, there were 308 males aged 18-74 yrs (mean 32 yrs), 153 females aged 18-71 yrs (mean 43 yrs), and 213 children aged 1-17 yrs (mean 8 yrs). Viral infections documented in these patients included HBV (50.4%), HCV (36.2%), HBV/HCV (7.2%) and HBV/HDV (0.7%); cryptogenic and autoimmune hepatitis (AIH) accounted for 2.9% and 2.6% all cases, respectively. In the group of minimal hepatitis (16.1%), HBV infection was documented in 66.4% of cases, HCV-in 29.1%, HBV/HCV-in 3.6% (one case of AIH was included into this group). In the group of mild hepatitis (44.2%), HBV infection accounted for 47.3% of cases, HCV-for 41.9%, HBV/HCV-for 9.9%, and 0.9% was diagnosed as cryptogenic. In the group of moderate hepatitis (19.6%), HBV infection accounted for 50% of cases, HCV-for 37.3%, and HBV/HCV-for 4.5%; cases of cryptogenic and AIH accounted for 3.7% and 4.5%, respectively. In the group of severe hepatitis (20.1%), HBV etiology was found in 44.9% of cases, HCV-in 28.3%, HBV/HCV-in 6.5% and HBV/HDV-in 3.6%; cryptogenic and AIH accounted for 6.5% and 8.0% of cases, respectively. There was a high incidence of low-titer autoantibodies (SMA, ANA and LKM) ranging from 75% in cryptogenic hepatitis and 51% in each HBV and HBV/HCV hepatitis to 46.3% in HCV hepatitis.

[Humoral response to HBV antigens in acute and chronic hepatitis B]. / Odpowiedz humoralna na antygeny HBV w ostrym i przewleklym wir usowym zapaleniu watroby typu B.

Sera of patients with acute and chronic hepatitis B and antigenemia were tested for the presence of anti-HBe and anti-HBs antibodies, free or bound in immune complexes. The possible occurrence of immune complexes of HBcAg in these sera was also investigated. Immune complexes were identified by antigen specific enzyme immunoassay, in which polyclonal antibodies against synthetic fragments of proteins S and C of HBV and mono- and polyclonal anti-HBc antibodies were used as a solid phase. Free and/or antigen bound anti-HBe antibodies were detected in 100% of patients with acute (81% HBeAg positive) and in 37% of patients with chronic hepatitis, all HBeAg positive. Anti-HBs antibodies or their immune complexes were found in 83% and 37% of patients, respectively. In not any patient circulating complexes of HBcAg could be identified. The results obtained support the observations that humoral immune response to HBeAg and HBsAg can be detected earlier than generally accepted; they also suggest that the detection of anti-HBs in a single sample of serum should not be considered as the evidence of elimination of infection.

[Treatment in XIIth c. Poland according to medical writings of Nicholas of Poland]. / Leczenie w trzynastowiecznej polsce wedlug pism lekarskich mikolaja z Polski.

The authors present the person of Mikolaj of Poland, a thirteenth century doctor, connected with the Princes of Pomerania and Greater Poland, educated in France, and known from his two major writings, Antipocras (Anti-Hypocrates) and Experimenta. On the background of medieval medicine, the methods of healing he suggested appear as unusual and unconventional. He healed with amulets, mud, dung, river and sea water, frogs, moles, vipers, flies and worms. Using them, he produced powders, pills, ointments and oils which were to have outstanding healing results. They were to be used in lithiasis, skin irritations, nephritis, hepatitis, deafness, epilepsy, and toothache. Women might use them as cosmetics, too. Considering thirteenth century medicine, Mikolaj with no doubts represents medieval medical "empiry", creating an interesting alternative against official standards binding doctors of that time.

[Rational laboratory diagnosis of cholestasis syndrome]. / Rationale Laboratoriumsdiangostik des Cholestase-Syndroms.

Laboratory diagnostics efficiently applied is of decisive importance for a great deal of questions in spite of the technical and endoscopic methods which are available today in the field of examinations. By means of a screening programme consisting of ALAT, gamma-GT, ChE at a sensitivity of > 90% alterations in both the hepatobiliary system and cholestasis can be recognized with sufficient reliability. Clinical data and a defined laboratory routine programme as a second step in diagnostics results in reliable indication for distinction between obstructive and non-obstructive cholestasis which can be promoted by computer-aided techniques. On the basis of such pre-selections special laboratory methods (differential diagnosis of consecutive non-obstructive cholestasis in liver diseases) or invasive methods to clarify their reason and localization diagnostics of biliary obstruction can then be applied in a well-directed manner to obtain a definite nosologic diagnosis. Effective diagnostic procedures in this three-step programme are described.

Evaluation of HBV and HCV antigens expression in correlation with HBV DNA and HCV RNA occurrence in liver biopsy specimens of patients with chronic hepatitis type B and chronic hepatitis type C, respectively.

MATERIAL AND METHODS: The material studied consisted of single liver biopsy specimens and serum samples from 97 patients diagnosed by clinical and serological criteria as having chronic hepatitis of either type B (38 patients seropositive for HBsAg) or type C (59 patients seropositive for anti-HCV). Diagnosis of chronic hepatitis, including grading and staging of the process, was established by histopathological examination of routinely stained serial paraffin sections. The expression of HBV and HCV antigens was detected in frozen sections by amplified immunoperoxidase method (EnVision, DAKO) with the use of monoclonal anti-HBs antibodies (DAKO), polyclonal anti-HBc antibodies (Biogenex) and FITC-labeled human antibodies to HCV antigens. HBV DNA and HCV RNA were searched for in tissue homogenates with PCR (In Gen; Terpol, Sieradz) and RT PCR (Cobas Amplicor HCV RNA, Roche), respectively. RESULTS: HBsAg was detected in all and HBcAg in 26 of the 38 biopsy specimens with chronic hepatitis type B from patients who were seropositive for HBsAg and anti-HBc, and for either HBeAg (25 cases) or anti-HBe (13 cases). HBV DNA was identified in 32 out of 38 liver biopsy specimens. Out of the 32 HBV DNA positive specimens, 6 that had been obtained from patients seropositive for anti-HBe, lacked HBcAg expression. HCV antigens were found in 27 (50%) out of 54 specimens which showed the presence of HCV RNA. CONCLUSIONS: These results are indicative for a strong positive correlation between the expression of HBV antigens and that of HBV DNA in liver biopsy specimens. The detection of HCV antigens has proved to positively correlate with that of HCV RNA in 50% of the specimens examined. It appears, therefore, that testing of liver biopsy specimens for HBV and HCV antigens may, in a significant proportion of cases, extend the histopathological diagnosis as to include identification of the etiologic factor.

Cloning and sequencing of full-length cDNAs of RNA1 and RNA2 of a Tomato black ring virus isolate from Poland.

Full-length cDNA clones corresponding to the RNA1 and RNA2 of the Polish isolate MJ of Tomato black ring virus (TBRV, genus Nepovirus) were obtained using a direct recombination strategy in yeast, and their complete nucleotide sequences were established. RNA1 is 7358 nucleotides and RNA2 is 4633 nucleotides in length, excluding the poly(A) tails. Both RNAs contain a single open reading frame encoding polyproteins of 254 kDa and 149 kDa for RNA1 and RNA2 respectively. Putative cleavage sites were identified, and the relationships between TBRV and related nepoviruses were studied by sequence comparison.