Apical lymph node dissection of the inferior mesenteric artery.

AIM: It is controversial whether a high or low ligation of the inferior mesenteric artery (IMA) is superior. The former allows an extended lymph node clearance whereas the latter preserves the distal vascular supply via the left colic artery (LCA). Apical lymph node dissection of the IMA (ALMA) harvests nodal tissue along the IMA proximal to the LCA whilst performing a low ligation. This anatomically replicates the oncological benefit of high ligation and the vascular preservation of low ligation. Our study evaluates the nodal yield of ALMA and the short-term outcome of this technique. METHOD: We retrospectively studied 19 patients with sigmoid or rectal cancer who underwent curative surgical resection with ALMA. All ALMAs were performed with a standard technique previously described (Kobayashi et al., Surg Endosc 2005, 20:563-9; Sekimoto et al. Surg Endosc 2010, 25:861-6) . The lymph node yield from the dissection (the ALMA specimen) was compared with the total lymph node yield. Data on the LCA anatomy, time required to perform ALMA, complications and postoperative recovery were evaluated. RESULTS: ALMA was successful in 18 patients. Median postoperative hospitalization was 5 (2-26) days without ALMA-related morbidity or mortality. The median lymph node yield was 20 (9-41) and a median of 14.3 (0-80)% were harvested with ALMA. Two patients not having neoadjuvant chemoradiotherapy had fewer than 12 lymph nodes, excluding nodes harvested from ALMA. The average time required for ALMA was 18 min. CONCLUSION: ALMA is a safe and feasible technique, allowing extended lymphadenectomy without sacrificing the LCA. In this small group of patients none were upstaged due to cancerous involvement of the proximal nodes.

The effect of spent coffee ground (SCG) loading, matrix ratio and biological treatment of SCG on poly(hydroxybutyrate) (PHB)/poly(lactic acid) (PLA) polymer blend.

This study investigates the effects of SCG embedded into biodegradable polymer blends and aimed to formulate and characterise biomass-reinforced biocomposites using spent coffee ground (SCG) as reinforcement in PHB/PLA polymer blend. The effect of SCG filler loading and varying PHB/PLA ratios on the tensile properties and morphological characteristics of the biocomposites were examined. The results indicated that tensile properties reduction could be due to its incompatibility with the PHB/PLA matrixSCG aggregation at 40 wt% content resulted in higher void formation compared to lower content at 10 wt%. A PHB/PLA ratio of 50/50 with SCG loading 20 wt% was chosen for biocomposites with treated SCG. Biological treatment of SCG using Phanerochaete chrysosporium CK01 and Aspergillus niger DWA8 indicated P. chrysosporium CK01 necessitated a higher moisture content for optimum growth and enzyme production, whereas the optimal conditions for enzyme production (50-55 %, w/w) differed from those promoting A. niger DWA8 growth (40 %, w/w). SEM micrographs highlighted uniform distribution and effective wetting of treated SCG, resulting in improvements of tensile strength and modulus of biocomposites, respectively. The study demonstrated the effectiveness of sustainable fungal treatment in enhancing the interfacial adhesion between treated SCG and the PHB/PLA matrix.

Quantifying the effectiveness of ultraviolet-C light at inactivating airborne Mycobacterium abscessus.

BACKGROUND: Mycobacterium abscessus (MABS) group are environmental organisms that can cause infection in people with cystic fibrosis (CF) and other suppurative lung diseases. There is potential for person-to-person airborne transmission of MABS among people with CF attending the same care centre. Ultraviolet light (band C, UV-C) is used for Mycobacterium tuberculosis control indoors; however, no studies have assessed UV-C for airborne MABS. AIM: To determine whether a range of UV-C doses increased the inactivation of airborne MABS, compared with no-UVC conditions. METHODS: MABS was generated by a vibrating mesh nebulizer located within a 400 L rotating drum sampler, and then exposed to an array of 265 nm UV-C light-emitting diodes (LED). A six-stage Andersen Cascade Impactor was used to collect aerosols. Standard microbiological protocols were used for enumerating MABS, and these quantified the effectiveness of UV-C doses (in triplicate). UV-C effectiveness was estimated using the difference between inactivation with and without UV-C. FINDINGS: Sixteen tests were performed, with UV-C doses ranging from 276 to 1104 µW s/cm2. Mean (±SD) UV-C effectiveness ranged from 47.1% (±13.4) to 83.6% (±3.3). UV-C led to significantly greater inactivation of MABS (all P-values ≤0.045) than natural decay at all doses assessed. Using an indoor model of the hospital environment, it was estimated that UV-C doses in the range studied here could be safely delivered in clinical settings where patients and staff are present. CONCLUSION: This study provides empirical in-vitro evidence that nebulized MABS are susceptible to UV-C inactivation.

The identification of MHC identical siblings without HLA typing.

By comparing genomic sequences of different MHC haplotypes, we defined highly polymorphic markers. After amplification, electrophoresis, and scanning with a laser, we have identified profiles that serve as signatures of the haplotype and its component alleles. One set of markers can be used to define the block that includes HLA-B and HLA-C, among other loci. Another set provides signatures for the entire HLA-DR and -DQ multigene cluster. By profile overlay, it is possible to identify siblings who share both haplotypes from HLA-C to HLA-DQ. Here we demonstrate the value of genomic analysis ("block matching") in selecting genotypically identical siblings prior to transplantation. Forty-six siblings from 10 families were genotyped by family analysis after meticulous HLA, C4, and Bf typing including molecular methods for HLA-DRB1. In 43 siblings, the haplotype assignments were unequivocal. Twenty-two identical sibling pairs could then be compared with 77 nonidentical pairs. Independent genomic analysis yielded entirely concordant results. In three siblings, the possibility of parental recombination was considered but could not be defined by the conventional typing. By genomic analysis, however, it was clear that recombination had indeed occurred in one case. In the remaining two cases, additional, more telomeric markers will be necessary to resolve the issue. This simple, cost-effective method has immediate application to the identification of matched pairs (HLA-C to HLA-DQ) for bone marrow and renal transplantation.

Sequence analysis of the MHC class I region reveals the basis of the genomic matching technique.

The genomic matching technique (GMT) improves survival following bone marrow transplantation (BMT) between unrelated donor and recipient pairs correlating with a decrease in incidence and severity of graft-versus-host disease (GvHD). The principles of this technique are based on the duplication and polymorphic characteristics of the major histocompatibility complex (MHC). Specifically, the beta block GMT matches for a 300 kb region that contains the human leukocyte antigen (HLA-B and -C) genes as well as other non-HLA genes such as the natural killer cell receptor ligand PERB11 (MIC). The block contains two large segmental duplications. One results in two PERB11 genes (11.1 and 11.2), the other in two class I genes (HLA-B and -C). With the complete sequencing of the class I region of the MHC in different haplotypes, we can now show that the beta block GMT profiles reflect amplification of the duplicated PERB11 segments and not the duplicated segments containing HLA-B and -C, and yet provide a signature that characterizes the entire block rather than individual loci.

Histocompatibility matching for bone marrow transplantation. Donor-recipient pairs in the 4AOHW cell panel.

While the results of unrelated bone marrow transplantation are continually improving, a number of important issues remain: what are the histocompatibility requirements, what genes are involved, what mismatches are acceptable, and what are the best methods for determining donor-recipient match? In this study of material provided through the 4AOHW and the US NMDP, the match between 53 donor-recipient pairs was determined using several different markers within the MHC. The data showed that many apparently well-matched pairs have many mismatches, including mismatches for non-HLA genes (i.e., non-class-I or non-class-II) within the MHC. New methods matching for blocks of DNA around HLA-B and around HLA-DR/DQ are available that are sensitive and identify additional mismatches that are not apparent using conventional typing methods. The 4AOHW cells provide a valuable resource for the comparison and assessment of new matching techniques.

Reconstruction of the block matching profiles.

Block matching is a valuable tool for selecting donors for bone marrow transplantation. Identical, electrophoretic profiles of unrelated bone marrow donor-recipient pairs have been shown to be associated with long-term survival and a reduction of graft versus host disease (GVHD). This study was undertaken to determine the sequences of the PCR products which are generated. PCR products obtained with beta-block primers following the amplification of DNA extracted from cell lines homozygous for 7.1 and 8.1 ancestral haplotypes were cloned and sequenced. The PCR products were characterised and the beta block profiles reconstructed. The data indicate that the profiles consist of homoduplexes and heteroduplexes which are formed by the products of probably 3 different sequence locations.

MHC haplotype analysis by artificial neural networks.

Conventional matching is based on numbers of alleles shared between donor and recipient. This approach, however, ignores the degree of relationship between alleles and haplotypes, and therefore the actual degree of difference. To address this problem, we have compared family members using a block matching technique which reflects differences in genomic sequences. All parents and siblings had been genotyped using conventional MHC typing so that haplotypes could be assigned and relatives could be classified as sharing 0, 1 or 2 haplotypes. We trained an Artificial Neural Network (ANN) with subjects from 6 families (85 comparisons) to distinguish between relatives. Using the outputs of the ANN, we developed a score, the Histocompatibility Index (HI), as a measure of the degree of difference. Subjects from a further 3 families (106 profile comparisons) were tested. The HI score for each comparison was plotted. We show that the HI score is trimodal allowing the definition of three populations corresponding to approximately 0, 1 or 2 haplotype sharing. The means and standard deviations of the three populations were found. As expected, comparisons between family members sharing 2 haplotypes resulted in high HI scores with one exception. More interestingly, this approach distinguishes between the 1 and 0 haplotype groups, with some informative exceptions. This distinction was considered too difficult to attempt visually. The approach provides promise in the quantification of degrees of histocompatibility.

The significance of HLA matching in cardiac transplantation.

It is argued that HLA matching is not worthwhile in heart transplantation. However, transplanting HLA compatible hearts enhances graft survival and should significantly reduce infection and malignancies related to aggressive immunosuppression. It is our view that the problem is technical and we offer a potential solution.

Matching for MHC haplotypes results in improved survival following unrelated bone marrow transplantation.

Unrelated bone marrow donor-recipient pairs were assessed retrospectively for matching of the HLA-B, -C region (beta-block) and HLA-DR, DQ region (delta block) of the major histocompatibility complex (MHC) using a new DNA-based method referred to as MHC-block typing. The method utilises non-HLA DNA polymorphisms in the MHC as markers of blocks of ancestral haplotypes. Kaplan-Meier analysis of recipients who were matched at both the beta- and delta-blocks revealed a 6 months survival of 54%. Survival was better than for patients who were matched only by conventional criteria, including SSO-typing for class II.

Sequencing of 42kb of the APO E-C2 gene cluster reveals a new gene: PEREC1.

Through the sequencing of a 42kb cosmid clone we describe a new gene, designated PEREC1, located approximately 1.5kb centromeric of the human apolipoprotein (APO) E-C2 cluster. The combination of dotplot analysis, predicted coding potential and interrogation of the Expressed Sequence Tag (EST) database determined the genomic organisation of PEREC1. Sequence alignment with multiple overlapping ESTs confirmed the predicted splice sites. The predicted cDNA and amino acid sequences of PEREC1 have extensive similarity to the Caenorhabditis elegans protein, C18E9.6. Conserved structural and functional motifs have been defined by combining nucleotide and amino acid analyses to identify third base degeneracy and therefore selection at the protein level. The Poliovirus Receptor Related Protein2 gene (PRR2), previously mapped to chromosome 19q13.2 by Fluorescent In-Situ Hybridisation, has also been located approximately 17kb centromeric of APO E.

The Marei Ika Daigaku (Syonan Medical College) during the Japanese occupation of Singapore (1942-1945).

During the Japanese Occupation of Singapore (1942-1945), Singapore was renamed Syonan (or Syonanto). The Japanese Military Administration established The Medical College on 27 April 2603 (1943) and it was known as The Marei Ika Daigaku or Syonan Medical College. It was sited at the Tan Tock Seng Hospital (Hakua Byoin). The Ika Daigaku relocated to the General Hospital, Malacca in February 2604 (1944) where it functioned till the end of the Japanese Occupation in September 1945. About 200 students from Singapore, Malaya, Sumatra and Java attended the Syonan Medical College; the students were taught mainly Japanese language and culture.

The Malai Ika Daigaku (Syonan Medical College) in Malacca (1944 to 1945) during the Japanese occupation of Singapore and Malaya.

During the Japanese Occupation of Singapore and Malaya (1941-1945), Singapore was renamed Syonan (or Syonanto) and Malaya was called Malai (or Marai; Marei). On 27 April 2603 (1943) the Japanese Military Administration established. The Marai Ika Daigaku (Syonan Medical College) at the Tan Tock Seng Hospital (Hakuai Byoin), Syonan. The Medical College shifted to the General Hospital, Malacca in February 2604 (1944) where it functioned till the end of the Japanese Occupation in September 2605 (1945).

Psychosocial aspects of repeat abortions in Singapore--a preliminary report.

PIP: The rate of repeat abortions in Singapore has risen from 10% of all abortions in 1975 to 42% in 1982. This study sought to identify psychosocial characteristics of 100 Chinese women 15-44 years of age who requested a repeat abortion; 100 antenatal patients and 100 1st-time abortees, matched with subjects for age and race, were used as controls. There were no significant differences between cases and controls in most of the variables analyzed. Educational and socioeconomic status, personality components (extroversion, neuroticism, psychoticism), and mood were similar in women from all 3 groups. However, repeat abortees had more prior pregnancies and more living children. Repeat abortees had an average of 4.27 prior pregnancies and 1.94 living children compared with 2.07 pregnancies and 0.88 living children among antenatal patients and 2.67 pregnancies and 1.52 living children among 1st-time abortees. Contraceptive methods reported most commonly among repeat abortees included a combination of methods (27%), condom (21%), and rhythm (15%); these were the 3 methods most frequently reported by 1st-time abortees as well. The Zung Self-Rating Depression Scale was administered to all abortion patients before abortion and 6 weeks after the procedure. The mean score before abortion was 39.04 among 1st-time abortees and 41.25 among repeat abortees--well below the mean of 60 found among clinically depressed patients. 6 weeks after the procedure, the depression score had declined to 34.46 among 1st-time abortees and to 35.14 among repeat abortees.^ieng

Motor neurone disease.

No abstract available.

A probe for measuring current density during magnetic stimulation.

Time-varying magnetic fields induce currents in conductive media, and when the induced current is large enough in excitable tissue, stimulation occurs. This phenomenon has been applied to the human brain and peripheral nerves for diagnostic evaluation of the neural system. One important aspect that is presently unknown is the current level necessary in tissue for stimulation induced by magnetic fields. This study presents a method of measuring the induced current density from pulsed magnetic fields in vitro and in vivo. The current-density probe was inserted into three concentrations of saline and into the brains of ten anesthetized cats. Two stimulation systems with coils 9 cm and 5 cm in diameter were used. The two systems provided sinusoidal and pulsatile coil currents. Measurements made in saline were compared with those calculated theoretically for a semi-infinite medium. The measured values were within 5% of the calculated values. Measurements made in the cat brain showed a 67% decrease compared with the theoretic model. This variance is attributed to the finite bounds of the skull. The results indicate that direct measurement of current density is possible. Subsequent measurements will aid in the design of improved magnetic stimulation systems.

Chicken bone perforation of an irreducible inguinal hernia: a case report and review of the literature.

Foreign bodies causing perforation of hernias are extremely uncommon with only a few cases reported in the literature. Here, we present a case of a patient with ingestion of a foreign body, which was initially managed expectantly but developed a perforation due to the foreign body impacting and causing perforation of an irreducible inguinal hernia. Management of this condition usually involves resection of the involved loop of bowel with repair of the hernia defect at the time of surgery. Patients with ingested foreign bodies who have irreducible hernias have altered anatomy and should be considered for early surgical intervention to prevent complications.